Multiple Skleroz Tanısı Olan Ergenlerin Manyetik Rezonans Görüntülemesinde Volümetrik Ölçümlerin Kognitif Fonksiyonlar, Anhedoni ve Depresyonla İlişkisinin Değerlendirilmesi

Abstract

This study is a cross sectional study that compares the psychosocial impact on adolescents ages 12-18 who have been diagnosed with childhood MS (cMS) and their parents to that of the adolescents ages 12-18 in a control group who presented with complaints of headache and their parents. The study also evaluates the relationship between anhedonia, fatigue and depression observed in both groups and volumetric measurements of the brain and determines the relationship between the cognitive parameters of the adolescent with cMS, as determined by the WISC-IV test, volumetric measurements of the brain. A total of 66 adolescents between ages 12-18 (41 with cMS diagnosis, 25 with complaint of headache) participated in the study. The Schedule for Affective Disorders and Schizophrenia for School Age Children- Present and Lifetime Version (K-SADS-PL) psychiatric diagnostic interview was administered to adolescents in both groups. The adolescents also completed the Children’s Depression Inventory, Pittsburgh Sleep Quality Index (PSQI), Snaith-Hamilton Pleasure Scale, The Pediatric Quality of Life Inventory (PedsQL) The Child Self-Report, Parenting Style Scale, State-Trait Anxiety Scale for Children and Fatigue Severity Scale. The parents of the adolescents completed The Pediatric Quality of Life Inventory (PedsQL) The Parent Proxy Report, Coping Orientation to Problems Experienced Inventory (COPE), SCL-90 Symptom Checklist. Brain MRI images of adolescents were obtained and volumetrically analyzed. The volumes of 12 anatomical regions including the white matter, gray matter, subcortical gray matter, cortical gray matter, cerebellar gray matter, cerebrum, cerebellum, hippocampus, thalamus, lateral ventricles, third and fourth ventricles, and the percentages of these volumes relative to their intracranial cavities were evaluated. Result from K-SADS-PL psychiatric checklist showed that 14.6% of the adolescents with cMS had major depressive disorder (MDD), 12.2% had dysthymia, 17.1% had anxiety disorders, 17.8% had ADHD, 2.4% had ODD and 2.4% had enuresis. Adolescent with cMS had a higher frequency of psychiatric diagnoses, compared to the control group. No significant differences were observed between the groups when the adolescents were compared in terms of symptoms of depression, anhedonia, and fatigue. However, it was observed that the cMS group had poorer sleep quality compared to the control group. It was found that symptoms of depression, anxiety and fatigue negatively affect sleep quality in adolescents with cMS. No differences were observed between groups in terms of the parental attitudes, but the parents of adolescents with cMS were found to use problem-focused coping more frequently, which may have reduced the incidence of mental illness in this group. When adolescents with cMS were evaluated cognitively using the WISC-IV test; it was found that their scores for Working Memory Index, Perceptual Reasoning Index and Full-Scale IQ were lower than the universal average. When the groups were evaluated using volumetric measurements of the brain, significant differences were observed in terms of the subcortical gray matter percentage, thalamus brain percentage and volume, lateral ventricles brain percentage, third ventricle brain percentage and volume. A correlation was observed between the hippocampus and thalamus volumes of the cMS patients and the cognitive parameters. But correlation was not observed between anhedonia, depressive, fatigue symptoms and the volumetric measurement of the brain in childhood MS. In childhood MS patients, the relationship between the disease duration, the number of relapses and the age of the first attack, and the quality of life, the volumetric measurements of the brain and cognitive functions were evaluated. It was found that there is a relationship between the duration of disease, the number of relapses and the age of the first attack and brain atrophy. It was observed that the prolongation of the disease duration decreased the score for the Working Memory Index, Processing Speed Index and Full-Scale Intelligence. It was observed that the increase of duration of disease and number of relapses lowered the quality of life of the adolescents with cMS diagnosis. In addition, it was observed that low sleep quality, high depressive and fatigue symptoms decreased the quality of life in adolescents with MS. These findings suggest that adolescents with cMS may be at risk for cognitive and psychosocial difficulties and furher research is needed to better understand and address these issues.