Cognitive and psychosocial features of childhood and juvenile MS

Objective: To assess the impact of multiple sclerosis (MS) on cognitive and psychosocial functioning in childhood and juvenile cases. Methods: We used an extensive neuropsychological battery assessing IQ, memory, attention/concentration, executive functions, and language. Fatigue and depression were also measured. An interview on school and daily living activities was obtained from the parents. Performance of cases was compared with that of demographically matched healthy controls. Results: Sixty-three patients and 57 healthy controls were assessed. Five patients (8%) exhibited a particularly low IQ (<70). Criteria for cognitive impairment (failure on at least three tests) were fulfilled in 19 patients (31%), whereas 32 patients (53%) failed at least two tests. Beyond deficits in memory, complex attention, and executive functions, the profile of deficits was characterized by involvement of linguistic abilities. In the regression analysis, the only significant predictor of cognitive impairment was an IQ score lower than 90 (odds ratio [OR] 18.2, 95% CI 4.6–71.7, p < 0.001). Considering the IQ score as a dependent variable, the only significant predictor was represented by younger age at onset (OR 0.7, 95% CI 0.5–0.9, p = 0.009). Depressive symptoms were reported by 6% of the cases, and fatigue was reported by 73% of the cases. MS negatively affected school and everyday activities in 56% of the subjects. Conclusions: In childhood and juvenile cases, multiple sclerosis (MS) is associated with cognitive impairment and low IQ scores, the latter related to younger age at onset. These aspects are of critical importance in helping children and adolescents with MS to manage their difficulties and psychosocial challenges.

[1]  R. Reitan The relation of the trail making test to organic brain damage. , 1955, Journal of consulting psychology.

[2]  K. Jambor Cognitive Functioning in Multiple Sclerosis , 1969, British Journal of Psychiatry.

[3]  D. Wechsler Manual of the Wechsler Intelligence Scale for Children-Revised , 1974 .

[4]  H. Nelson A Modified Card Sorting Test Sensitive to Frontal Lobe Defects , 1976, Cortex.

[5]  T. Shallice Specific impairments of planning. , 1982, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[6]  J. Kurtzke Rating neurologic impairment in multiple sclerosis , 1983, Neurology.

[7]  Michael J. Kovacs Children’s Depression Inventory , 2014 .

[8]  A. Bye,et al.  MULTIPLE SCLEROSIS IN CHILDHOOD: A NEW LOOK , 1985, Developmental medicine and child neurology.

[9]  Marcella Laiacona,et al.  Tre test clinici di ricerca e produzione lessicale , 1986 .

[10]  M. Camuffo,et al.  C.D.I. Children's Depression Inventory. Questionario di autovalutazione di M. Kovacs. Manuale , 1988 .

[11]  N. Larocca,et al.  The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. , 1989, Archives of neurology.

[12]  Stephen M. Rao,et al.  Cognitive dysfunction in multiple sclerosis. , 1991, Neurology.

[13]  E. Warrington,et al.  Cognitive abnormalities in multiple sclerosis: a psychometric and MRI study , 1991, Psychological Medicine.

[14]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[15]  L. Amaducci,et al.  Cognitive impairment in early-onset multiple sclerosis. Pattern, predictors, and impact on everyday life in a 4-year follow-up. , 1995, Archives of neurology.

[16]  J. Ruutiainen,et al.  Memory deficits and early cognitive deterioration in MS , 1996, Acta neurologica Scandinavica.

[17]  N. Larocca,et al.  The Impact of Early-Onset Multiple Sclerosis on Cognitive and Psychosocial Indices , 1999 .

[18]  C. Bever,et al.  Language functions in patients with multiple sclerosis. , 1999, The Clinical neuropsychologist.

[19]  A. Thompson,et al.  Cognitive function in primary progressive and transitional progressive multiple sclerosis: a controlled study with MRI correlates. , 1999, Brain : a journal of neurology.

[20]  J. Grafman,et al.  Neuropsychological effects of interferon β‐1a in relapsing multiple sclerosis , 2000 .

[21]  B. Harding,et al.  Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children. , 2000, Brain : a journal of neurology.

[22]  J. Grafman,et al.  Neuropsychological effects of interferon beta-1a in relapsing multiple sclerosis. Multiple Sclerosis Collaborative Research Group. , 2000, Annals of neurology.

[23]  K. Zakzanis,et al.  Distinct neurocognitive profiles in multiple sclerosis subtypes. , 2000, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[24]  A. Compston,et al.  Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis , 2001, Annals of neurology.

[25]  S. Sorbi,et al.  Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. , 2001, Archives of neurology.

[26]  P. Pasqualetti,et al.  La valutazione delle funzioni esecutive nella pratica neuropsicologica: dal Modified Card Sorting Test al Modified Card Sorting Test: Roma Version. Dati di standardizzazione , 2002 .

[27]  Rohit Bakshi,et al.  Fatigue associated with multiple sclerosis: diagnosis, impact and management , 2003, Multiple sclerosis.

[28]  Stephen M Rao,et al.  Cognitive dysfunction in multiple sclerosis: a review of recent developments. , 2003, Current opinion in neurology.

[29]  A Achiron,et al.  Cognitive impairment in probable multiple sclerosis , 2003, Journal of neurology, neurosurgery, and psychiatry.

[30]  N. De Stefano,et al.  Neocortical volume decrease in relapsing–remitting MS patients with mild cognitive impairment , 2004, Neurology.

[31]  R. Bakshi,et al.  Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change , 2005, Journal of the Neurological Sciences.

[32]  R. Siegert,et al.  Depression in multiple sclerosis: a review , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[33]  L. Krupp,et al.  Cognitive functioning in children and adolescents with multiple sclerosis , 2005, Neurology.

[34]  B. Banwell,et al.  The cognitive burden of multiple sclerosis in children , 2005, Neurology.

[35]  Marco Battaglini,et al.  Association of neocortical volume changes with cognitive deterioration in relapsing-remitting multiple sclerosis. , 2007, Archives of neurology.

[36]  Lauren B. Krupp,et al.  Consensus definitions proposed for pediatric multiple sclerosis and related disorders , 2007, Neurology.

[37]  L. Krupp,et al.  Longitudinal Neuropsychological Assessment in Pediatric Multiple Sclerosis , 2007, Developmental neuropsychology.

[38]  A. Bar-Or,et al.  Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions , 2007, The Lancet Neurology.

[39]  R. Fields,et al.  White matter in learning, cognition and psychiatric disorders , 2008, Trends in Neurosciences.

[40]  M. Amato,et al.  Cognitive changes in multiple sclerosis , 2008, Expert review of neurotherapeutics.

[41]  M. Wintermark,et al.  Difference in disease burden and activity in pediatric patients on brain magnetic resonance imaging at time of multiple sclerosis onset vs adults. , 2009, Archives of neurology.

[42]  Hadi Hussain,et al.  COGNITIVE AND PSYCHOSOCIAL FEATURES OF CHILDHOOD AND JUVENILE MS , 2009, Neurology.

[43]  M. Johnston,et al.  Plasticity in the developing brain: implications for rehabilitation. , 2009, Developmental disabilities research reviews.