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      Cognitive Dysfunction in Multiple Sclerosis

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          Abstract

          In Multiple Sclerosis (MS) prevalence studies of community and clinical samples, indicate that 45–60% of patients are cognitively impaired. These cognitive dysfunctions have been traditionally described as heterogeneous, but more recent studies suggest that there is a specific pattern of MS-related cognitive dysfunctions. With the advent of disease-modifying medications for MS and emphasis on early intervention and treatment, detection of cognitive impairment at its earliest stage becomes particularly important. In this review the authors address: the cognitive domains most commonly impaired in MS (memory, attention, executive functions, speed of information processing, and visual–spatial abilities); the pathophysiological mechanism implied in MS cognitive dysfunction and correlated brain MRI features; the importance of neuropsychological assessment of MS patients in different stages of the disease and the influence of its course on cognitive performance; the most used tests and batteries for neuropsychological assessment; therapeutic strategies to improve cognitive abilities.

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          Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning.

          G Leo, L Ellington, P. Rao … (1991)
          We designed a study to assess the specific contribution of cognitive dysfunction to multiple sclerosis patients' problems in daily living. Based on the results of a comprehensive neuropsychological test battery, we classified 100 MS patients as either cognitively intact (N = 52) or cognitively impaired (N = 48). In addition to a neurologic examination, MS patients completed questionnaires on mood and social functioning, underwent a comprehensive in-home occupational therapy evaluation, and were rated by a close relative or friend regarding specific personality characteristics. While there were no significant differences between the two groups on measures of physical disability and illness duration, patients in the cognitively impaired group were less likely to be working, engaged in fewer social and avocational activities, reported more sexual dysfunction, experienced greater difficulty in performing routine household tasks, and exhibited more psychopathology than cognitively intact patients. These findings suggest that cognitive dysfunction is a major factor in determining the quality of life of patients with MS.
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            Minimal neuropsychological assessment of MS patients: a consensus approach.

            Patrick W. Beatty, John Fisk, Frederick Munschauer … (2002)
            Cognitive impairment is common in multiple sclerosis (MS), yet patients seen in MS clinics and neurologic practices are not routinely assessed neuropsychologically. In part, poor utilization of NP services may be attributed to a lack of consensus among neuropsychologists regarding the optimal approach for evaluating MS patients. An expert panel composed of neuropsychologists and psychologists from the United States, Canada, United Kingdom, and Australia was convened by the Consortium of MS Centers (CMSC) in April, 2001. Our objectives were to: (a) propose a minimal neuropsychological (NP) examination for clinical monitoring of MS patients and research, and (b) identify strategies for improving NP assessment of MS patients in the future. The panel reviewed pertinent literature on MS-related cognitive dysfunction, considered psychometric factors relevant to NP assessment, defined the purpose and optimal characteristics of a minimal NP examination in MS, and rated the psychometric and practical properties of 36 candidate NP measures based on available literature. A 90-minute NP battery, the Minimal Assessment of Cognitive Function in MS (MACFIMS), emerged from this discussion. The MACFIMS is composed of seven neuropsychological tests, covering five cognitive domains commonly impaired in MS (processing speed/working memory, learning and memory, executive function, visual-spatial processing, and word retrieval). It is supplemented by a measure of estimated premorbid cognitive ability. Recommendations for assessing other factors that may potentially confound interpretation of NP data (e.g., visual/sensory/motor impairment, fatigue, and depression) are offered, as well as strategies for improving NP assessment of MS patients in the future.
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              Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial.

              Ludwig Kappos, Mark Freedman, Chris Polman … (2009)
              The Betaferon/Betaseron in newly emerging multiple sclerosis for initial treatment (BENEFIT) trial investigated the effect of treatment with interferon beta-1b after a clinically isolated syndrome. The 5-year active treatment extension compares the effects of early and delayed treatment with interferon beta-1b on time to clinically definite multiple sclerosis (CDMS) and other disease outcomes, including disability progression. Patients with a first event suggestive of multiple sclerosis and a minimum of two clinically silent lesions in MRI were randomly assigned to receive interferon beta-1b 250 microg (n=292; early treatment) or placebo (n=176; delayed treatment) subcutaneously every other day for 2 years, or until diagnosis of CDMS. All patients were then eligible to enter a prospectively planned follow-up phase with open-label interferon beta-1b up to a maximum of 5 years after randomisation. Patients and study personnel remained unaware of initial treatment allocation throughout the study. Primary endpoints were time to CDMS, time to confirmed disability progression measured with the expanded disability status scale, and the functional assessment of multiple sclerosis trial outcomes index (FAMS-TOI) at 5 years. Analysis of the primary endpoints was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00185211. 235 (80%) patients from the early treatment and 123 (70%) from the delayed treatment group completed the 5-year study. Early treatment reduced the risk of CDMS by 37% (hazard ratio [HR] 0.63, 95% CI 0.48-0.83; p=0.003) compared with delayed treatment. The risk for confirmed disability progression was not significantly lower in the early treatment group (0.76, 0.52-1.11; p=0.177). At 5 years, median FAMS-TOI scores were 125 in both groups. No significant differences in other disability related outcomes were recorded. Frequency and severity of adverse events remained within the established safety and tolerability profile of interferon beta-1b. Effects on the rate of conversion to CDMS and the favourable long-term safety and tolerability profile support early initiation of treatment with interferon beta-1b, although a delay in treatment by up to 2 years did not affect long-term disability outcomes. Bayer Schering Pharma.
              Article 0 comments Cited 71 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Front Neurol
                Journal ID (iso-abbrev): Front Neurol
                Journal ID (publisher-id): Front. Neur.
                Title: Frontiers in Neurology
                Publisher: Frontiers Research Foundation
                ISSN (Electronic): 1664-2295
                Publication date (Electronic preprint): 11 March 2012
                Publication date (Electronic): 24 May 2012
                Publication date Collection: 2012
                Volume: 3
                Electronic Location Identifier: 74
                Affiliations
                [1] 1simpleMS Clinic, Department of Neurology, Centro Hospitalar São João Porto, Portugal
                [2] 2simpleFaculty of Medicine, University of Porto Porto, Portugal
                [3] 3simpleFaculty of Health Sciences, University Fernando Pessoa Porto, Portugal
                Author notes

                Edited by: João Massano, University of Porto, Portugal

                Reviewed by: Dafin F. Muresanu, University of Medicine and Pharmacy “Iuliu Hatieganu,” Romania; Federica Agosta, Vita-Salute San Raffaele University, Italy

                *Correspondence: Joana Guimarães, Department of Neurology, Centro Hospitalar São João, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal e-mail: jguimraes9@ 123456hotmail.com

                This article was submitted to Frontiers in Dementia, a specialty of Frontiers in Neurology.

                Article
                DOI: 10.3389/fneur.2012.00074
                PMC ID: 3359427
                PubMed ID: 22654782
                SO-VID: a5ab5c22-0533-4315-ac33-0b421fb2c4a0
                Copyright © Copyright © 2012 Guimarães and Sá.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non Commercial License, which permits non-commercial use, distribution, and reproduction in other forums, provided the original authors and source are credited.

                History
                Date received : 05 February 2012
                Date accepted : 14 April 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 81, Pages: 8, Words: 7674
                Categories
                Subject: Neuroscience
                Subject: Review Article

                ScienceOpen disciplines: Neurology
                Keywords: multiple sclerosis,neuropsychological batteries,cognition
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: multiple sclerosis, neuropsychological batteries, cognition

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