title: Cognitive impairment at diagnosis predicts 10-year multiple sclerosis progression.
abstract: BACKGROUND
  Cognitive impairment occurs from the early phases of multiple sclerosis (MS), and more frequently affects secondary progressive (SP) subjects than relapsing-remitting (RR).
  
  
  OBJECTIVE
  To investigate relationships between cognitive dysfunctions in newly diagnosed RRMS, and long-term MS-related outcomes.
  
  
  METHODS
  The present 10-year retrospective longitudinal study included 155 RRMS subjects, tested with the Rao Brief Repeatable Battery at MS diagnosis. The reaching of Expanded Disability Status Scale (EDSS) 4.0, and the SP conversion were recorded.
  
  
  RESULTS
  67 subjects (43.2%) reached EDSS 4.0, and 34 subjects (21.9%) converted to SP during a follow-up period of 10.0±1.8 years. Subjects with cognitive impairment at diagnosis had a rate of reaching EDSS 4.0 more than three times greater (p<0.001; HR=3.183), and a rate of SP conversion more than two times greater, as compared to cognitively preserved subjects (p=0.008; HR=2.535). In particular, better scores in the Selective Reminding Test-Delayed Recall and in the Symbol Digit Modalities Test at baseline were associated with lower SP conversion rates during the follow-up period (p=0.018; HR=0.835; and p=0.001; HR=0.941, respectively).
  
  
  CONCLUSIONS
  Cognitive impairment, with particular involvement of processing speed and memory, predicts disability progression and SP conversion in newly diagnosed RRMS, highlighting the importance of cognitive assessment from the beginning of MS.
authors.affiliation: Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Moccia
authors.affiliation: Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy robertalanzillo@libero.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lanzillo
authors.affiliation: Department of Primary Care and Public Health, Imperial College, London, UK/Department of Public Health, Federico II University, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Palladino
authors.affiliation: Department of Primary Care and Public Health, Imperial College, London, UK.
authors.forename: Kiara Chu-Mei
authors.initials: KC
authors.lastname: Chang
authors.affiliation: Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Costabile
authors.affiliation: Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Russo
authors.affiliation: Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: De Rosa
authors.affiliation: Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Carotenuto
authors.affiliation: Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saccà
authors.affiliation: Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy/Clinic of Neurology, AORN "Antonio Cardarelli", Naples, Italy.
authors.forename: Giorgia Teresa
authors.initials: GT
authors.lastname: Maniscalco
authors.affiliation: Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Brescia Morra
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008568:Memory / Q000502:physiology; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis*; D009483:Neuropsychological Tests; D012189:Retrospective Studies
keywords: Multiple sclerosis; cognition; cognitive impairment; disability; progression