Brief international cognitive assessment for MS (BICAMS) and NEDA maintenance in MS patients: A 2-year follow-up longitudinal study

IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY European Journal of Neurology Pub Date : 2024-12-21 DOI:10.1111/ene.70007

E. Leveraro, M. Cellerino, C. Lapucci, M. Dighero, L. Nasone, T. Sirito, D. Boccia, N. Cavalli, G. Bavestrello, A. Uccelli, G. Boffa, M. Inglese

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Abstract

Background

The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been validated in many cross-sectional studies. However, longitudinal data on BICAMS subset trajectories and their correlation with disease activity during follow-up are scarce.

Objectives

We aimed to (i) assess BICAMS changes in MS patients initiating high-efficacy disease-modifying-treatments (DMTs), (ii) compare these changes based on maintenance of “no-evidence-of-disease-activity” (NEDA-3) status over 24 months, and (iii) determine baseline clinical parameters predictive of cognitive changes.

Methods

We enrolled 101 MS patients (mean age:40,45 ± 11; Relapsing–Remitting-MS:81%) initiating highly-effective-DMTs. Patients underwent Expanded Disability Status Scale (EDSS), BICAMS, and Hospital Anxiety and Depression Scale (HADS), at baseline and after 24 months. Regression-based change index (RB-CI) had been used for cognitive change evaluation over follow-up.

Results

During follow-up, 78 (77.3%) patients maintained NEDA-3 status. Considering a 90% of confidence levels for RB-CI, 12 (11.9%) improved at SDMT, 13 (12.9%) at CVLT-II and 13 (12.9%) at BVMT-R; while 7 (6.9%) were classified as worsened at SDMT, 11 (10.9%) at CVLT-II and 8 (7.9%) at BVMT-R. SDMT scores significantly improved at follow-up for the entire group (p = 0.003) and in patients maintaining NEDA-3 (p < 0.001). The multivariable regression model assessing the SDMT improvement (n = 12; z = 1.65), was significant and explained 21% of the variance (p = 0.038; Nagelkerke R² = 0.212). Lower EDSS proved to be an independent predictor of SDMT reliable improvement (p = 0.027) in our sample.

Conclusions

Our findings showed that early disease activity control—especially in patients with low baseline disability—may yield significant benefits even in terms of cognitive performance.

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多发性硬化症患者的简短国际认知评估（BICAMS）和 NEDA 维护：为期两年的追踪纵向研究

背景多发性硬化症简明国际认知评估（BICAMS）已在许多横断面研究中得到验证。然而，有关 BICAMS 子集轨迹及其与随访期间疾病活动相关性的纵向数据却很少。目标我们的目的是：(i) 评估开始接受高效疾病改变疗法（DMT）的多发性硬化症患者的 BICAMS 变化；(ii) 根据 24 个月内 "无疾病活动证据"（NEDA-3）状态的维持情况比较这些变化；(iii) 确定预测认知变化的基线临床参数。方法我们招募了 101 名开始接受高效 DMTs 治疗的多发性硬化症患者（平均年龄：40.45 ± 11；复发-缓解型多发性硬化症：81%）。患者在基线和 24 个月后接受了残疾状况扩展量表 (EDSS)、BICAMS 和医院焦虑抑郁量表 (HADS)。基于回归的变化指数（RB-CI）用于评估随访期间的认知变化。结果在随访期间，78 名（77.3%）患者保持了 NEDA-3 状态。在RB-CI的90%置信水平下，12例（11.9%）患者的SDMT评分有所改善，13例（12.9%）患者的CVLT-II评分有所改善，13例（12.9%）患者的BVMT-R评分有所改善；7例（6.9%）患者的SDMT评分有所恶化，11例（10.9%）患者的CVLT-II评分有所恶化，8例（7.9%）患者的BVMT-R评分有所恶化。整组患者的 SDMT 评分在随访时均有明显改善（p = 0.003），NEDA-3 患者的 SDMT 评分也有明显改善（p < 0.001）。评估 SDMT 改善情况的多变量回归模型（n = 12；z = 1.65）具有显著性，可解释 21% 的方差（p = 0.038；Nagelkerke R2 = 0.212）。在我们的样本中，较低的 EDSS 是 SDMT 可靠性改善的独立预测因子（p = 0.027）。结论我们的研究结果表明，早期疾病活动控制--尤其是对基线残疾程度较低的患者--可能会在认知表现方面产生显著的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).