Early cognitive dysfunction in multiple sclerosis [Disfunção cognitiva inicial na esclerose múltipla]

• Type: Article in International Scientific Journal
• Date: 2005

Authors

Joana Guimaraes (Author) FMUP; Sousa, C (Author) Other; Fonseca, R (Author) Other; Sa, MJ (Author) Other

Journal

Title: Sinapse

Vol. 5

Pages: 36-40

ISSN: 1645-281X

Publisher: Sociedade Portuguesa de Neurologia

Indexing

Scopus - 0 Citations

Other information

Authenticus ID: P-007-EKT

Abstract (EN): Introduction: Cognitive dysfunction is an important cause of disability in patients with Multiple Sclerosis (MS). Its prevalence is estimated at 45 to 65% and typically is detected later in the course of MS. The authors describe a patient whose initial presentation of MS was cognitive dysfunction. Case report: A 42-year-old man, professor, with a subacute history of short-term memory deficit and spatial disorientation with progressive course, performs a cerebral CT-scan that doesn't reveal any changes. Four years later he is observed by a neurologist who detects cognitive impairment and right kinetic cerebellum syndrome. Thus, he was admitted at the Neurology Department (in 1997) and submitted to a diagnostic work-up: cerebral MRI - multiple demyelinating lesions and cortico-subcortical atrophy; CSF study - positive oligoclonal bands restricted to the CSF; visual and auditory evocated potentials - positive for demyelination. These changes allowed the establishment of the final diagnosis at discharge as multiple sclerosis. Neuropsychological evaluation revealed impairment of motor functions, attention and memory. The patient was afterwards admitted to our MS outpatient clinical care, and, at the moment, he presents a secondary progressive MS (EDSS: 6.5), in which the cognitive dysfunction is the most important disability. In 2001, the follow-up neuropsychological assessment disclosed a global cognitive decline, with severe impairment of memory domain. Several therapeutics strategies were tried, but the patient developed a progressive cognitive deterioration with an important repercussion in his functionality. The last neuropsychological evaluation (2004) disclosed a severe impairment of cognitive function in domains frequently involved in MS, compatible with a demential process. Discussion: This case highlights an uncommon first manifestation of MS, and also reinforces the idea that once cognitive dysfunction develops in a patient with MS it usually does not remit. We discuss the management of cognitive impairment - immunomodulatory drugs and other therapeutics strategies - more appropriated for dealing with cognitive problems at initial phases of the disease.

Language: Portuguese

Type (Professor's evaluation): Scientific