title: Benign multiple sclerosis: physical and cognitive impairment follow distinct evolutions.
abstract: BACKGROUND
  Benign multiple sclerosis (BMS) definitions rely on physical disability level but do not account sufficiently for cognitive impairment which, however, is not rare.
  
  
  OBJECTIVE
  To study the evolution of physical disability and cognitive performance of a group of patients with BMS followed at an University Hospital Multiple Sclerosis Center.
  
  
  METHODS
  A consecutive sample of 24 BMS cases (diagnosis according to 2005 McDonald's criteria, relapsing-remitting course, disease duration ≥ 10 years, and expanded disability status scale [EDSS] score ≤ 2.0) and 13 sex- and age-matched non-BMS patients differing from BMS cases for having EDSS score 2.5-5.5 were included. Main outcome measures were as follows: (i) baseline and 5-year follow-up cognitive impairment defined as failure of at least two tests of the administered neuropsychological battery; (ii) EDSS score worsening defined as confirmed increase ≥ 1 point (or 0.5 point if baseline EDSS score = 5.5).
  
  
  RESULTS
  At inclusion, BMS subjects were 41 ± 8 years old and had median EDSS score 1.5 (range 0-2), while non-BMS patients were 46 ± 8 years old and had median EDSS score 3.0 (2.5-5.5). At baseline 16% of patients in both groups were cognitively impaired. After 5 years, EDSS score worsened in 8% of BMS and 46% of non-BMS patients (P = 0.008), while the proportion of cognitively impaired subjects increased to 25% in both groups.
  
  
  CONCLUSIONS
  Patients with BMS had better physical disability outcome at 5 years compared to non-BMS cases. However, cognitive impairment frequency and decline over time appeared similar. Neuropsychological assessment is essential in patients with BMS given the distinct pathways followed by disease progression in cognitive and physical domains.
authors.affiliation: Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.|UOC Neurologia dU, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gajofatto
authors.affiliation: UO Neurologia, Casa di Cura Privata Pederzoli, Peschiera del Garda, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Turatti
authors.affiliation: Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.|UOC Neurologia dU, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: M R
authors.initials: MR
authors.lastname: Bianchi
authors.affiliation: Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.|UOC Neurologia dU, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Forlivesi
authors.affiliation: Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.|UOC Neurologia dU, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gobbin
authors.affiliation: Istituto Auxologico Italiano, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Azzarà
authors.affiliation: Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.|UOC Neurologia dU, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Monaco
authors.affiliation: UOC Neurologia dU, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: M D
authors.initials: MD
authors.lastname: Benedetti
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000503:physiopathology* / Q000523:psychology*; D009483:Neuropsychological Tests; D016896:Treatment Outcome
keywords: benign course; cognitive impairment; multiple sclerosis; physical disability