Cognitive impairment in clinically isolated syndrome: a systematic review

Anhoque, Carolina Fiorin; Domingues, Simone Cristina Aires; Teixeira, Antônio Lúcio; Domingues, Renan Barros

doi:10.1590/S1980-57642010DN40200002

Abstract

The pattern of cognitive abnormalities in multiple sclerosis (MS) has been extensively studied and well characterized. However, little is known about the cognitive involvement in patients with the clinically isolated syndrome (CIS ).

Objectives:

To perform a systematic review of the results of the studies on cognitive dysfunction in CIS patients .

Methods:

Cochrane, Lilacs, PubMed/Medline and SciELO databases were searched for studies involving patients with clinically isolated syndrome submitted to neuropsychological evaluation.

Results:

Seven studies fulfilled the selection criteria adopted in this review. The pattern of cognitive abnormalities in CIS resembles that found in patients with MS and is characterized by attention deficit, reduced information processing speed and impaired working memory and executive functions. The frequency of cognitive impairment in CIS seems to be lower than in MS.

Conclusions:

Cognition should be evaluated in patients with CIS. Future studies are required to evaluate the impact of cognitive abnormalities and to correlate them with axonal damage findings in patients with CIS.

Key words:
cognition; cognitive impairment; clinically isolated syndrome; demyelinating disease.

Resumo

As alterações cognitivas na esclerose múltipla (EM) são muito estudadas e bem caracterizadas. No entanto, pouco se sabe sobre o envolvimento cognitivo em pacientes com síndrome clínica isolada (SCI).

Objetivos:

Revisar sistematicamente resultados obtidos em estudos sobre cognição em pacientes com SCI.

Métodos:

Revisamos as seguintes bases de dados: Cochrane, Lilacs, Pubmed/Medline e Scielo buscando artigos em que pacientes com SCI foram submetidos à avaliação neuropsicológica.

Resultados:

Sete estudos preencheram critérios adotados pelos autores desta revisão. O padrão do prejuízo cognitivo em SCI é semelhante ao encontrado na EM, caracterizado por déficit de atenção, redução da velocidade de processamento, comprometimento da memória de trabalho e de funções executivas. A freqüência de disfunção cognitiva é inferior na SCI do que na EM.

Conclusões:

Pacientes com CIS devem ser avaliados quanto à cognição. Estudos futuros são necessários para avaliar o impacto do prejuízo cognitivo e correlacioná-lo com achados de dano axonal em pacientes com SCI.

Palavras-chave:
cognição; prejuízo cognitivo; síndrome clínica isolada; doença desmielinizante.

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Full text available only in PDF format.

