| BackgroundNeuromyelitis optica (NMO) is an inflammatory disease of the central nervous system (CNS) characterized by severe optic neuritis and transverse myelitis. They are considered to be the same disease in various studies and did not make a strict distinction for a long time. However, in recent years, a growing number of studies found its clinical, pathological and immunological aspects of the different characteristics of MS lesions, suggesting that NMO is a separate disease unit. Owing to NMO simultaneous or sequential involvement of the brain and brain stem, even though optic nerve and spinal cord was damaged worse, resulting the cognitive impairment attention gradually. In2008, there has report NMO patients cognitive impairment characteristics at abroad, but so far the report in country is still missing. Cognitive dysfunction and somatic dysfunction can affect patients with activities of daily living, social functioning, and mental status; it must be pay importantly attention to research.With the development of social, people have become increasingly demanding on the material level, except the World Health Organization (WHO) proposed quality of life (QOL) in1994, which can assessment the concept of a comprehensive health. health problems were increasingly concerned by the groups. Form then on, more and more researches began to focus on the problem of diseases caused by QOL. Although currently on QOL concept and constitutes do not reach a consensus, but there are three recognized:First, QOL is a multidimensional concept. including the four aspects of the overall quality of life, physiological function, psychological function and social function; Secondly, QOL is a subjective evaluation and should be measured by its own evaluation; Last, QOL is literate dependence and must be built in a certain under the cultural value system. With the changes in the pattern of social medicine, traditional concepts of health and health evaluation occur gradually change, health is not only the absence of disease and weak phenomenon, but the integrity of the state of a physical, psychological and social adaptation. All in all, quality of life in perfect interpretation of the concept of health. At the same time, the significance of QOL assessment reflects it can be used as a reference indicator of disease prognosis; it can be used as a clinical evaluation of the efficacy of a comprehensive evaluation; through the analysis of its influencing factors, screening can be implemented comprehensive intervention measures to improve the patient’s QOL. NMO is the common demyelization disease of the central nervous system, its of recurrent, multifocal, progress and difficult to cure characteristics makes it serious damage to physical function, cognitive decline, reduced social function, psychological change and economic burden the problem seriously affect patients QOL. In the past, the lots of researches focus on somatic obstacles, such as Kanamori and co-workers using the health survey quality of life (SF-36) assessment of NMO patients, but the scale was not included in the assessment of cognitive function. So, to study quality of life in cognitive impairment is the concerns in this study.To study NMO patients with cognitive impairment characteristics and its impact on quality of life, it will be a more comprehensive understanding of the clinical manifestations of NMO patients, to understand the relationship between cognitive impairment and others dysfunction or disease prognosis. The efficacy, prognosis judgment and cognitive disorders early detection, early intervention are benefited from understanding of cognitive impairment and improved the quality of life of patients. Chinese version of PASAT which assess NMO patients cognitive function and MS/NMO patients quality of life scale-54(Multiple Sclerosis Quality of Life-54, MS/NMOQOL-54) which evaluate MS/NMO patients quality of life were got reliability and validity in our preliminary work. These provide a solid foundation for the implementation of the topics.Experiment1:ObjectiveTo investigate the characteristics of cognitive impairment in Neuromyelitis Optica (NMO) patients.MethodsIn Nov.2011to Jun.2012, from the Nanfang Hospital, Zhujiang Hospital, the Second People’s Hospital of Guangdong Province, the zengchen city center hospital, Nansha District City People’s Hospital, NMO patients as research subjects and MS patients as the case-control group were consecutively collected in city of Guangzhou, at the same time, we collect normal people as the normal control group, which the demographic data matched MS/NMO subjects. The inclusion criteria:①NMO group: NMO patients’standard for the clinical diagnosis established by Wingerchuck (2006); during an acute relapse; patient’s consent to participate voluntarily; age between18and60years, regardless of sex.②MS group:According to McDonald criteria (2010); the others criteria are the same as NMO.