Psychopathological changes and cognitive impairment in encephalomyelitis disseminata

Two hundred and twelve patients with clinically evidenced encephalomyelitis disseminata (ED), hospitalized in a neurological hospital, were observed w ith regard to psychopathological characteristics and cognitive changes in c onformity with ICD-10 diagnostic criteria. The basis of this investigation was a standardized psychiatric interview. The age of the patients averaged 47 years whereas the duration of the disease averaged 14.3 years. 83.5% of the patients had a disease history of more than 6 years. The medium range o f EDSS scores was 5.95%, the BPRS 36.7%. In 5.2% of the patients the course of ED was primarily chronic-progressive while 48% suffered from the interm ittent, incomplete-reversible form: 47.6% developed secondary chronic-progr essive symptoms. 18 psychopathological symptoms could be identified, the ma in symptom was depressive mood (49%), followed by impairment of affective s ensitivity (34.9%) and affective instability/incontinence (31.1%). The most prevalent diagnoses were dementia (23.1%), organic personality disorder (1 8.5%), mild cognitive impairment (9%), and depressive disorder (7.6%) Only 33.5% were psychopathologically unaffected. The duration of the disease in all demented patients exceeded 6 years. Patients with an organic personalit y disorder showed a marked increase in the later stages of their illness in contrast to patients suffering from depressive disorder. At the beginning of ED, a highly significant (p < 0.0001) impairment of vision was found in all psychiatric patients. Dementia patients and organic personality patient s, on the other hand, showed an advanced degree of ataxia. Actually, there was a considerably lesser incidence of pareses in the non-psychopathologica l group whereas ataxia was significantly more prevalent in the three cognit ively impaired ED-subgroups than in the control group. These findings set t he stage for constructive discussions, taking due consideration of existing research results on ED with particular reference to the implications regar ding future research as well as the clinical therapy of patients.