References

¹
Tintoré M, Rovira A, Rio J, et al. Is optic neuritis more benign than other first attacks in multiple sclerosis? Ann Neurol 2005;57:210-215.
²
Thrower BW. Clinically isolated syndromes: predicting and delaying multiple sclerosis. Neurology 2007;68(24 Suppl 4):12-15.
³
Simioni S, Ruffieux C, Bruggimann L, Annoni JM, Schluep M. Cognition, mood and fatigue in patients in the early stage of multiple sclerosis. Swiss Med Wkly 2007;137(35-36):496-501.
⁴
Feinstein A, Kartsounis LD, Miller DH, Youl BD, Ron MA. Clinically isolate lesions of the type seen in multiple sclerosis: a cognitive, psychiatric and MRI follow up study. J Neurol Neurosurg Psychiatry 1992;55:869-876.
⁵
Achiron A, Barak Y. Cognitive changes in early MS: a call for a common framework. J Neurol Sci 2006;245:47-51.
⁶
De Stefano N, Narayanan S, Francis GS, Arnaoutelis R, Tartaglia MC, Antel JP. Evidence of axonal damage in the early stages of multiple sclerosis and its relevance to disability. Arch Neurol 2001;58:65-70.
⁷
Amato MP, Zipoli V, Goretti B, et al. Benign multiple sclerosis cognitive, psychological and social aspects in a clinical cohort. J Neurol 2006;253:1054-1059.
⁸
Feuillet L, Reuter F, Audoin B, et al. Early cognitive impairment in patients with clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 2007;13:124-127.
⁹
Potagas C, Giogkaraki E, Koutsis G, et al. Cognitive impairment in different MS subtypes and clinically isolated syndromes. J Neurol Sci 2008;267:100-106.
¹⁰
Audoin B, Au Duong MV, Ranjeva JP, et al. Magnetic resonance study of the influence of tissue damage and cortical reorganization on PASAT performance at the earliest stage of multiple sclerosis. Hum Brain Mapp 2005;24:216-228.
¹¹
Audoin B, Ibarrola D, Ranjeva J, et al. Compensatory cortical activation observed by fMRI during a cognitive task at the earliest stage of MS. Hum Brain Mapp 2003;20:51-58.
¹²
Nilsson P, Rorsman I, Larsson EM, Norrving B, Sandberg-Wollheim M. Cognitive dysfunction 24-31 years after isolated optic neuritis. Mult Scler 2008;14:913-918.
¹³
Summers M, Swanton J, Fernando K, et al. Cognitive impairment in multiple sclerosis can be predicted by imaging early in the disease. J Neurol Neurosurg Psychiatry 2008;79:955-958.
¹⁴
Glanz BI, Holland CM, Gauthier SA, et al. Cognitive dysfunction in patients with clinically isolated syndromes or newly diagnosed multiple sclerosis. Mult Scler 2007;13:1004-1010.
¹⁵
Kappos L, Freedman MS, Polman CH, et al. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial. Lancet Neurol 2009; 8:987-997.
¹⁶
Comi G, Martinelli V, Rodegher M, et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled Trial. Lancet 2009;374:1503-1511.
¹⁷
Filippi M, Rovaris M, Inglese M, et al. for the ETOMS Study Group. Interferon beta-1a for brain tissue loss in patients at presentation with syndromes suggestive of multiple sclerosis: a randomised, double-blind, placebo-controlled trial. Lancet 2004;364:1489-1496.
¹⁸
Beck RW, Chandler DL, Cole SR, et al. Interferon beta-1a for early multiple sclerosis: CHAMPS trial subgroup analyses. Ann Neurol 2002;51:481-490.
¹⁹
Sperling RA, Guttmann CR, Hohol MJ, et al. Regional magnetic resonance imaging lesion burden and cognitive function in multiple sclerosis: a longitudinal study. Arch Neurol 2001; 58:115-121.
²⁰
Amato MP, Portaccio E, Goretti B, et al. Association of neocortical volume changes with cognitive deterioration in relapsing-remitting multiple sclerosis. Arch Neurol 2007;64:1157-1161.
²¹
Sepulcre J, Sastre-Garriga J, Cercignani M, Ingle GT, Miller DH, Thompson AJ. Regional gray matter atrophy in early primary progressive multiple sclerosis: a voxel-based morphometry study. Arch Neurol 2006;63:1175-1180.

Publication Dates

Publication in this collection
Apr-Jun 2010

History

Received
26 Jan 2009
Accepted
31 Mar 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Tintoré M, Rovira A, Rio J, et al. Is optic neuritis more benign than other first attacks in multiple sclerosis? Ann Neurol 2005;57:210-215.

[2] ²
Thrower BW. Clinically isolated syndromes: predicting and delaying multiple sclerosis. Neurology 2007;68(24 Suppl 4):12-15.

[3] ³
Simioni S, Ruffieux C, Bruggimann L, Annoni JM, Schluep M. Cognition, mood and fatigue in patients in the early stage of multiple sclerosis. Swiss Med Wkly 2007;137(35-36):496-501.