③Control group:control groups must be finish the MoCa test (the Beijing version) and the scores should be more than26; age with patients difference of less than3years old; the education years difference of less than5years, rest of the standard is the same as the above. The exclusion criteria:can not be able to communicate in Putonghua proficiency; can not read and comprehension tests, do not match and adhere to the completion of the test; history of serious head trauma or other neuropsychiatric diseases of psychoactive substance dependence because may affect cognitive function; at last, severe visual impairment, hearing impairment, or hand movement disorders affecting cognitive tests. All subjects were consent by family members or oral informed and want to cooperate with the testers to complete testing. The NMO group was enrolled12people, the MS group and the normal group respectively was enrolled15people, a total of42people entered the study. All of the test must be arrange in a quiet and unified environment. First, testers collected epidemiological data (gender, age, years of education, duration of disease, relapse frequency) of the various groups, and then used cognitive function assessment scale to assess their cognitive function. The Minimal Assessment of Cognitive Function in MS (MACFIMS) is composed of seven neuropsychological tests, covering five cognitive domains commonly impaired in MS (processing speed/working memory, learning and memory, executive function, visual-spatial processing, and word retrieval):①Information processing speed and working memory capacity was evaluated by the Chinese Paced Auditory Serial Addition test which reliability and validity was tested by Wang Li et.②The Chinese Rey Auditory Verbal Learning Test (CRAVLT) was developed to measure verbal learning and memory domain.③The Verbal Fluency Test (VFT) which reference in the vision of Chinese Wechsler Memory Scale is used to measure the spontaneous production of words.④The Rey Complex Figure Test is used to measure the visual-spatial processing.⑤The Chinese Version of the Stroop Colour-Word Test is to test executive function. At last, the others assessment were tested in NMO and MS patients:Disability was measured using the Expanded Disability Status Scale(EDSS), depression and anxiety was respectively assessed using the Hamilton Depression Rating Scale-17(HAMD-17) and Hamilton Anxiety Scale(HAMA), and fatigue was assessed using the Fatigue Severity Scale(FSS).Data were expressed as the means/standard deviations, the statistical analyses were performed using the SPSS software package version13.0(SPSS Inc., Chicago,IL, USA). Statistical significance was defined as p<0.05. Age and the education years were taken one-way analysis of variance,but non-parametric distribution of the variable (EDSS, disease duration, sexy, relapse frequency) were tested by Nonparametric test. For the cognitive function scores, PASAT-3/-2, CRAVLTN1-5scores were tested by Kruskal-Wallis tests, but CRAVLTN6,7,8and9, the Stroop Colour-Word Test, the Rey Complex Figure Test, the Verbal Fluency Test were used one-way ANOVA. HAMD, HAMA, FSS, PSQI scores also taken one-way ANOVA.ResultThe PASAT-3accomplishments [(33.3±9.6),(38.9±14.3),(45.5±8.6) respectively], the VFT scores [(24.8±8.7),(26.4±8.4),(31.7±4.7) respectively] in NMO group, MS group and control group, the differences of PASAT-3and VFT among three groups were significant (p<0.05). However, PASAT-2, CRAVLT (N1-5, N6,7,8,9), RCFT and Stroop test scores were not significant differenent (p>0.05).Experiment2ObjectiveTo explore the differences quality of life in cognitive dysfunction patients group and without cognitive dysfunction group of the NMO patients, to explore differences in the quality of life between existence of cognitive impairment in patients with NMO and existence of cognitive impairment in patients with MS.MethodsIn Nov.2011to Nov.2012, from the hospitals of the experiment one, NMO patients as research subjects and MS patients as the case-control group were consecutively collected in the city of guangzhou, at the same time, we collect normal people as the normal control group, which the demographic data matched MS/NMO subjects. The inclusion criteria:①NMO group:NMO patients’standard for the clinical diagnosis established by Wingerchuck (2006); during an acute relapse; patient’s consent to participate voluntarily; age between18and60years, regardless of sex.②MS group:According to McDonald criteria (2010); the others criteria are the same as NMO.③Control group:control groups must be finish the MoCa test (the Beijing version) and the scores should be more than26; age with patients difference of less than3years old; the education years difference of less than5years, rest of the standard is the same as the above. The exclusion criteria:can not be able to communicate in Putonghua proficiency; can not read and comprehension tests, do not match and adhere to the completion of the test; history of serious head trauma or other neuropsychiatric diseases of psychoactive substance dependence because may affect cognitive function; at last, severe visual impairment, hearing impairment, or hand movement disorders affecting cognitive tests. All subjects were consent by family members or oral informed and want to cooperate with the testers to complete testing. The NMO group was enrolled15people except one cannot finished (female,57y), the MS group and the normal group respectively was enrolled18,15people, a total of48people entered the study. All of the test must be arrange in a quiet and unified environment. First, testers collected epidemiological data (gender, age, years of education, duration of disease, relapse frequency) of the various groups, and then used cognitive function assessment scale to assess their cognitive function. The Minimal Assessment of Cognitive Function in MS (MACFIMS) is composed of seven neuropsychological tests, covering five cognitive domains commonly impaired in MS:①Information processing speed and working memory capacity was evaluated by the Chinese Paced Auditory Serial Addition test which reliability and validity was tested by Wang Li et.