SPOZNAJNI POREMEĆAJI U MULTIPLOJ SKLEROZI

ROBERT ŽIVADINOV, JURAJ SEPČIĆ

Multipla skleroza, uz živčane ispade, očituje se i poremećajima spoznajnih funkcija. Poremećaji pamćenja, prisjećanja, obrade informacija, vizualno-prostorne percepcije, pažnje i izvršnih funkcija, u manjoj mjeri i govora, prisutni su u približno 60% bolesnika. Srodni su poremećajima u drugih supkortikalnih demencija. Jednom prisutni, rijetko se povlače. Konvencionalna, a pogotovo nekonvencionalna magnetska rezonancija točnije ocjenjuju tkivni supstrat tih poremećaja – difuzno neuroaksonalno oštećenje cijelog moždanog parenhima – nego klinički nalaz već u ranim fazama bolesti. Promjene u slikovnom prikazu mozga očituju se T2-hiperintenzivnim i T1-hipointenzivnim lezijama, atrofijom ranog javljanja, smanjenjem neuronalnog biljega N-acetil-aspartata u magnetskoj spektroskopiji, smanjenjem magnetisation transfer ratio te porastom diffusivity sa smanjenjem anizotropije u diffusion-eighted imaging. Ukupni volumen oštećenja mozga, promjer korpusa kalozuma i odnos mjera moždanih komora prema ostatku mozgovine najbolji su pokazatelji spoznajnih disfunkcija u multiploj sklerozi. Njihovo dijagnosticiranje u samom početku bolesti dopušta ranu primjenu terapijskih postupaka. Simptomatsko liječenje tih poremećaja nije učinkovito, a imunomodulirajuće, poglavito primjena bioloških inačica interferona β, pokazuje prijeporne učinke. Spoznajne disfunkcije utječu na život odnosa i radnu sposobnost bolesnika.

Summary. In addition to neurological symptoms, multiple sclerosis is characterized by cognitive function impairment. Distur- bances of memory, recall, information processing, visual-spacial perception, attention, and executive function, in less extent of speech, are present in about 60% of patients. They are similar to disorders in other subcortical dementias. Once they appear, they rarely recede. Conventional, and especially nonconventional magnetic resonance imaging evaluates more precisely the tissue substrate – diffuse neuroaxonal lesion of the entire brain parenchyma – than clinical findings, already in the early stage of the disease. Alterations in the brain imaging are manifested by T2 hyperintensive and T1 hypointensive lesions, decreased neuronal marker N-acetyl-aspartate in magnetic spectroscopy, decreased magnetization transfer ratio, and increased diffusivity with reduced anisotropy in diffusion-weighted imaging. Total volume of brain lesion, corpus callosum diameter, and relation of measures of brain chambers and the rest of the brain, are best indices of cognitive dysfunction in multiple sclerosis. Their diagnosis in the very beginning of the disease allows early application of therapeutic procedures. Symptomatic treatment of these disorders is not efficient, and immunomodulation, particularly the use of biologic versions of interferon-beta, shows disputable effects. Cognitive dysfunctions affect relationships and working ability of patients.