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Published on: December 9, 2015
Brief international cognitive assessment for MS (BICAMS) and NEDA maintenance in MS patients: A 2-year follow-up
E Leveraro1, M Cellerino1, C Lapucci2
1Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child Health (DINOGMI), University of Genoa, Genoa, Italy.
Background:
The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been validated in many cross-sectional studies. However, longitudinal data on BICAMS subset trajectories and their correlation with disease activity during follow-up are scarce.
Objectives:
We aimed to (i) assess BICAMS changes in MS patients initiating high-efficacy disease-modifying-treatments (DMTs), (ii) compare these changes based on maintenance of "no-evidence-of-disease-activity" (NEDA-3) status over 24 months, and (iii) determine baseline clinical parameters predictive of cognitive changes.
Methods:
We enrolled 101 MS patients (mean age:40,45 ± 11; Relapsing-Remitting-MS:81%) initiating highly-effective-DMTs. Patients underwent Expanded Disability Status Scale (EDSS), BICAMS, and Hospital Anxiety and Depression Scale (HADS), at baseline and after 24 months. Regression-based change index (RB-CI) had been used for cognitive change evaluation over follow-up.
Results:
During follow-up, 78 (77.3%) patients maintained NEDA-3 status. Considering a 90% of confidence levels for RB-CI, 12 (11.9%) improved at SDMT, 13 (12.9%) at CVLT-II and 13 (12.9%) at BVMT-R; while 7 (6.9%) were classified as worsened at SDMT, 11 (10.9%) at CVLT-II and 8 (7.9%) at BVMT-R. SDMT scores significantly improved at follow-up for the entire group (p = 0.003) and in patients maintaining NEDA-3 (p < 0.001). The multivariable regression model assessing the SDMT improvement (n = 12; z = 1.65), was significant and explained 21% of the variance (p = 0.038; Nagelkerke R2 = 0.212). Lower EDSS proved to be an independent predictor of SDMT reliable improvement (p = 0.027) in our sample.
Conclusions:
Our findings showed that early disease activity control-especially in patients with low baseline disability-may yield significant benefits even in terms of cognitive performance.