②The Chinese Rey Auditory Verbal Learning Test (CRAVLT) was developed to measure verbal learning and memory domain.③The Verbal Fluency Test (VFT) which reference in the vision of Chinese Wechsler Memory Scale is used to measure the spontaneous production of words.④The Rey Complex Figure Test is used to measure the visual-spatial processing.⑤The Chinese Version of the Stroop Colour-Word Test is to test executive function. At last, the others assessment were tested in NMO and MS patients:Disability was measured using the Expanded Disability Status Scale (EDSS), depression and anxiety was respectively assessed using the Hamilton Depression Rating Scale-17(HAMD-17) and Hamilton Anxiety Scale (HAMA), and fatigue was assessed using the Fatigue Severity Scale (FSS).At last, the NMO and MS patients QOL was measured by the Chinese version of Multiple Sclerosis Quality of Life (MS/NMOQOL)-54instrument. Data were expressed as the means/standard, the statistical analyses were performed using the SPSS software package version13.0(SPSS Inc, Chicago, IL, USA). Z scores were calculated for each individual neuropsychology test based on the normal control group. Impairment for a single test was defined as a z<1.5score, overall cognitive function impairment generally was defined as a defect on two or more test measures. NMO patients five cognitive domains were assessed in accordance with the Z-score, and then compare disorder and normal group in working memory and information processing speed, verbal memory ability. The quality of life scores in NMO and MS patients with cognitive disorders comparisons, the working memory and information processing speed, verbal memory capacity are grouped to compare. Using statistical methods are as follows:Epidemiological information was tested by the independent sample t-test between NMO and normal group. The quality of life scores were taken independent sample Mest. However, when compare the NMO and MS group epidemiological information, the independent sample Mest and Kruskal-Wallis tests were used. The quality of life score all using independent sample t test or else Satterthwaite approximate t test. Statistical significance was defined as p<0.05.Resultsl.The NMO patients quality of life scores which in working memory and information processing speed disorder group, the overall, physical aspects, psychological and social aspects of scores[(75.4±13.3),(58.2±17.0),(65.7±10.6),(73.0±17.2) respectively], and quality of life scores in non-disorder group [(37.5±16.3),(30.0±16.2),(42.2±19.4),(38.6±28.2) respectively] was differences statistics significance (P<0.05),however, the verbal memory ability and overall cognitive dysfunction group and non-disorder group differences was not statistics significance (P>0.05) in the above four big aspects. The obstacle group in energy, due to physical role limitations, self-assessment score and emotional status scores [76.0±15.0),(43.78±31.5),(75.4±13.3),(91.0±11.5) respectively],[(42.2±27.2),(6.8±22.6),(52.7±14.9),(46.5±21.6)] in no-obstacle differences was not statistically significant (P>0.05), the others sub aspects differences was not statistically significant (P>0.05).2. The four aspects and the all sub aspects of quality of life scores in NMO patients and MS patients which existed working memory and information processing speed, verbal memory ability disorder difference was not statistically significant (P>0.05).3. NMO group EDSS score, HAMA score, PAQI score [(4.1±2.1),(11.9±7.0),(11.1±6.7) respectively], with the score of the MS group [(2.5±1.2),(7.8±3.3),(6.7±5.0) respectively] differences was statistically significant (P<0.05),however, the age, years of education, duration of relapses,HAMD-17, FSS score differences was not statistically significant (P>0.05).Conclusions1. These data demonstrated that NMO patients existed obstacle in working memory and information processing speed, semantic fluency, but still retained other aspects of the verbal memory capacity, executive function, visual-spatial structures and visual memory ability. The characteristics of cognitive impairment in NMO patients are not exactly the same as in MS patients.2. Working memory and information processing speed may affect NMO patients’ energy, due to physical role limitations, self-assessment score and emotional status score and thus impact on four aspects quality of life; however, verbal memory ability and overall cognitive function do not affect the quality of life of patients.3. There are no differences in quality of life of the four aspects and the sub-areas in NMO and MS patients which existence working memory, information processing speed and verbal memory ability dysfunction.4. NMO patients with more severe anxiety, poorer quality of sleep and higher EDSS scores than MS people. But the age, years of education, duration, number of recurrences, depression and fatigue is no difference.Taking into account the quality of life influenced by many factors, the small sample size of this study, these conclusions need to expand the sample to be confirmed. |
PDF Full Text Request