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Cognitive deterioration in multiple sclerosis
P. de Castro1, A. Aranguren2, E. Arteche2, M. Otano3 1. Departamento
de Neurología. Clínica Universitaria de Navarra. Universidad de Navarra.
Pamplona. |
Amongst
the varied symptomology of multiple sclerosis is to be found the alteration of
higher functions (cognitive deficit), which has considerable repercussions on
the quality of life of patients. The
old descriptions of the disease rarely differentiate cognitive affectation from
the more general category of “mental symptoms”, which also includes a broad
range of affective disorders. Towards 1960 neuropsychological tests began to be
employed, and it was from the 1970s onwards that a clear distinction was drawn
between deterioration of the higher functions and psycho-affective aspects in
the disease. The
pattern of cognitive deterioration in patients with multiple sclerosis is not
uniform. During the initial phases of the disease it is, in general, light and
it has an insidious start, although inter-individual variability is wide,
depending on the predominant pathological alterations in the lesions and on
their number and localisation. In more severe cases, it is possible to include
within the debatable term of subcortical dementia, intellectual slowness,
problems of attention, alterations in abstract reasoning, shortcomings in the
resolution of problems and memory dysfunction. It
is an almost invariable complication of the advanced stages of the disease,
since the lesions characterised by axonal loss affect broad areas of white
matter, which determines the deafferentation
of several areas of cortical association. There
does not appear to be any correlation between cognitive deterioration and the
variables of the disease considered in an independent way, such as demographic
data, clinical course, alterations of mood, consumption of medicines or fatigue.
Although, evidently, the disease’s progressive secondary forms of greater
duration and the accumulation of lesions are what present the greatest
deterioration. With
present-day techniques of neuroimaging it has been possible to show a
correlation between cognitive deterioration and the existence of an increase in
ventricular size, periventricular lesions and atrophy of the callous body. Key
words. Cognitive
deterioration. Multiple sclerosis.
Correspondencia Aceptado para su publicación el 22 de abril de 2002.
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