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Serum Tumor Necrosis Factor-Alpha Levels Correlate with Cognitive Function Scales Scores in Multiple Sclerosis
Khalid El-Salem1, Abdel-Hameed Al-Mistarehi2, Hanan Khalil3
1Division of Neurology, Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Background:
Cognitive dysfunction is an important feature and source of disability for patients with multiple sclerosis (MS). The correlation of cognitive function scales' scores and serum levels of the proinflammatory cytokine tumor necrosis factor-alpha (TNF-α) in MS is not well established. We aim to investigate the correlation of TNF-α serum levels with cognitive function as measured by multiple cognitive scales in patients with MS.
Methods:
Eligible sequential MS patients attending neurology clinics between October 2018 and June 2019 at King Abdulla University Hospital (KAUH) in Jordan were included. Demographic data were collected from all participants. Motor disability was measured using the Expanded Disability Status Score (EDSS), the Functional System Score (FSS), as well as the Patient Determined Disease Steps (PDDS). The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and the Montreal Cognitive Assessment (MOCA) were used to evaluate the cognitive status. TNF-α serum levels were measured for each patient. Correlations of TNF-α levels with cognitive function scales' scores and motor disability scores were statistically analyzed.
Results:
A total of 88 MS patients were included in the study. The mean age (± SD) was 35.78 (± 10.30) years, and 72.7% were females. The majority of patients (82) had relapsing multiple sclerosis (RMS). Serum TNF-α levels were significantly correlated with scores of motor disability scales in the whole patient cohort (EDSS: Pearson correlation coefficient r = 0.230, p=0.031; FSS: r = 0.260, p=0.022; and PDDS: r = 0.261, p=0.014) and in females, but not in males. In the whole cohort, the correlation between TNF-α and EDSS score was also statistically significant (r = 0.216, p=0.047) after adjustment for confounding factors including age, disease duration, and type of MS. Likewise, Serum TNF-α levels were correlated with the scores of cognitive function scales in the whole patient cohort (BICAMS: r = -0.328, p=0.002; and MOCA: r = -0.256, p=0.016). After adjusting for age, gender, education, type of MS, and EDSS score, cognitive performance was still negatively correlated with TNF-α levels (p<0.05).
Conclusion:
Our findings confirm the presence of a significant correlation between TNF-α levels and different cognitive scales' scores in MS patients.
