Desempenho cognitivo de pacientes com esclerose múltipla: influência de sintomas depressivos

Abstract

Introduction: Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. Cognitive impairment (CI) is one of its core symptoms. Cognition is not commonly assessed in routine neurological examination. It influences functional, work and social activities and is a predictor for quality of life of MS patients. The cognitive profile of Brazilian MS population is unknown as studies are still scarce. Objective: To describe cognitive profile of MS patients, by comparing them to a control group, and evaluate the influence of clinical and psychiatric characteristics (depression symptoms) on cognitive performance. Methods: Clinical (age, education, disease duration and treatment) and neurological examination (EDSS - Expanded Disability Status Scale) data were collected from MS patients monitored at a tertiary hospital in Rio de Janeiro. Individuals were submitted to Depression screening (MINI - Mini International Neuropsychiatric Interview and BDI - Beck Depression Inventory) and neuropsychological assessment using the following tests: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Rey Auditory Verbal Learning Test (RALVT), Digit Span and Verbal Fluency Test (FAS and animal category). Results: Patients (n=35) performed worse than controls (n=33) in almost all tests. CI frequency among patients was 68.6%. The most affected cognitive domain was episodic memory (45.7%), followed by verbal fluency (42.8%) and information processing speed - IPS (22.8%). No statistically significant difference was found between patients' cognitive status and clinical, psychiatric and sociodemographic variables. EDSS had an inverse correlation with SDMT. Conclusions: CI is common among MS patients. It was shown that episodic memory and executive function were affected. Depression did not interfere in patients' test performance, although physical disability influenced IPS