About One-third of NMOSD Adults Have Cognitive Impairments: Study

Patricia Inacio, PhD avatar

by Patricia Inacio, PhD |

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About a third of adults with neuromyelitis optica spectrum disorder (NMOSD) have cognitive impairments, affecting mostly visual learning and memory, according to a small Spanish study.

Mood, fatigue, and satisfaction with life were among the contributing factors to cognitive impairment. According to the researchers, cognitive and psychological evaluation are important to include in NMOSD care.

The study “Cognitive Performance and Health-Related Quality of Life in Patients with Neuromyelitis Optica Spectrum Disorder” was published in the Journal of Personalized Medicine.

NMOSD is a progressive autoimmune disorder that affects the nervous system, leading to damage in the spinal cord and the optic nerve, which sends and receives signals from the eyes.

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While its main symptoms include vision and muscle control issues, patients can also have cognitive impairments. Its frequency, however, is highly variable, ranging from 3%—75% across studies. Moreover, the main areas of cognition affected in these patients vary and it’s not been known if the presence of self-reactive antibodies against the AQP4 protein — a diagnostic hallmark of NMOSD — may play a role.

A research team from Spain assessed the cognitive performance of 41 NMOSD adult patients recruited between November 2019 and July 2020 at 13 Spanish centers.

The patients (median age 44 years; 85% women) had a median disease duration of 8.1 years and minimal disability, as shown by a median score of 2 in the expanded disability status scale (EDSS).

Twenty-seven (66%) were positive for anti-AQP4 autoantibodies. Almost half (18; 44%) had symptoms of depression. Four patients had additional diseases; one was diagnosed with Sjogren’s syndrome and three with lupus.

Cognitive performance was evaluated using the Brief Repeatable Battery of Neuropsychological tests (BRB-N), which includes assessments on verbal memory, visual memory, attention, and information processing speed (IPS), as well as cognitive flexibility and semantic fluency, which generally consists of naming as many words from a single category as possible.

Fourteen patients (34%) were diagnosed with global cognition impairment. The most affected cognitive domain was visual memory (34%), followed by attention-IPS (32%), and verbal memory (24%). The least affected domain was semantic fluency (7%).

No differences in cognition were found regarding the presence or lack of anti-AQP4 autoantibodies. Also, cognitive performance showed a significant association with sex, mood, fatigue, satisfaction with life, and perception of stigma.

In the study around a third of NMOSD patients “had cognitive dysfunction, with visual learning and memory and attention-IPS being the most affected cognitive domains,” the researchers wrote.

“Cognition was mainly associated with mood, fatigue, and the patient’s positive attitude toward life and their perception of the disease,” they added. “Cognitive and psychological assessments may be crucial to achieve a holistic approach in NMOSD patient care.”