title: School performance as a marker of cognitive decline prior to diagnosis of multiple sclerosis.
abstract: BACKGROUND
  For many years, cognitive impairment has been established as a well-known symptom of multiple sclerosis. Moreover, we know that it was present even at the beginning of the disease.
  
  
  OBJECTIVE
  In this case-control study, we decided to evaluate whether there is an impairment of cognitive functions even before onset in those patients who will eventually suffer from multiple sclerosis.
  
  
  METHODS
  We evaluated the overall school performance, and particularly school performance in math and language in a group of patients who would later develop the disease and we compared our findings with a control group.
  
  
  RESULTS
  We found that school performance was poorer in subjects who were to become patients. And we found that the later the start of the first symptom, the better the qualifications.
  
  
  CONCLUSIONS
  Testing a premorbid cognitive deficit by a validated indirect evaluation method allowed us to verify that there was evidence of neurological compromise even before a clinical diagnosis or the completion of the first magnetic resonance imaging in patients who would then suffer from multiple sclerosis.
authors.affiliation: Institute of Cognitive Neurology (INECO), Argentina/Institute of Neurosciences, Favaloro Foundation, Argentina vladimirosinay@gmail.com.
authors.forename: Vladimiro
authors.initials: V
authors.lastname: Sinay
authors.affiliation: Hospital Dr César Milstein, Argentina.
authors.forename: Manuel
authors.initials: M
authors.lastname: Perez Akly
authors.affiliation: Hospital Dr César Milstein, Argentina.
authors.forename: Gisela
authors.initials: G
authors.lastname: Zanga
authors.affiliation: Hospital Dr César Milstein, Argentina.
authors.forename: Celina
authors.initials: C
authors.lastname: Ciardi
authors.affiliation: Institute of Cognitive Neurology (INECO), Argentina/Institute of Neurosciences, Favaloro Foundation, Argentina.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Racosta
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis*; D012574:Schools
keywords: Multiple sclerosis; cognitive symptoms; early diagnosis; education; incidental findings; prodromal symptoms