MULTİPL SKLEROZDA KOGNİTİF ETKİLENMENİN DEĞERLENDİRİLMESİ

Amaç Multipl skleroz (MS), santral sinir sisteminin ön planda beyaz cevherini etkileyen kronik inflamatuar demiyelinizan hastalığıdır. Kognitif bozukluk relapsing remitting multipl skleroz (RRMS) hastalarında sık karşılaşılan bir sorundur ve yaşam kalitesi üzerinde önemli rol oynamaktadır. MS hastalarının %30-70’inde kognitif bozukluk görülür. Bozukluklar tipik olarak bellek, dikkat, bilgi işleme fonksiyonlarındadır. Bu çalışmada erken evre MS hastalarındaki bilişsel bozulmanın paterninin belirlenmesi amaçlanmıştır. Gereç ve Yöntem Çalışmaya 30 RRMS hastası ve 30 sağlıklı gönüllü dahil edilmiştir. Tüm deneklere sözel ve görsel bellek, dikkat, yürütücü işlevler, görsel-uzamsal işlevler, lisan ve genel akıcı zekayı kapsayan geniş bir nöropsikolojik test bataryası uygulanmıştır. Özürlülük ve işlevselliğin etkilenen kognitif alanlarla ilişkisi değerlendirilmiştir. Bulgular Çalışmaya alınan MS hastaları ve sağlıklı gönüllülerin ortalama yaş ve eğitim süreleri arasında anlamlı bir farklılık yoktu. MS’li hastalarda ortalama hastalık süresi 62.20 ± 52.70 ay ve ortalama tanı alma süresi 39.16 ± 39.17 ay idi. Ortalama atak sayısı 3.13 ± 1.90 idi. Ortalama EDSS puanı 1.38 ± 1.31 idi. Psikomotor hız ve dikkat işlevlerini değerlendiren bir test olan İz Sürme Testi A ve B alt-testlerinde MS’li hastaların başarımı kontrol grubundakinden belirgin derecede daha düşüktü (p=0.005). Sonuç MS hastaları dikkat ve yürütücü işlevleri değerlendiren tüm testlerde daha kötü bir başarım sergilemiştir. Bu kötü başarım Multipl Skleroz İşlevsel Bileşiği (MSFC) ve Genişletilmiş Özürlülük Durum Ölçeği (EDSS) ile bağıntılıdır. MS hastalarında temel olarak bellek ve dikkat bozuklukları bildirilmiştir. Bulgularımız çalışma belleği, dikkat ve yürütücü işlev bozukluğunun hastalığın erken evrelerinden itibaren diğer bulgulara eşlik edebileceğini düşündürmektedir.

Anahtar Kelimeler:

MULTİPL SKLEROZ, BELLEK, DİKKAT, YÜRÜTÜCÜ İŞLEVLER, GÖRSEL-UZAMSAL İŞLEVLER, MSFC, EDSS

EVALUATION OF THE COGNITIVE IMPAIRMENT IN MULTIPLE SCLEROSIS

Objective Multiple sclerosis (MS) is a chronic-imflammatory demyelinating central nervus system disease affecting mainly the white matter. Cognitive impairment is a common problem in relapsing-remitting multiple sclerosis (RRMS) patients and plays a major role in the quality of life. Cognitive impairment occurs in 30-70% of patients with MS. Deficits typically occur in memory, attention and information processing functions. In this study it is aimed to determine pattern of cognitive impairment in MS patients who are in the early hase of disease. Material and Method Thirty RRMS patients and 30 healthy volunteers were included in the study. All subjects were administered a comprehensive neuropsychological test battery which encompases verbal and visual memory, attention, executive functions, visual spatial functions, language and general fluid intelligence. The relation of disability and functionality with affected cognitive domains were also evaluated. Results There was no significant difference mean age and duration of education between the MS patients and healthy controls. Mean duration of disease in MS patients is 62.20 ± 52.70 mounth and mean time to diagnosis is 39.16 ± 39.17 mounth, Mean number of attack is 3.13 ± 1.90 and mean EDSS score is 1.38 ± 1.31. In Trail Making Test A and B, which is a test that evaluates psychomotor speed and attention functions, patients with MS had significantly lower performance than control group. Conclusion MS patient exhibited a worse performance in all tests evaluating attention and executive functions. This worse performance was correlated with Multiple Sclerosis Functional Composite (MSFC) and Expanded Diasability Status Scale (EDSS). MS patients are reported to have mainly memory and attention deficits. Our results suggest that a working memory and attention deficits and executive dysfunction may associate with other findings of the disease since early phases of disease.

Keywords:

MULTIPLE SCLEROSİS, ATTENTION, MEMORY, EXECUTIVE FUNCTIONS, VISUAL-SPATIAL FUNCTIONS, MSFC, EDSS,

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