[4] ⁴
Feinstein A, Kartsounis LD, Miller DH, Youl BD, Ron MA. Clinically isolate lesions of the type seen in multiple sclerosis: a cognitive, psychiatric and MRI follow up study. J Neurol Neurosurg Psychiatry 1992;55:869-876.

[5] ⁵
Achiron A, Barak Y. Cognitive changes in early MS: a call for a common framework. J Neurol Sci 2006;245:47-51.

[6] ⁶
De Stefano N, Narayanan S, Francis GS, Arnaoutelis R, Tartaglia MC, Antel JP. Evidence of axonal damage in the early stages of multiple sclerosis and its relevance to disability. Arch Neurol 2001;58:65-70.

[7] ⁷
Amato MP, Zipoli V, Goretti B, et al. Benign multiple sclerosis cognitive, psychological and social aspects in a clinical cohort. J Neurol 2006;253:1054-1059.

[8] ⁸
Feuillet L, Reuter F, Audoin B, et al. Early cognitive impairment in patients with clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 2007;13:124-127.

[9] ⁹
Potagas C, Giogkaraki E, Koutsis G, et al. Cognitive impairment in different MS subtypes and clinically isolated syndromes. J Neurol Sci 2008;267:100-106.

[10] ¹⁰
Audoin B, Au Duong MV, Ranjeva JP, et al. Magnetic resonance study of the influence of tissue damage and cortical reorganization on PASAT performance at the earliest stage of multiple sclerosis. Hum Brain Mapp 2005;24:216-228.

[11] ¹¹
Audoin B, Ibarrola D, Ranjeva J, et al. Compensatory cortical activation observed by fMRI during a cognitive task at the earliest stage of MS. Hum Brain Mapp 2003;20:51-58.

[12] ¹²
Nilsson P, Rorsman I, Larsson EM, Norrving B, Sandberg-Wollheim M. Cognitive dysfunction 24-31 years after isolated optic neuritis. Mult Scler 2008;14:913-918.

[13] ¹³
Summers M, Swanton J, Fernando K, et al. Cognitive impairment in multiple sclerosis can be predicted by imaging early in the disease. J Neurol Neurosurg Psychiatry 2008;79:955-958.

[14] ¹⁴
Glanz BI, Holland CM, Gauthier SA, et al. Cognitive dysfunction in patients with clinically isolated syndromes or newly diagnosed multiple sclerosis. Mult Scler 2007;13:1004-1010.

[15] ¹⁵
Kappos L, Freedman MS, Polman CH, et al. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial. Lancet Neurol 2009; 8:987-997.

[16] ¹⁶
Comi G, Martinelli V, Rodegher M, et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled Trial. Lancet 2009;374:1503-1511.

[17] ¹⁷
Filippi M, Rovaris M, Inglese M, et al. for the ETOMS Study Group. Interferon beta-1a for brain tissue loss in patients at presentation with syndromes suggestive of multiple sclerosis: a randomised, double-blind, placebo-controlled trial. Lancet 2004;364:1489-1496.

[18] ¹⁸
Beck RW, Chandler DL, Cole SR, et al. Interferon beta-1a for early multiple sclerosis: CHAMPS trial subgroup analyses. Ann Neurol 2002;51:481-490.

[19] ¹⁹
Sperling RA, Guttmann CR, Hohol MJ, et al. Regional magnetic resonance imaging lesion burden and cognitive function in multiple sclerosis: a longitudinal study. Arch Neurol 2001; 58:115-121.

[20] ²⁰
Amato MP, Portaccio E, Goretti B, et al. Association of neocortical volume changes with cognitive deterioration in relapsing-remitting multiple sclerosis. Arch Neurol 2007;64:1157-1161.

[21] ²¹
Sepulcre J, Sastre-Garriga J, Cercignani M, Ingle GT, Miller DH, Thompson AJ. Regional gray matter atrophy in early primary progressive multiple sclerosis: a voxel-based morphometry study. Arch Neurol 2006;63:1175-1180.

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