Kognitive Defizite in frühen Stadien der schubförmigen multiplen Sklerose

Zusammenfassung

Einleitung Neuropsychologische Defizite werden im Rahmen der neurologischen Routine-Untersuchungen von Patienten mit multipler Sklerose häufig erst in fortgeschrittenen Stadien diagnostiziert. Jedoch können bereits geringe kognitive Defizite, insbesondere von Gedächtnis, Aufmerksamkeit und visuell-räumlichen Fähigkeiten zusammen mit affektiven Veränderungen im schub- und behinderungsfreien Frühstadium der MS zu erheblicher Einschränkung der Lebensqualität führen. Patienten und Methoden Wir untersuchten mittels einer umfangreichen neuropsychologischen Testbatterie eine homogene Gruppe von MS-Patientinnen (n = 27; Alter 24 - 46 Jahre) im Frühstadium ihrer Erkrankung mit schubförmigem Verlauf ohne Behinderungen (n = 13; EDSS ≤ 0 - 1,5) oder mit geringen bis mittelgradigen Behinderungen (n = 13; EDSS ≥ 2 - 5,5) und verglichen sie mit einer alters- und IQ-entsprechenden Gruppe von Kontrollpersonen (n = 16). Ergebnisse Alle Patientinnen wiesen im Wesentlichen Aufmerksamkeitsdefizite (phasische Alertnessreaktion, geteilte Aufmerksamkeit) auf. Patientinnen mit geringem Behinderungsgrad zeigten im Vergleich zu den gesunden Kontrollpersonen vor allem Störungen der visuell-räumlichen Fähigkeiten, der nonverbalen Merkfähigkeit sowie der Aufmerksamkeit (phasische Alertness, selektive und geteilte Aufmerksamkeit). Diskussion Bereits im Frühstadium ohne Behinderungen kann die neuropsychologische Diagnostik relevante Defizite bei Patientinnen mit multipler Sklerose nachweisen, die in die Bewertung von Lebensqualität, Therapie und Verlauf der MS einbezogen werden müssen.

Abstract

Introduction Awareness of neuropsychological deficits during routine neurological examination appears to be limited in patients with early stage multiple sclerosis. However, cognitive deficits, in particular of memory, attention and visual-spatial abilities can substantially influence the quality of life despite the absence of physical disability. Patients and Methods We evaluated a homogeneous group of female patients (n = 27, 24 - 46-years old) with relapsing-remitting MS with minor (EDSS ≥ 2 - 5.5) or no (EDSS ≤ 1.5) physical disabilities using an extensive neuropsychological test battery and compared them with age- and IQ-matched healthy women (n = 16). Results Cognitive deficits were present with respect to attention, phasic alertness-reactions and shared attention. Visuo-spatial abilities were impaired in patients with low scores on the expanded disability status scale (EDSS) compared to normal control subjects, as well as non-verbal memory, recognition of faces and subcomponents of attention. Discussion Detection of neuropsychological deficits in patients at an early stage of multiple sclerosis has to be taken into account with respect to assessment of quality of life, therapies and course of the disease.

multiple Sklerose - Neuropsychologie - Kognition

multiple sclerosis - neuropsychology - cognition

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