title: Isolated cognitive relapses in multiple sclerosis.
abstract: OBJECTIVE
  While cognition can be affected during sensorimotor multiple sclerosis (MS) relapses, the relevance of isolated cognitive relapses (ICRs ie, those occurring in absence of new sensorimotor symptoms) remain poorly characterised. Here, we decided to explore the relationship between ICR, subjective evaluation of cognitive performance and long-term cognitive decline in a group of subjects with relapsing-remitting MS.
  
  
  METHODS
  We analysed the cognitive performance of 99 clinically stable relapsing-remitting MS for whom data from four consequent clinical and cognitive evaluations were available, that is, a baseline evaluation (t₀), followed in the subsequent 6 months by a second evaluation performed not later than 2 weeks after a routine brain scan positive for at least one area of gadolinium enhancement (t₁) and two gadolinium enhancement-negative follow-up evaluations after 6 months (t₂) and 1 year (t₃) from t₁. Based on published literature, we defined as a meaningful change in cognition a transient reduction of Symbol Digit Modalities Test score of at least four points at t₁ compared with t₀ and t₂.
  
  
  RESULTS
  ICRs were found in 17 patients and were not associated with subjective cognitive deficits or depression. Subjects who presented with an ICR at t₁ presented with a significantly reduced cognitive performance at the follow-up evaluations compared with patients without ICR.
  
  
  CONCLUSIONS
  We showed that ICRs were not associated with changes in mood, fatigue levels or cognitive performance self-evaluations. Our study introduces an operational definition of ICRs and suggests to their role as a factor for cognitive decline in MS.
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy MS Centre, University College London Institute of Neurology, London, UK.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pardini
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Uccelli
authors.affiliation: Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, Illinois, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Grafman
authors.affiliation: MS Centre, University College London Institute of Neurology, London, UK Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Yaldizli
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Mancardi
authors.affiliation: Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy Department of Diagnostic and Interventional Neuroradiology, San Martino University Hospital, Genoa, Italy Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Roccatagliata
mesh_terms: D000328:Adult; D000339:Affect; D003072:Cognition Disorders / Q000150:complications* / Q000523:psychology*; D005221:Fatigue / Q000150:complications / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000523:psychology*; D009483:Neuropsychological Tests; D012008:Recurrence; D012647:Self-Assessment; D055815:Young Adult