Kognitivni poremećaj u multiploj sklerozi: povezanost sa insulinskom rezistencijom i polimorfizmima u genu za apolipoprotein E
Cognitive impairment in multiple sclerosis: association with insulin resistance and apolipoprotein E polymorphism.
Faculty:Универзитет у Крагујевцу, Факултет медицинских наука
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The aim of this study is examining the relationship between the presence of insulin rОsТstaЧМО (IR) aЧН tСО ε4 allОlО ТЧ tСО APOE РОЧО, ТЧНОpОЧНОЧtlв aЧН assШМТatОН with the existence, severity and pattern of cognitive impairment in patients with MS. According to our hypothesis the existence of cognitive impairment is positively МШrrОlatОН аТtС tСО prОsОЧМО ШП ТЧsulТЧ rОsТstaЧМО aЧН / Шr ε4 allОlО ШП tСО APOE РОЧО. Methods: Clinical observational cross-sectional study includes 81 patients diagnosed with clinically definite MS with RR disease course. The total group of respondents is composed of subgroups: 50 patients are receiving the immunomodulatory therapy IFNβ1b (Betaferon) from the moment of diagnosis and 31 patients did not, until the beginning of the study, receive any therapy that modifies the natural course of the disease. In all subjects we determined: the presence of insulin resistance (HOMA index); glucose intolerance using an oral glucose tolerance test (OGTT); the
APOE gene polymorphisms; cognitive status using four neuropsychological tests taken from a neuropsychological battery, "The Brief Repeatable Battery of Neuropsychological Tests", which examined the most frequently impaired cognitive domains. Results: The presence of cognitive impairment was 39.51.The most common is episodic memory impairment, in 67% of patients. Significantly higher incidence of patients with poor achievements in the visual memory test was in the group with an impaired glucose tolerance. (80% vs. 54.10%, p = 0.04). We determined a significant independent negative ОППОМt ШП tСО prОsОЧМО ШП ε4 allОlО ТЧ tСО ApШE РОЧО ШЧ tСО ШММurrОЧМО ШП ЦТlН МШРЧТtТvО impairment (OR = 5:55; 95% CI, 0.96-32.25, p = 0.049). TСО prОsОЧМО ШП tСО ε4 allОlО represents 5.5 times the risk that the patient will develop a mild cognitive deficit independently from the presence of IR indicators. It was found that the predictors of mild cognitive deficits and memory impairment were female sex, longer illness duration, fewer relapses and more progressive course of the disease. The predictors of cognitive impairment are longer and more progressive course of the disease. Application of the immunomodulatory therapy IFNβ1 sСШаОН ЧШ assШМТatТШЧ аТtС aЧв ШП tСО tОstОН parameters. Conclusion: This study examines for the first time the association between glucose and insulin metabolic disorders with the presence and characteristics of cognitive impairment in RR MS, indepenНОЧtlв aЧН assШМТatОН аТtС tСО ОбТstОЧМО ШП ε4 allОlОs ТЧ tСО APOE РОЧО. A ЦШrО ПrОquОЧt prОsОЧМО ШП ε4 allОlО aЦШЧР patТОЧts аТtС ЦТlН cognitive deficit in comparison to the cognitively preserved ones makes them a group of interest for further observation because of the possible greater vulnerability to future cognitive impairment. The study contributes to the early detection and better understanding of cognitive impairment in MS which is present from the earliest stages of the disease. This is important in predicting the course of the disease,the degree of functional disability and represents an important factor in determining the therapy that alters the natural course of the disease.View More
Keywords:multipla skleroza, kognitivni poremećaj, insulinska rezistencija, APOE4