Avaliação cognitiva e de volumetria cerebral em uma amostra brasileira de pacientes com esclerose múltipla: um estudo transversal
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Data
2020-04-09
Autores
Medeiros, Leonardo Mariano Inácio
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: a esclerose múltipla (EM) é uma doença desmielinizante e inflamatória, de etiologia autoimune, com componente degenerativo, comprometendo o sistema nervoso central. Nos últimos anos, muitos centros de pesquisa e tratamento de pacientes com EM estão voltando a atenção para os aspectos cognitivos e de volume cerebral. Objetivo: avaliar em pacientes com diagnóstico de EM as características clínicas, sociodemográficas, cognitivas e de neuroimagem, a fim de mensurar se há relação entre os aspectos cognitivos e de volumetria. Método: os participantes foram submetidos à avaliação da incapacidade funcional por meio do EDSS, a bateria do BICAMS (SDMT, CVLT-2 e o BVMT-R) para avaliação cognitiva e a um questionário para detecção de sintomas depressivos e de ansiedade. Os participantes realizaram exame de ressonância magnética de crânio e após quantificação do volume cerebral pelo MSmetrix. Resultados: foram incluídos no estudo 54 pacientes com EM. A amostra foi formada principalmente por mulheres e com faixa etária média de 36 anos de idade, com nível de escolaridade alta e média de EDSS de 1,6. Em relação à presença de sintomas depressivos, foi observado correlação estatisticamente significativa (p < 0,05) com o BICAMS e com a fadiga. O EDSS apresentou correlação negativa com o SDMT oral (p = -0,40) e o BVMT-R T1 (p = -0,28) e a coordenação motora demonstrou correlação negativa com SDMT oral (p = -0,57) e com CVLT-2 (p = -0,34). Além disso, percebemos uma correlação entre o SDMT oral e a volumetria cerebral, tanto total (p = 0,009920), quanto de substância cinzenta (p = 0,009531) e com a carga lesional (p = 0,000123). Finalmente, ao realizarmos análise de regressão linear, em que a variável dependente foi o SDMT, percebemos que a depressão foi responsável por 27,26% do Coeficiente de Determinação (R2), demonstrando sua importância na avaliação do paciente com EM. Conclusões: os resultados deste trabalho sugerem que pacientes com EM e sintomas depressivos possuem pior desempenho nos testes cognitivos e pior nível de incapacidade funcional, devendo ser avaliado em todo paciente com EM; além disso, o SDMT mostrou correlação positiva com a volumetria cerebral.
Introduction: multiple sclerosis (MS) is a demyelinating and inflammatory disease, of autoimmune etiology, with a degenerative component, affecting the central nervous system. In recent years, many research and treatment centers for patients with MS are turning their attention to cognitive and brain volume aspects. Objective: to evaluate the clinical, sociodemographic, cognitive and neuroimaging characteristics of patients diagnosed with MS, in order to assess whether there is a relationship between cognitive and volumetric aspects. Method: the participants underwent functional disability assessment using EDSS, BICAMS battery (SDMT, CVLT-2 and BVMT-R) for cognitive assessment and a questionnaire for detecting mood and anxiety disorders. The participants underwent a cranial magnetic resonance exam and afterwards the brain volume was quantified by MSmetrix. Results: 54 patients with MS were included in the study. The sample was formed mainly by women and with an average age of 36 years old, with a high level of education and an average EDSS of 1.6. Regarding the presence of depressive symptoms, a statistically significant correlation (p <0.05) with BICAMS and fatigue was observed. EDSS showed a negative correlation with oral SDMT (p = -0.40) and BVMT-R T1 (p = -0.28) and motor coordination showed a negative correlation with oral SDMT (p = -0.57) and with CVLT-2 (p = -0.34). In addition, we noticed a correlation between oral SDMT and cerebral volumetry, both total (p = 0,009920) and gray matter (p = 0,009531) and with the lesion load (p = 0,000123). Finally, when performing linear regression analysis, where the dependent variable was SDMT, we realized that depression was responsible for 27.26% of the Coefficient of Determination (R2), demonstrating its importance in the assessment of patients with MS. Conclusions: the results of this study suggest that patients with MS and depressive symptoms have a worse performance in cognitive tests and a worse level of functional disability, and should be evaluated in all patients with MS, in addition, the SDMT showed a positive correlation with brain volume.
Introduction: multiple sclerosis (MS) is a demyelinating and inflammatory disease, of autoimmune etiology, with a degenerative component, affecting the central nervous system. In recent years, many research and treatment centers for patients with MS are turning their attention to cognitive and brain volume aspects. Objective: to evaluate the clinical, sociodemographic, cognitive and neuroimaging characteristics of patients diagnosed with MS, in order to assess whether there is a relationship between cognitive and volumetric aspects. Method: the participants underwent functional disability assessment using EDSS, BICAMS battery (SDMT, CVLT-2 and BVMT-R) for cognitive assessment and a questionnaire for detecting mood and anxiety disorders. The participants underwent a cranial magnetic resonance exam and afterwards the brain volume was quantified by MSmetrix. Results: 54 patients with MS were included in the study. The sample was formed mainly by women and with an average age of 36 years old, with a high level of education and an average EDSS of 1.6. Regarding the presence of depressive symptoms, a statistically significant correlation (p <0.05) with BICAMS and fatigue was observed. EDSS showed a negative correlation with oral SDMT (p = -0.40) and BVMT-R T1 (p = -0.28) and motor coordination showed a negative correlation with oral SDMT (p = -0.57) and with CVLT-2 (p = -0.34). In addition, we noticed a correlation between oral SDMT and cerebral volumetry, both total (p = 0,009920) and gray matter (p = 0,009531) and with the lesion load (p = 0,000123). Finally, when performing linear regression analysis, where the dependent variable was SDMT, we realized that depression was responsible for 27.26% of the Coefficient of Determination (R2), demonstrating its importance in the assessment of patients with MS. Conclusions: the results of this study suggest that patients with MS and depressive symptoms have a worse performance in cognitive tests and a worse level of functional disability, and should be evaluated in all patients with MS, in addition, the SDMT showed a positive correlation with brain volume.
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Palavras-chave
BICAMS, Cognição, Depressão, Esclerose múltipla, Volumetria cerebral, Cognition, Depression, Multiple sclerosis