The chronic and progressive nature of multiple sclerosis (MS) often excludes patients from neuropsychological treatment. At the Multiple Sclerosis Rehabilitation Hospital, Haslev, 40 patients with mild to moderate cognitive and behavioral impairment associated with MS were randomized to either specific cognitive treatment (20 pts) by direct training, compensatory strategies and neuropsychotherapy, or to non-specific, deliberately diffuse mental stimulation (20 pts). Treatment was for a mean of 46 days. The effects of treatment were evaluated by neuropsychological tests before treatment, immediately after treatment (short-term effects) and 6 months later (long-term effects). After short-term treatment, effects on cognitive measures were not convincing, but on the Beck Depression Inventory (BDI) the specific cognitive treatment group reported significantly less depression. After 6 months only this group showed an effect, since the visuo-spatial memory was improved. However, the depression ratings (BDI) were almost maintained from the short-term level. Interestingly, the non-specific treatment group rated themselves as significantly more depressed. Conclusively, it is worth while to offer specific neuropsychological treatment to MS patients with cognitive and behavioral dysfunction.

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We developed a measurement scale for assessment of impairment in MS patients (MSIS) in accordance with the recommendations of WHO. The items were kept close to a standard neurologic examination, and a short battery of cognitive tests was added. Normality was assigned to the value, zero, and the theoretical maximum score was 204. Two-hundred and ten multiple sclerosis (MS) patients were rated by one neurologist on the MS impairment Scale (MSIS), the Extended Disability Status Scale (EDSS), and the Ambulation Index (AI). The median MSIS score was 52 (5-147), the median EDSS 6.5 (1-9.5), and the median AI 5 (1-5). The relation between the MSIS scores and the EDSS was best described by an exponential function (non-linear regression coefficient, R = 0.87). Sixty-two of the patients were reexamined and rated by another neurologist. The interrater reliability coefficient (R) of the MSIS was 0.95, of the EDSS 0.91, and of the AI 0.94. Forty patients were examined twice by the first neurologist. The intrarater reliability coefficient was 0.97 for the MSIS, 0.95 for the EDSS, and 0.98 for the AI. The MSIS is easy to use and is robust to observer dissimilarities. It has a monomodal univariate distribution and has a better discriminatory power than the EDSS, especially in the EDSS range 6-9, while the interrater reliability of the MSIS is at least as good as that of the EDSS and the AI.

Background: Whole-brain N-acetyl aspartate (NAA), a measure of neuronal function, can be assessed by multislice echo-planar spectroscopic imaging. Objective: To test the hypothesis that the global brain NAA/creatine (Cr) ratio is a better predictor of cognitive dysfunction in multiple sclerosis than conventional magnetic resonance imaging measures. Design: Survey. Setting: Research-oriented hospitals. Patients: Twenty patients, 16 women and 4 men (mean age, 36 years), with early relapsing-remitting multiple sclerosis (mean Expanded Disability Status Scale score, 2.5). Main Outcome Measures: Correlation between the global NAA/Cr ratio and a cognitive dysfunction factor comprising 16 measures from an extensive neuropsy-chological test battery that best distinguished patients with multiple sclerosis from healthy control subjects. Results: A significant partial correlation between the global NAA/Cr ratio and the cognitive dysfunction factor was found (partial r = 0.62, P = .01), and 9 cognitively impaired patients had significantly lower global NAA/Cr ratios than 11 unimpaired patients (P=.04). No significant correlations were found between the cognitive dysfunction factor and conventional magnetic resonance imaging measures (ie, brain parenchymal fraction and lesion volume). Conclusions: Multislice echo-planar spectroscopic imaging provides global metabolic measures that distinguish between cognitively impaired and unimpaired patients with multiple sclerosis and correlate with a global cognitive measure. Standardization of the technique is needed, and largerscale studies that include healthy controls are suggested.

A total of 43 patients with multiple sclerosis (MS) consecutively admitted to the Multiple Sclerosis Rehabilitation Hospital in Haslev completed a Danish version of the Laman & Lankhorst Questionnaire (LLQ) on quality of life (qol), and the Beck Depression Inventory (BDI). Twenty‐one of the 43 pts completed the questionnaires at discharge as well. All patients received the standard multidiciplinary rehabilitative treatment. The purpose was to evaluate the LLQ as a measure of qol and as an outcome measure. The 43 MS‐patients had low weighted qol scores on the following items: readily tired, fatigue, dependence on other people, worry about deterioration and walk. Correspondingly, the BDI showed high scores on fatigability, work difficulty and somatic preoccupation. The correlation between LLQ and BDI was statistically significant (0.54, p<0002), but weak. ANOVA with repeated measures (LLQ and BDI at admission and discharge) was applied to evaluate rehabilitation outcome in 21 patients. LLQ: The patients experienced a significant reduction in disability on fatigue and mood; and in the importance of being able to climb stairs and to work. The weighted qol‐scores increased significantly on physical endurance, work and mood. BDI scores showed a significant decrease on pessimism, irritability, loss of libido and total BDI‐score. The changes measured by the LLQ were mainly on behavioral aspects. As the correlation coefficient was only 0.54, the LLQ and the BDI seem to address different aspects of quality of life.