Abstract Details

Title Cognitive Impairment in Neuromyelitis Optica Spectrum Disorder (NMOSD)

Topic Autoimmune Neurology

Presentation(s) P15 - Poster Session 15 (5:30 PM-6:30 PM)

Poster/Presentation
Number 9-003

Objective

To elucidate the prevalence and correlates of cognitive impairment in patients with Neuromyelitis Optica Spectrum Disorder (NMOSD).

Background Neuromyelitis optica spectrum disorder (NMOSD) is a chronic central nervous system autoimmune, demyelinating disorder targeting self-antigens including aquaporin-4 and myelin oligodendrocyte glycoprotein. Cognitive impairment (CI) is an under-recognized and poorly understood in patients with NMSOD.

Design/Methods

Montreal Cognitive Assessment (MoCA) were performed on 219 NMOSD patients in CIRCLES (Collaborative International Research in Clinical and Longitudinal Experience Study), a multicenter, longitudinal biorepository. The comparator group included 19 individuals, predominately patients with multiple sclerosis and healthy controls. MoCA were obtained at 6-month intervals from 2017-2020. Descriptive statistics, correlation analyses, and regression models were employed at baseline and longitudinally.

Results 29% (64/219) of NMOSD patients demonstrated mild CI (MoCA 20-26/30) and 5% (11/219) demonstrated moderate CI (MoCA<20/30). Expanded Disability Status Scale (p<0.0001), educational level (p<0.001), immune therapy (p<0.029), and pain scores (p=0.002) significantly correlated with CI. Annual relapse rate, age, gender, disease duration, AQP4 serostatus or presence of brain lesions were not correlated. CI among NMOSD patients was more pronounced among African American than White patients (p<0.0002). Age adjusted degree of change in MoCA over time did not differ between NMOSD patients and comparator. Serial MoCA analysis within the NMOSD group revealed that 30% (45/150) had consistently decreasing MoCA scores, with most impacted attention and language functions.

Conclusions

To our knowledge, this is the largest and most diverse patient sample study of CI in NMOSD and the first to evaluate potential CI progression. Our results indicate that 34% of NMOSD patients experience mild to moderate cognitive impairment, a third of whom have cumulative CI. They highlight the potential for relapse-independent disease activity and the importance of assessing neuropsychological outcomes in NMOSD. Correlations of CI with clinical and demographic characteristics may provide the potential for targeted evaluation and intervention.

Authors/Disclosures
Luka Vlahovic, MD (Providence Health) PRESENTER	Dr. Vlahovic has nothing to disclose.
Jamie C. McDonald, MD (Stanford University)	Dr. McDonald has nothing to disclose.
	No disclosure on file
Anna J. Tomczak, MSc (Stanford)	Miss Tomczak has nothing to disclose.
Christopher Lock, MD, MBBS, PhD (Stanford University)	Dr. Lock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Lock has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Lock has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Turning Point Litigation. Dr. Lock has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Goodell, DeVries, Leech & Dann, LLP. Dr. Lock has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for McQuaide Blasko Attorneys at Law. Dr. Lock has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for BENNETT BIGELOW & LEEDOM P.S. .
	No disclosure on file
Lorene M. Nelson, PhD (Stanford University School of Medicine)	Dr. Nelson has nothing to disclose.
May Han, MD (Stanford University)	Dr. Han has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Han has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arena Pharmaceuticals.

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