Kognityvinių funkcijų sutrikimai, sergant recidyvuojančia remituojančia ir antrine progresuojančia išsėtine skleroze, ir jų ryšys su MRT pakitimais.

Introduction. Recent studies demonstrate relationship between type of multiple sclerosis (MS) and cognitive dysfunction (CD). It is also known that cognitive dysfunction depends on the other factors such as number of demyelinated lesions and local atrophy detected in brain magnetic resonance imaging (MRI). At the very beginning of the disease cognitive alterations might be the only markers indicating impairment in MS. Progression in cognitive dysfunction despite stable values calculated according Expanded disability status scale, EDSS, shows MS progression itself, therefore studies in this field are very relevant. Different patterns of cognitive alterations and their expression in relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) are revealed. Determination in cognitive and MRI markers differences between RRMS and SPMS could be helpful in distinguishing forms of MS additionally in clinical examination. Despite stability in physical examination, progression in CD shows that MS treatment potentially is not enough effective and requires revision in selection of disease modifying therapy more effective as possible. Goals. In this study we sought to compare patients having relapsing-remitting (RR) MS to those having secondary-progressive (SP) MS with respect to congnitive impairments and investigate the relationship of cognitive dysfunction with linear MRT markers, number of lesions and as well as type of MS. Methods. The study involved 43 patients with established RR (mean age 33.65±9.24) and 45 patients with established SP (47.82±7.72) MS. All patients were investigated in Vilnius University hospital "Santariškių klinikos". Inclusion criteria were as follows: MS diagnosis established according McDonalds revisited 2005 criteria, compatible with reviewed McDonalds 2010 criteria, concomitant diseases were excluded, patients did not used antidepressants and anxiolythics during one month period. In order to assess cognitive functions the cognitive tests battery was applied. Working memory was tested by performing Digit Span Forwards Test (DSf), speed of psychomotor reactions was detected by using Digital Symbol Substitution Test (DSST), Trail Making Test A (TMT A), frontal functions were tested by Trail Making Test B (TMT B), Five Point Test (FPT), Letter Fluency Test (DAS), Category fluency Test, verbal memory - Rey Auditory Verbal Learning Test (RAVLT), visual memory - Rey-Osterrieth Complex Figure Test (ROCFT). Brain MRI T2W and T1W lesion load was calculated. Linear MRI parameters to measure local atrophy were applied: width of third ventricle, bicaudatus index, bifrontal index, Hucmann index, index of frontal atrophy, Evans index and index of corpus callosum. Results. Comparison of RR and SP groups with respect to congnitive function has shown that there were differences with respect to all tests but* DSF test (4.88±0.98 (RR) vs 5.20±3.47 (SP); p=0.478). Comparison with respect to linear MRT markers did not produce difference only in case of bifrontal index (1.86±0.23 (RR) vs 1.86±0.22 (SP); p = 0.978). Looking for the best predictor of type of MS results were as follows. In case of cognitive tests the best predictive ability was demonstrated by RAVLT4 (area under receiver operator curve = 0.884; p<0.001) and DSST (area under receiver operator curve = 0.873; p<0.001) whereas in case of linear MRT markers bicaudalus index was the most informative one (area under receiver operator curve = 0.864; p<0.001). Cognitive function tests correlated with MRT markers (maximal correlation was observed between DSST and bicaudalus index: r=-0.570 (p<0.001)) as well as number of MRI lesions (maximal correlation was observed with TMTA: r=0.339 (p<0.001) however binary variable indicating MS type was most frequently retained in stepwise linear regression models for prediction of cognitive dysfunction by MRT markers, number of lesions and MS type. Conclusions. Our results confirm that cognitive dysfunction in MS are related to linear MRT markers, number of lesions and type of MS, however in SPMS the alterations are expresssed more. Slowing in verbar learning, speed of psychomotor reactions and decreased attention are the mostly affected domains of CD in MS. Rey Auditor Verbal Learning Test, RAVLT(4), and Digital Symbol Substitution Test, DSST, are the most prominent tests when distinguishing between RRMS and SPMS forms. Linear MRT marker bicaudalus index was the most informative in discrimination between RR and SP MS forms. [ABSTRACT FROM AUTHOR]