Effect of relapse on cognition for patients with multiple sclerosis (MS).
Résumé
INTRODUCTION: The existence of cognitive variation during relapses or relapses with only cognitive signs are not well established though that could induce change for the treatments. OBJECTIVE: To describe cognitive profile during the relapse and to look for some cognitive variation after relapse. METHOD: A comprehensive french neuropsychological battery (BCcogSEP) (based on the BRB-N) was carried out during the relapse (before the corticoid administration) and 4 months after. Anxiety, depression and fatigue were assessed during and after the relapse with FIS, BDI-II and STAI. RESULTS: 18 patients were included. 7 didn’t have bcCogSEP tests after the relapse. Median’s EDSS before the relapse was 4.5. During the relapse, 55 % had cognitive impairment. 30 % had slower information processing and sustained attention deficit, 21 % had deficit in executive functions, 19 % had fewer short term and/or working memory capacities, 9 % had verbal or visual episodic memory deficit. There wasn’t correlation between cognitive performances and depression, anxiety, or fatigue. Without the influence of training into analyse, there was a significant improvement after relapse for sustained attention (PASAT 2sec.; p<0,026), immediate recall (p<0,013) and delayed recall of SRT (p<0,024). In contrast, with the training effect into analyse, by a specific coefficient of ponderation (Dujardin et al., 2004), there was a significant worsening for attention (code subtest) (p<0,016) and short term memory (direct digit span) (p<0,01) and a trend of improvement for delayed recall of SRT (p<0,55). DISCUSSION: There don’t find a specific cognitive profile during relapse. The paradoxical cognitive worsening after relapse can be explained by: - longer cognitive improvement than physical improvement, - longer duration of relapse than 4 months, - higher coefficient of ponderation, calculated for healthy subjects and not for MS patients. CONCLUSION: There is cognitive variation during relapse of MS, with a cognitive profile similar to the one during the remission