Abstract：
BACKGROUND: Retinal nerve fiber layer (RNFL) thickness is a promising biomarker of axonal loss and a potential outcome predictor in Multiple Sclerosis (MS). Cognitive impairment (CoI) exhibits a high prevalence in patients with MS (pwMS), even in the early phases of the disease. Our aim was to explore the role of RNFL thickness as a predictor of physical and cognitive disability in pwMS.
METHODS: All newly diagnosed pwMS referred to the MS centre of the University-Hospital \"Policlinico-San Marco\" between 2015-2019 were evaluated at baseline and at 3 years. RNFL and ganglion cell layer (GCL) thickness for right (r.e.) and left eyes (l.e.) were measured with Optical Coherence Tomography (OCT). Disability level and cognitive profile were assessed, using the Expanded Disability Status Scale (EDSS) and the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, respectively.
RESULTS: We consecutively enrolled 487 pwMS, including 68 (14.0%) with primary progressive MS (PPMS). At baseline, RNFL and GCL were bilaterally thinner in PPMS (r.e. 90.4 ± 12.7; l.e. 90.2 ± 13.5, and r.e. 80.1 ± 11.2; l.e. 80.3 ± 12.6, respectively) compared to relapsing-remitting MS (RRMS) (r.e. 94.6 ± 13.1; l.e. 94.3 ± 14.8, and r.e. 85.1 ± 9.5; l.e. 84.9 ± 9.3, respectively) (p < 0.01). Both groups exhibited reduced RNFL and GCL thickness, worse cognitive performance and higher EDSS scores at 3-years follow-up compared with baseline. RNFL thickness ≤ 88.0 μm was an independent predictor of CoI (OR = 5.32; 95% CI = 1.84-9.12; p = 0.02) and disability worsening (OR = 3.18; 95% CI = 1.21-10.33; p = 0.05).
CONCLUSIONS: RNFL thickness, as a biomarker of neurodegeneration, could be considered a predictive biomarker of cognitive degeneration and physical disability in MS.
METHODS: All newly diagnosed pwMS referred to the MS centre of the University-Hospital \"Policlinico-San Marco\" between 2015-2019 were evaluated at baseline and at 3 years. RNFL and ganglion cell layer (GCL) thickness for right (r.e.) and left eyes (l.e.) were measured with Optical Coherence Tomography (OCT). Disability level and cognitive profile were assessed, using the Expanded Disability Status Scale (EDSS) and the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, respectively.
RESULTS: We consecutively enrolled 487 pwMS, including 68 (14.0%) with primary progressive MS (PPMS). At baseline, RNFL and GCL were bilaterally thinner in PPMS (r.e. 90.4 ± 12.7; l.e. 90.2 ± 13.5, and r.e. 80.1 ± 11.2; l.e. 80.3 ± 12.6, respectively) compared to relapsing-remitting MS (RRMS) (r.e. 94.6 ± 13.1; l.e. 94.3 ± 14.8, and r.e. 85.1 ± 9.5; l.e. 84.9 ± 9.3, respectively) (p < 0.01). Both groups exhibited reduced RNFL and GCL thickness, worse cognitive performance and higher EDSS scores at 3-years follow-up compared with baseline. RNFL thickness ≤ 88.0 μm was an independent predictor of CoI (OR = 5.32; 95% CI = 1.84-9.12; p = 0.02) and disability worsening (OR = 3.18; 95% CI = 1.21-10.33; p = 0.05).
CONCLUSIONS: RNFL thickness, as a biomarker of neurodegeneration, could be considered a predictive biomarker of cognitive degeneration and physical disability in MS.
摘要：
背景：视网膜神经纤维层（RNFL）厚度是轴突丢失的有希望的生物标志物，也是多发性硬化（MS）的潜在预后预测因子。认知障碍(CoI)在MS(pwMS)患者中表现出很高的患病率，甚至在疾病的早期阶段。我们的目的是探索RNFL厚度作为pwMS中身体和认知障碍的预测因子的作用。
方法：在基线和3年时对2015-2019年间转诊至大学医院“Policlinico-SanMarco”MS中心的所有新诊断的pwMS进行评估。用光学相干断层扫描(OCT)测量右眼(r.e.)和左眼(l.e.)的RNFL和神经节细胞层(GCL)厚度。评估残疾水平和认知概况，使用扩展的残疾状态量表（EDSS）和多发性硬化症的简短国际认知评估（BICAMS）电池，分别。
结果：我们连续注册了487pwMS，包括68（14.0%）原发性进展型MS（PPMS）。在基线,与复发缓解型MS（RRMS）（r.e.94.6±13.1；l.e.94.3±14.8和r.e.84.9±11.2；l.e.两组均表现出减少的RNFL和GCL厚度，与基线相比，3年随访时认知表现更差，EDSS评分更高。RNFL厚度≤88.0μm是CoI(OR=5.32;95%CI=1.84-9.12;p=0.02)和残疾恶化(OR=3.18;95%CI=1.21-10.33;p=0.05)的独立预测因子。
结论：RNFL厚度，作为神经变性的生物标志物，可以被认为是MS认知退化和身体残疾的预测性生物标志物。
方法：在基线和3年时对2015-2019年间转诊至大学医院“Policlinico-SanMarco”MS中心的所有新诊断的pwMS进行评估。用光学相干断层扫描(OCT)测量右眼(r.e.)和左眼(l.e.)的RNFL和神经节细胞层(GCL)厚度。评估残疾水平和认知概况，使用扩展的残疾状态量表（EDSS）和多发性硬化症的简短国际认知评估（BICAMS）电池，分别。
结果：我们连续注册了487pwMS，包括68（14.0%）原发性进展型MS（PPMS）。在基线,与复发缓解型MS（RRMS）（r.e.94.6±13.1；l.e.94.3±14.8和r.e.84.9±11.2；l.e.两组均表现出减少的RNFL和GCL厚度，与基线相比，3年随访时认知表现更差，EDSS评分更高。RNFL厚度≤88.0μm是CoI(OR=5.32;95%CI=1.84-9.12;p=0.02)和残疾恶化(OR=3.18;95%CI=1.21-10.33;p=0.05)的独立预测因子。
结论：RNFL厚度，作为神经变性的生物标志物，可以被认为是MS认知退化和身体残疾的预测性生物标志物。
