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Cognitive functions in pediatric multiple sclerosis: 2-years follow-up
Zeynep Öztürk1, Kıvılcım Gücüyener2, Şebnem Soysal2
1Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey.
Insights
Pediatric multiple sclerosis (MS) significantly impacts cognition, particularly non-verbal reasoning, in children under 12. Regular cognitive assessments are vital for managing MS in children.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Cognitive Psychology
Background:
- Pediatric multiple sclerosis (MS) presents unique challenges in cognitive assessment.
- Longitudinal studies are crucial for understanding the progressive nature of cognitive deficits in pediatric MS.
Purpose of the Study:
- To evaluate the neuropsychological status of pediatric MS patients over time.
- To correlate cognitive function with clinical variables in a longitudinal cohort.
- To identify specific cognitive domains affected by pediatric MS.
Main Methods:
- A longitudinal study involving 46 pediatric MS patients and 53 healthy controls (HCs).
- Neuropsychological testing included non-verbal reasoning, attention/concentration, visuospatial judgment, and verbal fluency at baseline and 2-year follow-up.
- Cognitive impairment defined as failure on ≥3 of 4 tests; patients grouped by age of onset (≤12 vs >12 years).
Main Results:
- Cognitive impairment was observed in 47.8% of pediatric MS patients at follow-up.
- Worsening cognition correlated with higher Expanded Disability Status Scale (EDSS) scores.
- Attention/concentration and non-verbal reasoning were the most affected domains; non-verbal reasoning declined specifically in patients with onset ≤12 years.
Conclusions:
- Pediatric MS is associated with cognitive decline that parallels disability progression.
- Non-verbal reasoning is particularly vulnerable in patients with early disease onset (≤12 years).
- Routine assessment of non-verbal reasoning is recommended for optimal management of pediatric MS.
Abstract:
Objective: To assess the neuropsychological status of pediatric multiple sclerosis (MS) patients and its relationship with clinical variables in a longitudinal study.Methods: Patients with MS (n = 46) and age- and gender-matched healthy control subjects (HCs, n = 53) were given tests of non-verbal reasoning, attention/concentration, visuospatial judgement and verbal fluency at baseline visit and after 2 years of follow-up. Cognitive impairment was defined as a failure on at least three of the four tests. Patients were grouped according to the age of disease onset (≤12 years as group 1 and > 12 years as group 2).Results: Cognitive impairment was detected in 22 of 46 patients at follow-up (47.8%). Patients with cognitive worsening had higher EDSS scores at follow-up compared to cognitively improved/stable group (0.68 ± 1.16 vs 0.04 ± 0.2, p = 0.01). The most affected domains were attention/concentration and non-verbal reasoning. Comparison between baseline and follow-up tests showed impairment in non-verbal reasoning over time in group 1 patients while other functions improved over time in patient and control groups as expected.Conclusion: Pediatric MS is likely to affect patients' cognition concurrently with their disability levels. This effect is significant in the non-verbal reasoning area in patients with disease onset before age 12 years. A practical method assessing this function should be part of these patients' regular follow-up for optimal treatment, prevention and rehabilitation.
