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open access

Vol 58, No 2 (2024)
Research Paper
Submitted: 2023-10-04
Accepted: 2023-12-14
Published online: 2024-02-07
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Predicting clinical progression and cognitive decline in patients with relapsing-remitting multiple sclerosis: a 6-year follow-up study

Karolina Kania1, Mikołaj A. Pawlak1, Maria Forycka2, Monika Wiłkość-Dębczyńska3, Sławomir Michalak4, Agnieszka Łukaszewska1, Aleksandra Wyciszkiewicz5, Aleksandra Wypych6, Zbigniew Serafin7, Justyna Marcinkowska8, Wojciech Kozubski1, Alicja Kalinowska-Łyszczarz4
DOI: 10.5603/pjnns.97714
·
Pubmed: 38324117
·
Neurol Neurochir Pol 2024;58(2):176-184.
Affiliations
  1. Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
  2. Chair of Palliative Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland
  3. Department of Health Psychology, Faculty of Psychology, Kazimierz Wielki University in Bydgoszcz, Bydgoszcz, Poland
  4. Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland
  5. Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland
  6. Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Torun, Torun, Poland
  7. Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
  8. Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland

open access

Vol 58, No 2 (2024)
Research papers
Submitted: 2023-10-04
Accepted: 2023-12-14
Published online: 2024-02-07

Abstract

Introduction. Cognitive impairment occurs from the earliest stages of multiple sclerosis (MS) and progresses over time. The introduction of disease modifying therapies (DMTs) has changed the prognosis for MS patients, offering a potential opportunity for improvement in the cognitive arena as well.

Material and methods. 41 patients with relapsing-remitting multiple sclerosis (MS) were recruited to the study. Thirty patients were available for final follow-up and were included in the analysis. Baseline (BL) brain MRI including volumetry and neuropsychological tests were performed. Blood samples were collected at BL and follow-up (FU) and were tested for: vascular endothelial growth factor (VEGF), soluble vascular cell adhesion molecule-1 (sVCAM1), soluble platelet-endothelial CAM-1 (sPECAM1), and soluble intercellular CAM-1 (sICAM-1). Patients were invited for a final neuropsychological follow-up after a median of 6 years. Disease activity (relapses, EDSS increase, new/active brain lesions on MRI) was analysed between BL and FU.

Results. The study group deteriorated in the Rey–Osterrieth Complex Figure (ROCF) test (p = 0.001), but improved significantly in three other tests, i.e. semantic fluency test (p = 0.013), California Verbal Learning Test (CVLT, p = 0.016), and Word Comprehension Test (WCT, p < 0.001). EDSS increase correlated negatively with semantic fluency and WCT scores (r = –0.579, p = 0.001 and r = –0.391, p = 0.033, respectively). Improvements in semantic fluency test and WCT correlated positively with baseline deep grey matter, grey matter, and cortical volumes (p < 0.05, r > 0). Higher EDSS on FU correlated significantly negatively with baseline left and right pallidum, right caudate, right putamen, right accumbens, and cortical volume (p < 0.05, r < 0). No significant relationship was found between the number of relapses and EDSS on FU or neuropsychological deteriorations. Improvements in WCT and CVLT correlated positively with baseline sPECAM1 and sVCAM1 results, respectively (r > 0, p < 0.05). Deterioration in ROCF test correlated significantly with higher levels of baseline VEGF and sVCAM1 (p < 0.05).

Conclusions. Brain volume is an important predictor of future EDSS and cognitive functions outcome. MS patients have a potential for improving in neuropsychological tests over time. It remains to be established whether this is related to successful disease modification with immunotherapy. Baseline volumetric measures are stronger predictors of cognitive performance than relapse activity, which yet again highlights the importance of atrophy in MS prognosis.

Abstract

Introduction. Cognitive impairment occurs from the earliest stages of multiple sclerosis (MS) and progresses over time. The introduction of disease modifying therapies (DMTs) has changed the prognosis for MS patients, offering a potential opportunity for improvement in the cognitive arena as well.

Material and methods. 41 patients with relapsing-remitting multiple sclerosis (MS) were recruited to the study. Thirty patients were available for final follow-up and were included in the analysis. Baseline (BL) brain MRI including volumetry and neuropsychological tests were performed. Blood samples were collected at BL and follow-up (FU) and were tested for: vascular endothelial growth factor (VEGF), soluble vascular cell adhesion molecule-1 (sVCAM1), soluble platelet-endothelial CAM-1 (sPECAM1), and soluble intercellular CAM-1 (sICAM-1). Patients were invited for a final neuropsychological follow-up after a median of 6 years. Disease activity (relapses, EDSS increase, new/active brain lesions on MRI) was analysed between BL and FU.

Results. The study group deteriorated in the Rey–Osterrieth Complex Figure (ROCF) test (p = 0.001), but improved significantly in three other tests, i.e. semantic fluency test (p = 0.013), California Verbal Learning Test (CVLT, p = 0.016), and Word Comprehension Test (WCT, p < 0.001). EDSS increase correlated negatively with semantic fluency and WCT scores (r = –0.579, p = 0.001 and r = –0.391, p = 0.033, respectively). Improvements in semantic fluency test and WCT correlated positively with baseline deep grey matter, grey matter, and cortical volumes (p < 0.05, r > 0). Higher EDSS on FU correlated significantly negatively with baseline left and right pallidum, right caudate, right putamen, right accumbens, and cortical volume (p < 0.05, r < 0). No significant relationship was found between the number of relapses and EDSS on FU or neuropsychological deteriorations. Improvements in WCT and CVLT correlated positively with baseline sPECAM1 and sVCAM1 results, respectively (r > 0, p < 0.05). Deterioration in ROCF test correlated significantly with higher levels of baseline VEGF and sVCAM1 (p < 0.05).

Conclusions. Brain volume is an important predictor of future EDSS and cognitive functions outcome. MS patients have a potential for improving in neuropsychological tests over time. It remains to be established whether this is related to successful disease modification with immunotherapy. Baseline volumetric measures are stronger predictors of cognitive performance than relapse activity, which yet again highlights the importance of atrophy in MS prognosis.

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Keywords

multiple sclerosis, cognitive functions, brain atrophy, CVLT, predictors, ROCF, semantic fluency, choroid plexus, EDSS

About this article
Title

Predicting clinical progression and cognitive decline in patients with relapsing-remitting multiple sclerosis: a 6-year follow-up study

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 58, No 2 (2024)

Article type

Research Paper

Pages

176-184

Published online

2024-02-07

Page views

321

Article views/downloads

260

DOI

10.5603/pjnns.97714

Pubmed

38324117

Bibliographic record

Neurol Neurochir Pol 2024;58(2):176-184.

Keywords

multiple sclerosis
cognitive functions
brain atrophy
CVLT
predictors
ROCF
semantic fluency
choroid plexus
EDSS

Authors

Karolina Kania
Mikołaj A. Pawlak
Maria Forycka
Monika Wiłkość-Dębczyńska
Sławomir Michalak
Agnieszka Łukaszewska
Aleksandra Wyciszkiewicz
Aleksandra Wypych
Zbigniew Serafin
Justyna Marcinkowska
Wojciech Kozubski
Alicja Kalinowska-Łyszczarz

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