Integration of cognitive impairment in the expanded disability status scale of 215 patients with multiple sclerosis.
BACKGROUND
Estimates of the prevalence of cognitive impairment among patients with multiple sclerosis (MS) range between 40 and 70%. The current cerebral functional system (CFS) of the Expanded Disability Status Scale (EDSS) is subjective.


OBJECTIVE
To define a new cerebral functional system (NCFS) based on neuropsychological evaluation (NE).


METHODS
We prospectively included 215 MS patients. NE evaluated cognitive functions. Fatigue was assessed with the Fatigue Impact Scale. The NCFS was devised with grades from 0 to 5, excluding depression but including fatigue. Grade 1 of the NCFS was integrated in the EDSS as other functional scores. The NCFS and new EDSS including the NCFS were compared with the current CFS and EDSS.


RESULTS
215 patients (69% women, 67% with relapsing-remitting MS, median EDSS 3.0) were assessed. 98% of these patients presented fatigue and/or cognitive impairment with the NCFS compared to 62% with the CFS. The NCFS was higher than the CFS, and the EDSS had changed in 31% of the 113 patients with an EDSS <3.5. Change in functional score was not correlated to current age or age at onset of MS.


CONCLUSIONS
We propose a new CFS grading based on NE, including fatigue, and integrating grade 1 at EDSS.
Department of Neurology, Hôpital Central, Nancy, France.
Hélène
H
Brissart
Mathilde
M
Sauvée
Clotilde
C
Latarche
Céline
C
Dillier
Marc
M
Debouverie
D000293:Adolescent; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004185:Disability Evaluation; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000503:physiopathology; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D055815:Young Adult