Kognitive Teilleistungsstörungen und Demenz bei Patienten mit Multipler Sklerose: Status quo und offene Fragen

Zusammenfassung

Multiple Sklerose (MS) ist die häufigste chronische immunmediierte Erkrankung, die mit gravierenden somatischen und psychischen Symptomen einhergehen kann. Lag der Fokus früherer Forschungsarbeiten auf den neurologischen Symptomen der Erkrankung, hat es in den letzten Jahren vermehrt Veröffentlichungen zu den psychischen Symptomen und Begleiterscheinungen gegeben. Inzwischen ist bekannt, dass kognitive Defizite bei ungefähr der Hälfte der MS-Patienten auftreten und sich nachteilig auf die Lebensführung und -qualität der Betroffenen auswirken. Bislang werden die kognitiven Störungen als mehr oder weniger isoliert auftretende kognitive Funktionsstörungen moderaten bis mäßigen Ausmaßes beschrieben, während gravierende Funktionseinbußen im Sinne einer Demenz als eher selten angesehen werden. Im vorliegenden Artikel beschreiben wir die bei MS typischerweise defizitär ausgeprägten kognitiven Funktionsbereiche und stellen differenzialdiagnostische Überlegungen darüber an, ob die Diagnose „Demenz“ bei MS-Patienten aus diversen Gründen (u. a. Progredienz kognitiver Defizite im Krankheitsverlauf, bis dato zu starke Fokussierung auf Gedächtnisdefizite als Leitsymptom demenzieller Erkrankungen, Mangel an longitudinalen Untersuchungen des kognitiven Leistungsniveaus) möglicherweise unterrepräsentiert ist. Ferner empfehlen wir für die Praxis ein mehrstufiges neuropsychologisch-diagnostisches Vorgehen, das darauf abzielt, kognitive Defizite bei Personen mit MS möglichst frühzeitig zu diagnostizieren und den Betroffenen im weiteren Verlauf der Erkrankung möglichst passgenaue Therapien anbieten zu können, mit dem Ziel einer Optimierung des psychosozialen Funktionsniveaus.

Abstract

Multiple sclerosis (MS) is the most common chronic immune-mediated disease which goes along with serious somatic and psychic symptoms. Whereas recent research rather focussed on the neurological symptoms of MS, there is nowadays an increasing interest among researchers in psychological symptoms of the disease. It is known that about half of the MS patients suffer from cognitive deficits, and that cognitive decline has a disadvantageous impact on lifestyle and quality of life in affected persons. So far, cognitive deficits in subjects with MS have been described as rather isolated, specific cognitive disturbances with otherwise intact intellectual abilities, while global deterioration of mental skills in terms of dementia is considered as being rather rare. In the present article, we describe cognitive domains which are typically impaired in subjects with MS and reflect on the question if the diagnosis of dementia might be underrepresented in MS patients due to several reasons (e. g., progression of cognitive deficits in the course of the disorder, adhering very closely to memory deficits as cardinal symptom of dementia, lack of longitudinal studies of cognitive performance levels). Furthermore, we recommend a multistage neuropsychological diagnostic procedure for clinical practice which aims at diagnosing cognitive deficits already in early stages of the illness. In so doing, practitioners may be able to offer adequate therapies to affected persons in all stages of the disorder in order to improve psychosocial functional levels.

Schlüsselwörter

Multiple Sklerose - Kognition - Demenz - leichte kognitive Störung - neuropsychologische Diagnostik

Key words

multiple sclerosis - cognition - mild cognitive impairment - dementia - neuropsychological assessment

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