多发性硬化患者认知功能损害及其影响因素

Characteristics and influencing factors of cognitive impairment in patients with multiple sclerosis

目的观察多发性硬化(multiple sclerosis,MS)患者认知功能损害特征,分析其影响因素。方法选取2019年4月至2022年4月四川大学华西医院收治的MS患者105例为MS组,另选同期的健康者30例为对照组,两组均行头颅磁共振(MRI)检查,采用韦氏成人智力量表检查(Wechsler intelligencescale,WAIS)、威斯康星卡片分类测验(Wisconsincard-storting task,WSCT)系统分别对患者整体认知功能进行评价,并对MS组患者行头颅磁共振成像检查及扩展功能障碍状态量表(expaned disability statusscale,EDSS)检查。结果在WAIS量表比较上,MS组患者言语智商、操作智商以及总智商均低于对照组(P<0.05)。在WSCT量表中总测验数、错误应答、持续性以及非持续性错误数上,MS组患者的测验得分均较对照组更高(P<0.05),其分类数、正确应答数、正确应答百分比测验得分较对照组更低(P<0.05)。MS组操作智商(r=-0.695)、SDS得分(r=-0.420)分别与EDSS负相关(P<0.05)。结论MS患者存在认知功能损害,表现为概括抽象、理解表达、思维观察、记忆能力结构综合、抽象空间技能和执行功能等均有减退,躯体功能障碍越严重,操作智商得分越低。

Objective To observe the characteristics of cognitive impairment in patients with multiple sclerosis(MS)and analyze its influencing factors.Methods A total of 105 patients with MS admitted to the West China Hospital from April 2019 to April 2022 were selected as the MS group,and 30 healthy individuals who received physical examination during the same period were selected as the control group.Both groups were examined with brain magnetic resonance imaging(MRI).The Wechsler Adult Intelligence Scale(WAIS)and Wisconsin Card Sorting Test(WSCT)system were used to evaluate the patients′overall cognitive function.Patients in the MS group were additionally evaluated with the Expanded Disability Status Scale(EDSS).Results On the WAIS scale,the verbal IQ,operational IQ and total IQ of the MS group were lower than those of the control group(P<0.05).The scores for the total number of tests,false responses,persistent errors,and nonpersistent errors in the WSCT of the MS group were higher than those in the control group,while the scores for classification,correct responses,and percentage of correct responses were lower than those in the control group(P<0.05).The operation IQ(r=-0.695)and SDS score(r=-0.420)were negatively correlated with EDSS score in the MS group(P<0.05).Conclusion Patients with MS have cognitive impairment,which manifests as the reduction of summary abstraction,comprehension and expression,thinking and observation,structural synthesis of memory ability,abstract spatial skills and executive function.The more severe the physical dysfunction,the lower the operational IQ score.