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Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS

From the Department of Clinical Neuropsychology, Vrije Universiteit, (Dr. Huijbregts), and Departments of Neurology (Drs. Kalkers, de Groot, and Polman), Pediatrics (Dr. de Sonneville), and Medical Psychology (I.E.W. Reuling), Vrije Universiteit Medical Centre, Amsterdam, the Netherlands.

Address correspondence and reprint requests to Dr. S.C.J. Huijbregts, School of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, UK; e-mail: S.Huijbregts{at}soton.ac.uk

Objective: To investigate the cognitive skills of patients with relapsing remitting multiple sclerosis (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS) relative to healthy control subjects and to assess whether there is heterogeneity in the type of cognitive disabilities demonstrated by patients with different MS phenotypes.

Methods: RRMS patients (n = 108), SPMS patients (n = 71), PPMS patients (n = 55), and healthy control subjects (n = 67) underwent neuropsychological assessment with the Brief Repeatable Battery of Neuropsychological Tests.

Results: Relative to controls, cognitive performance of RRMS patients was deficient when tasks required higher-order working memory (WM) processes (Word List Generation, 10/36 Spatial Recall Test, Symbol Digit Modalities Test). PPMS and SPMS patients performed poorer than control subjects on all tasks. SPMS patients performed more poorly than PPMS patients when tasks required higher-order WM processes, except when speed of information processing played a relatively important role (Symbol Digit Modalities Test, Paced Auditory Serial Addition Test). Whereas RRMS patients generally performed better than the progressive subtypes, they showed relatively poor verbal fluency.

Conclusion: MS patients with different disease courses have different cognitive profiles.

Received December 9, 2002. Accepted in final form March 22, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 27 issue to find the title link for this article.

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