TROUBLES COGNITIFS DANS LA SCLEROSE EN PLAQUES

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UNIVERSITE SAINT-ESPRIT DE KASLIK

Faculte de medecine

TROUBLES COGNITIFS DANS LA SCLEROSE EN PLAQUES

These en vue de !'obtention d'un doctorat en medecine

Preparee par Lucie Tawk Sous la direction de Dr Kamal Kallab

Kaslik-Liban{

"Liban"}

2012

Soutenue le 4 Juin 2012 devant le jury compose de:

Dr Simon Karam President

Dr Abdallah Rahbani Rapporteur

Dr Raymond Chemaly Membre invite

Resume

Objectif: Etudier les troubles cognitifs chez les patients ayant une sclerose en plaques

Methodes: Etude transversale sur six mo1s chez les patients ayant une sclerose en plaques hospitalises a l'HNDS. L'attention soutenue, la vitesse de traitement de !'information, la memoire de travail, la memoire anterograde, la memo ire visuelle,

inhibition et la sensibilite a ^1' interference ont ete testes en comparaison avec des temoins n'ayant pas de troubles neurologiques, apparies pour 1' age, le sexe et le niveau educatif.

Resultats: Six patients ayant une sclerose en plaques remittente, ainsi que six temoins apparies ont ete recrutes. Les patients ont eu des resultats inferieurs aux patients dans tous les tests, mais cette difference n'est significative que pour le P ASAT testant la memo ire de travail et 1' attention soutenue (p=

0.012).

Conclusion: Les patients ayant une SEP souffrent de troubles cognitifs, touchant surtout la memoire de travail et !'attention soutenue. Ces troubles sont sous diagnostiques et ont des repercussions sur la qualite de vie des patients.

Mots-cle: Sclerose en plaques. Troubles cognitifs. Tests psychometriques.

Attention. Memoire de travail.

6

Abstract

Objective: The aim of this study was to assess cognitive function in multiple sclerosis patients.

Methods: ^It is a cross-sectional study conducted over a period of six months, with patients known to have multiple sclerosis admitted to HNDS hospital.

Attention, processing speed, working memory, long-term memory, visual memory, inhibition and resistance from interference were assessed. Subjects were matched for age, sex and educational level with control subjects.

Results: Six patients and their matched controls were recruited. There was no significant differences between MS patients and controls m neuropsychological tests, except for the PASAT (p=O.Ol2) which assesses working memory and attention.

Conclusion: MS patients have cognitive impairment, especially in the fields of working memory and attention. These deficits are underestimated and they can affect the overall quality of life of the patient.

Key words: Multiple sclerosis. Cognitive impairment. Neuropsychological

tests. Attention. Working memory

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Table des matieres

1) Introduction ... 8

2) Revue de Ia litterature ... 9

a) Generalites ... 9

i) Pathophysiologiel XE

"Pathophysiologic" 1 ...

ii) Epidemiologiel XE

"Epidemiologic" 1 ...

iii) Formesl XE

"Formes" 1 ...

iv) Syrnptomesi XE

"Symptomes" 1

"signes" 1

v) Diagnosticl XE

"Diagnostic" 1 ...

vi) Traitements ... 15

b) Atteinte cognitivel XE

"Atteinte cognitiVe" 1 ...

i) Troubles cognitifs ... 17

ii) Attentionl XE

"Attention" 1

"traitement" 1

iii) Memoirel XE

"Memoire" 1 ...

iv) Fonctions executiveslXE

"Fonctions executives"1 ...

v) Evaluation ... 22

vi) Facteurs confondants ... 24

vii) Imagerie

1

"Imagerie" 1 ...

viii) Repercussion et evolution ... 28

ix) T raitement ... 29

3) Methodes

I

"Methodes" 1 ...

4) Resultatsl XE

"Resultats" 1 ...

Caracteristiques des patients et temoins ... 35

Resultatsl XE I!Resultats" 1 aux tests psychometriquesl XE "tests psychometriques" 1 ... 37

lmageriel XE

"lmagerie" 1 ...

5) Discussionl XE

"Discussion" 1 ...

Imageriel XE

"lmagerie" 1 ...

Depistage ... 45

Prise en charge ... 46

6) Conclusion ... 48

8

Annexes ... 49 Index ... 58 Bibliographie ... 59

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