A prospective, longitudinal, multicentre study of 217 patients with NMOSD found a lower prevalence of cognitive deficits than was previously reported. A subset of patients was cognitively impaired in visual processing speed and semantic fluency, regardless of their serostatus.
To what extent NMOSD patients face cognitive deficits is unclear. Previous studies showed inconsistent results, with a prevalence ranging between 30–70% . A prospective, longitudinal, multicentre, observational study, initiated by Dr Martin Hümmert (Hannover Medical School, Germany) and colleagues aimed to determine the frequency and type of cognitive impairment and to assess whether there are changes over time in NMOSD.
Included was data from 217 NMOSD patients from 17 specialised German centres. Of these participants, 174 (80%) were anti-aquaporin-4 antibody-positive (AQP4-IgG+) and 43 (20%) were seronegative. To determine their cognitive status, participants underwent the Symbol Digit Modalities Test (SDMT, testing visual processing speed), the Paced Auditory Serial-Addition Task (PASAT, a hearing test of processing speed), and/or the Multiple Sclerosis Inventory Cognition (MUSIC, a screening test of the most frequently impaired cognitive domains in MS: immediate recall, semantic fluency, visual processing speed, inhibition score, and delayed recall). Test results were compared with normative data from healthy controls. To assess changes over time, intra-individual cognitive performances were analysed after 1–2 years.
The median age was 52 years, with a median disease duration of 6 years and an Expanded Disability Status Scale (EDSS) score of 3.5. Compared with healthy controls, NMOSD patients were impaired in SDMT (P=0.007), MUSIC verbal fluency (P<0.001), and MUSIC congruent naming speed (P<0.001). About one-fifth of patients (23/123; 19%) showed impaired performance in at least 2 test scores; 40% (62/157) showed impaired performance in at least 1 test score. There was no significant decrease in individual performance after 1–2 years. EDSS scores were associated with lower test performance and SDMT scores were related to physical disability (r=-0.43; P<0.0010) and visual disability (r=-0.32; P<0.001). No differences were present between AQP4-IgG-seropositive and -seronegative NMOSD patients.
The authors concluded that the prevalence of cognitive deficits was lower than previously reported and did not noticeably deteriorate after 2 years. They argued that neuropsychological measurements should be adapted to physical and visual disabilities typically seen in NMOSD patients. In order to assess elderly (>60 years) patients, normative data of healthy controls is needed.
- Hümmert MW. Cognition in patients with neuromyelitis optica spectrum disorders: A prospective longitudinal multicentre study of 217 patients (CogniNMO-Study). Poster P020, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.
Copyright ©2022 Medicom Medical Publishers
« Evidence-based consensus on pregnancy in NMOSD Next Article
Ravulizumab significantly reduced relapses in AQP4+ NMOSD »
Table of Contents: ECTRIMS 2022
Letter from the Editor
ECTRIMS 2022 Highlights Podcast
Diagnosis and Prediction of Disease Course
A case for including optic nerve lesions in the McDonald criteria
Cerebrospinal fluid kappa-free light chains for MS diagnosis
Early, non-disabling relapses increase disability accumulation
Physical impairment is present before perceived MS onset
Chronic active MS lesions respond poorly to anti-CD20 antibodies
Treatment: Trials & Strategies
Dimethyl fumarate reduces the risk of a first clinical event in RIS
How and when to make a timely switch to high-efficacy DMT
Comparing real-world effectiveness of DMTs
Study fails to show non-inferiority of rituximab to ocrelizumab
Autologous haematopoietic stem cell transplantation versus DMTs
Stem cell transplantation not superior to natalizumab in progressive MS
Efficacy of DMTs fades away in secondary progressive MS
Smartphone tapping can help detect progressive MS
Early treatment with DMT effective in paediatric-onset MS
Fingolimod in paediatric MS: results of up to 6 years
Switching treatment after initial platform injectable DMT: real-world data
Pregnancy and infant outcomes in women receiving ocrelizumab
New safety data of anti-CD20 mAbs around pregnancy
MS activity and pregnancy outcomes after long-term use of natalizumab
Ravulizumab significantly reduced relapses in AQP4+ NMOSD
NMOSD patients are cognitively impaired regardless of serostatus
Evidence-based consensus on pregnancy in NMOSD
COVID-19 and MS: lessons learned thus far
Ocrelizumab and fingolimod increase the risk of COVID-19 and of worse outcomes
Humoral and cellular immune responses after SARS-CoV-2 vaccination
Re-myelination strategies in MS still pose many unanswered questions
MS associated with a broader Epstein-Barr virus specific T-cell receptor repertoire
Cognitive rehab and mindfulness reduce cognitive complaints in MS
Two trials comparing relapsing MS treatments
Sustained reduction in disability progression with ocrelizumab
Teriflunomide found safe in long-term follow-up in >22K MS patients