Assessment and Management of Cognitive Impairment in Multiple Sclerosis
Assessment and Management of Cognitive Impairment in Multiple Sclerosis
Introduction
This document is a summary of Expert Opinion paper produced by Medical Advisory Board of the National Multiple Sclerosis Society. The paper is based on existing literature and expert opinion derived from clinical practice and experience. It is designed to help clinicians be sensitive to the possibility of cognitive deficits in their patients with multiple sclerosis (MS), be more aware of the impact of such deficits, and learn about potential interventions to alleviate the negative consequences of these deficits.
Summary
- Cognitive deficits appear to be present in more than half of MS patients, however the majority of persons with MS do not have impairments that significantly impair daily functioning.
- Learning/memory, speed of information processing, working memory, cognitive flexibility and other executive functions appear to be most commonly impaired.
- Periodic screening for such deficits is recommended.
- Intervention for such deficits is recommended.
- Training in strategies to compensate for deficits.
- Counseling/psychotherapy for patients and family to address accompanying behavioral changes and emotional responses, and develop realistic expectations.
- Treatment with medications (disease-modifying and/or symptomatic therapies).
Prevalence of Cognitive Dysfunction and MS
Studies suggest that cognitive impairment may occur in up to 50% of all MS patients although the prevalence has not been adequately determined by prospective, population-based studies.The most common cognitive impairments are:
- Impaired learning and memory, i.e. encoding, storage, manipulation, retrieval of information, especially episodic memory (experiential knowledge of events)
- Slowed information processing, i.e. reductions in speed of thinking that can affect efficiency of cognitive function
- Impaired working memory, especially alternating attention (or shifting attention back and forth between two stimuli-cognitive flexibility) and complex attention (simultaneously attending to multiple stimuli)
- While less common, deficits in spatial abilities and higher executive function are recognized and are detrimental to adaptive behavior
