Kognitive Dysfunktion bei Multipler Sklerose

I.-K. Penner

doi:10.1055/s-0038-1627703

Nervenheilkunde, Table of Contents

Nervenheilkunde 2014; 33(07/08): 505-510
DOI: 10.1055/s-0038-1627703

Fortbildung Karlsruhe

Schattauer GmbH

Kognitive Dysfunktion bei Multipler Sklerose

Cognitive dysfunction in multiple sclerosis

I.-K. Penner

¹Fakultät für Psychologie, Universität Basel

› Author Affiliations

Abstract

Zusammenfassung

Kognitive Beeinträchtigungen treten bei etwa jedem zweiten MS-Betroffenen unabhängig von der Verlaufsform auf. Sie zeigen weder Linearität zum körperlichen Beeinträchtigungsgrad gemessen mittels Expanded Disability Status Scale (EDSS), noch gibt es eine direkte Relation zur Erkrankungsdauer. Kognitive Defizite können bereits früh im Krankheitsgeschehen, beispielsweise bei einem Clinically Isolated Syndrome (CIS) oder Radiologically Isolated Syndrome (RIS) auftreten und werden auch bei Patienten mit einem benignen Verlauf beobachtet. Obgleich die Progression als eher moderat betrachtet werden kann, wirken sich kognitive Einbußen in beinahe jedem Stadium stark negativ auf die Lebensqualität und die Therapieadhärenz aus. Diagnostisch sind wir in der Lage mittels sensitiver Screeninginstrumente diejenigen kognitiven Teilfunktionen zu erfassen, die bei MS-Patienten am häufigsten beeinträchtigt sind. Wie so häufig in der Medizin hinkt jedoch die Therapie dem Fortschritt bei der Diagnostik hinterher, sodass wir keine zuverlässige evidenzbasierte symptomatische Therapie zur Behandlung kognitiver Defizite bei MS zur Verfügung haben. Derzeit sind nonpharmakologische Ansätze, mit dem Ziel die kognitive Reserve des Gehirns zu stärken, Erfolg versprechend. Methodisch saubere Wirksamkeitsstudien stehen allerdings noch aus.

Summary

With a prevalence of 50%, cognitive impairment belongs to the major symptoms in multiple sclerosis affecting patients irrespective of their disease course, disease severity as measured by the Expanded Disability Status Scale (EDSS) or their disease duration. Cognitive deficits can already occur at the very early stages of the disease such as in patients with clinically isolated syndrome (CIS) or radiologically isolated syndrome (RIS). Further, even in patients with a so-called “benign” disease course, cognitive dysfunction has been described. Although the progression of the deficits can be regarded as moderate, cognitive impairment at all stages negatively impacts on quality of life. From a diagnostic point of view we have made progress in developing sensitive screening instruments to reliably assess the cognitive core deficits in MS. However as often seen in medicine development of therapeutic approaches lags behind the progress of diagnostics. Thus at present there is no reliable evidence-based symptomatic treatment for cognitive impairment in MS. However, nonpharmacological approaches targeted towards supporting cognitive brain reserve look promising though large methodologically precise effectiveness studies are still an unmet need.

Schlüsselwörter

Multiple Sklerose - Kognition - Neurodegeneration - Neuroinflammation - kognitive Rehabilitation

Keywords

Multiple sclerosis - cognition - neurodegeneration - neuroinflammation - cognitive rehabilitation

Full Text

References

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