Desempenho cognitivo na Esclerose Múltipla e no Espectro da Neuromielite Óptica: estudo transversal em um centro de referência em neuroimunologia no Brasil

Abstract

Background: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are inflammatory demyelinating diseases of the central nervous system. Cognitive impairment is well established in MS but less defined in NMOSD. Objectives: Compare cognitive performance between NMOSD and MS patients in a Brazilian cohort and explore clinical correlates. Methods: This cross-sectional study included 64 patients (32 NMOSD, 32 MS). Diagnoses followed the 2015 NMOSD consensus and 2017 McDonald criteria. Epidemiological variables were analyzed, including the Expanded Disability Status Scale (EDSS). Cognition was assessed with the Brief Repeatable Battery of Neuropsychological Tests (Selective Reminding Test, Spatial Recall Test, Symbol Digit Modalities Test, Paced Auditory Serial Addition Test, Word Generation List) and the Hayling Sentence Completion Test. Motor function was evaluated with the Nine-Hole Peg Test (9-HPT) and Timed 25-Foot Walk. Mood was screened with the Hospital Anxiety and Depression Scale. Raw scores were converted into z-scores from Brazilian norms. Group comparisons used Mann–Whitney and chi-square tests, with generalized linear models adjusted (age, education, and EDSS). Cognitive impairment was defined as global z-score < –1.5. Results: Cognitive impairment occurred in 69% of NMOSD and 78% of MS patients (p=0.42). MS patients performed worse in executive control (Hayling, p=0.029), whereas NMOSD patients were slower on psychomotor tasks (9-HPT, p=0.017). EDSS correlated with executive and psychomotor deficits in NMOSD, and with psychomotor speed in MS. Conclusion: Cognitive impairment is frequent in both disorders, with overlapping but distinct patterns. These findings challenge the notion of NMOSD as cognition-sparing and support systematic cognitive screening and rehabilitation.