Cognitive impairment may reflect damages to brain structures, pathophysiological impairment, [BK1] or both and are usually detected too late to implement an effective preventive therapy
The objective of this study was describe and compare the annual percentage of brain volume loss (PBVL) during 3 years in patients with multiple sclerosis (MS) who developed cognitive impairment (CI) vs. patients that did not (noCI)
prospective cohort study that included recently diagnosed (less than 6 months since first relapse) and naïve relapsing remitting MS patients. Patients were followed for at least 36 months evaluating relapses and EDSS. Magnetic resonance image (MRI) evaluation was done at study entry and then at 12, 24 and 36 months. PBVL was done by SIENA. Cognitive evaluation was done at study entry to exclude patients with cognitive impairment (CI) (defined as patients who scored at least 2 SDs below controls on at least 2 domains) and then at month 36. Annual PBVL between CI and noCI were described and compare. Linear model with generalized estimating equations (GEE) was used
A total of 71 patients were included, mean age 35.4 ± 3 years, mean follow up time 43 ± 5 months. All patients received fingolimod after diagnosis. At month 36, 12% patients were classified as CI. PBVL at year 1 in CI and noCI group was -0.52 (± 0.07) vs. -0.42 (± 0.04), at year 2 was -0.41 (± 0.03) vs. -0.71 (± 0.07) and at year 3 was -0.43 (± 0.05) vs. -0.81 (± 0.05) respectively. PBVL for the entire period (0 to 3 year) in CI and no CI was -1.25 (± 0.11) vs. -2.05 (± 0.12) respectively.
In patients with CI, since the first year a significant difference in BVL was observed that increased almost 2-fold during the 2 and 3 year of follow up. Early differences in BVL were identified in patients that progressed CI vs. patients that did not progressed.