FV 658. Cognitive Impairment, Depression, Fatigue, and Quality of Life in Pediatric-Onset Multiple Sclerosis: Results of the Multiple Sclerosis Inventory of Cognition in ADOlescents Study

 

Background: Cognitive impairment (CI), depression and fatigue are common and troubling features of pediatric-onset multiple sclerosis (POMS) and are even present in the early stage of the disease. They are reported with divergent prevalences in the literature due to small sample sizes, missing control groups and different assessment approaches.

Objectives: The goal of the MUSICADO study was to assess CI, depression, fatigue, and loss of health-related quality of life (HRQOL) in a large cohort of patients with POMS and healthy controls (HCs) and to measure the sensitivity of a cognitive assessment approach (Multiple Sclerosis Inventory of Cognition in ADOlescents [MUSICADO]) for clinical practice.

Methods: In this cross-sectional study, a total of 106 pediatric-onset MS patients were included by 20 German and 2 Austrian neuropediatric departments of university hospitals and 210 HCs by six German centers at the age between 12 and 18 and June 2012 und January 2015. Demographical and clinical data were collected and intellectual functioning, an extensive neuropsychological testing and a brief assessment approach (MUSICADO), fatigue (PedsQLTM Multidemensional Fatigue Scale), depression (DTK, BDI-II), and HRQOL (PedsQLTM 4.0 Generic Score Scales) were evaluated. CI was defined as impairment in > 3 cognitive domains.

Results: Patients with POMS with a mean age of 14.1 years (SD 2. 4) and with a mean disease duration of 18.6 months showed a significant impairment of verbal fluency, working memory, speed processing and executive functioning. CI was diagnosed in 28.3% of patients with POMS and in 15,2% in HCs and differed significantly. We also developed the screening instrument MUSICADO consisting of three subtests (verbal fluency, TMT-A and digit span) that could identify patients with POMS with a CI. The prevalence of depression was 21.7% in patients with POMs and in 11.4% in HCs (p = 0.014) of fatigue 40.5% for patients with POMS and 17.2% for HCs. Patients with POMS were at a 2-fold increase in risk for mild fatigue (Wald 4,879, p = 0,027) and at a 9.6-fold increase in risk for severe fatigue (Wald 21,704, p = 0,000). There was a strong association of depression and fatigue (r = 0.747, p = 0.000). Forty-three of patients with POMS reported a loss of HRQOL, whereas only 15% of HCs reported loss of HRQOL. Patients with POMS were at a threefold increase in risk for loss of HRQOL (Wald = 13,379, p = 0.000) and at a ninefold increase in risk for severe loss of HRQOL (Wald = 20,557, p = 0.000).

Summary: Patients with POMS presented with a significant higher frequency of CI, depression, fatigue, and loss of HRQOL in a large cohort. Furthermore, MUSICADO is a valid and sensitive screening instrument in German language to identify cognitive impairment in juveniles with POMS.