Pattern of neuropsychological impairment in the early phase of relapsing-remitting multiple sclerosis

To investigate the neuropsychological profile in the first few years post-onset of relapsing-remitting multiple sclerosis (MS) we carried out a comprehensive neuropsychological evaluation of 33 patients characterized by very short evolution of this disease, minimal levels of neurological disability and preserved general cognition. Thirty-three individually pair-matched controls were also evaluated. Patients performed as well as controls on many of the cognitive exploration measures. Nevertheless, the group of patients evinced a general slowness that affected motor execution and cognitive processing. Memory functions were characterized by preservation of working memory, retrieval or storage of information and a deficit at the acquisition phase in (verbal and visual) supraspan tasks. In addition, significant correlations were observed between some measures of information processing speed and memory. These results highlight the importance of studying cognitive deficits not only in the different subtypes of MS but also in different phases of the disease.

[Neuropsychological assessment in multiple sclerosis]

OBJECTIVE

Over the past 20 years great advances have been made in understanding the neuropsychological changes in multiple sclerosis. In this paper we review the nature of mental deterioration in multiple sclerosis and the procedures used for its evaluation.

DEVELOPMENT

First we give a short summary of present knowledge of the involvement of different functions and the instruments most generally used to evaluate it. We then consider the different approaches to neuropsychological assessment, the use of broad guidelines as opposed to screening techniques, bearing in mind their advantages and disadvantages in the clinical field and in investigation. Similarly we mention the current trends in the evaluation and treatment of multiple sclerosis.

CONCLUSIONS

The general profile of neuropsychological alterations in multiple sclerosis is characterized by the presence of changes in secondary memory and speed of thought, although the nature of this defect is still not clear. Changes are also seen in other neuropsychological functions, although less frequently and more controversially. Our knowledge of the prevalence of these changes comes from the use of guidelines for thorough examination. However, the current tendency is to seek instruments for evaluation which combine diagnostic efficiency, clinical usefulness and brevity. In this respect, although progress is being made, there are still questions to be answered.

Cerebrovascular risk factors and later-life major depression. Testing a small-vessel brain disease model

The topic of vascular depression has received increasing prominence as a putative etiology of depression in later life. The authors examined one aspect of this model by comparing the burden of systemic cerebrovascular risk factors (CVRFs) in 130 psychiatric inpatients with major depression and 64 normal control (NC) subjects, all age > or = 50 years. Depressed subjects did not differ statistically from NCs on cumulative CVRF scores. Diabetes mellitus and atrial fibrillation were both associated with depression, but only atrial fibrillation retained an independent association after medical disability was statistically controlled. Among the depressed subjects, CVRF scores were not significantly associated with overall symptom severity, psychiatric disability, age at onset of depression, melancholic subtype, or psychotic depression. These data did not support the notion that a linear model of small-vessel disease might apply to the great majority of older inpatients with major depression.