1st March 2003
D M Pizzi
Real Living with Multiple Sclerosis
COGNITIVE IMPAIRMENTS are a common symptom of multiple sclerosis (MS). While they're usually mild in nature, they affect quality of life in individuals who experience them. Fortunately, cognitive impairments are easily diagnosed and treated.
An estimated 45% to 65% of patients with MS have some form of cognitive impairment. They may have problems with attention and verbal fluency, episodic memory, and speed of information processing. A smaller percentage of MS patients suffer from deficits in executive functions such as abstract reasoning, planning, and self-monitoring.
Tests, such as the Mini-Mental State Examination, the Neuropsychological Screening Battery for Multiple Sclerosis, the Screening Examination for Cognitive Impairment, and the Repeatable Battery for the Assessment of Neuropsychological Status, are effective in gauging the existence of cognitive impairment, but are not geared specifically for MS. Aaron Miller, MD, director, Department of Neurology, Maimonides Medical Center, Brooklyn, NY, and the chairman of the Real Living With Multiple Sclerosis editorial advisory board, stated that such instruments are used primarily to assess individuals for evidence of cognitive impairment. He stressed that full neuropsychological workups are necessary to gauge the level and types of impairment.
According to the National Multiple Sclerosis Society (NMSS) Sourcebook (http://www. nationalmssociety.org/sourcebook), cognitive dysfunction is usually more common in individuals who have been living with MS for a long time. However, "it can be seen early, and occasionally cognitive problems are present from the onset of the disease," according to the NMSS Sourcebook. "Even early in the disease, cognitive dysfunction can have an impact on role performance at home or work."
Initial signs are often subtle, such as the inability to find the right word or problems remembering how to perform common tasks. "Often, the family becomes aware of the problem first," states the NMSS Sourcebook, "noticing changes in personality and personal habits."
The NMSS Sourcebook also points out that, while cognitive impairment can be a direct result of MS, it can also be caused by the natural aging process. Cognitive problems are also an adverse effect of many medications. It's best to seek out a formal evaluation by a specially trained health professional-such as a neuropyschologist, speech/ language pathologist, or occupational therapist-to see if this is the case.
Following this evaluation, according to the NMSS Sourcebook, "the areas of cognitive deficit and strength can be determined. Strategies for coping with areas of deficit can usually be devised." Severe causes of cognitive impairment in which individuals can no longer be cared for in the home are rare, according to the NMSS Sourcebook. Professionals in your area can be found on the NMSS Web site or by calling 1-800-FIGHT MS.
There are currently no pharmacologic agents approved for the treatment of cognitive dysfunction in individuals with MS. However, the currently approved disease-modifying agents for the treatment of MS can delay disease progression and may potentially slow the rate of cognitive dysfunction in an individual. In individuals with cognitive deficits, accompanying symptoms such as fatigue and depression can be treated with appropriate medications. Nonpharmacologic measures, such as occupational therapy, psychotherapy, and cognitive rehabilitation, can be effective in strengthening cognition.
"The National MS Society continues to fund studies on better ways of diagnosing and treating cognitive problems seen in people with MS," according to the NMSS Sourcebook. "It is hoped that new treatments to slow the physical progression of MS will also slow cognitive deterioration as well."
Severe Problems Are Rare
Cognitive impairment can cause individuals with MS a great deal of frustration. Fortunately, the NMSS reports that only 10% of those who experience such problems do so at a level severe enough to significantly interfere with everyday activities.
"While mild cognitive impairment is common in MS, fortunately most individuals
are able to compensate for the deficits," said Dr. Miller. "Severe decline
is rather uncommon."
© 2003 Real Living with Multiple Sclerosis