Cognitive impairment is amongst the main symptoms affecting multiple sclerosis (MS) and should be comprehensively and accurately assessed. To study the added value of a computerized neuropsychological battery enabling the measurement of response times in the cognitive domains, 58 randomly selected MS patients and 71 age-, gender- and education-matched healthy subjects were evaluated. Construct and discriminant validity were assessed for the standard Neuropsychological Screening Battery for Multiple Sclerosis (NSBMS) and the Mindstreams Computerized Cognitive Battery (MCCB). The MCCB demonstrated good construct validity in comparison with the NSBMS in memory (P < 0.001), executive function (P < 0.001), attention (P < 0.05) and information processing (P < 0.05) domains. In addition, it showed high discriminant validity most prominently for executive function, attention and motor skills (P < 0.001). Response times measured by the computerized battery were longer in all cognitive domains and varied with cognitive load, demonstrating that response time deficits in MS are associated with particular task demands. We conclude that in MS prolonged response times on a range of cognitive tasks signify abnormal conduction within demyelinative tracts.

Clinical implications in referring persons with TBI with mild vs. severe depression to rehabilitation programmes are discussed.

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Disorders involving regulation of affect commonly occur in multiple sclerosis (MS). These include various clinical presentations with inconsistent definitions that lead to many nomenclatures. In order to simplify the clinical approach to dysregulation of affect (DyA) a phenomenological definition was applied that unifies and combines the current classifications. Accordingly, the prevalence of DyA was determined in MS patients and comorbidity was evaluated with psychiatric disorders. Using the Structured Clinical Interview for DSM-III-R (SCID), 651 consecutive MS patients were assessed (474 female, 177 male, mean age 43.6 years, mean disease duration 11.5 years) and it was found that the prevalence of DyA was 6.5% (n = 42). In 14 patients (33.3% of DyA patients) there was no associated psychiatric comorbidity, while in 28 patients (66.6%) there was comorbid psychopathology; 12 had been suffering from psychosis (28.6%), eight from mood disorders (19%), six from cognitive decline (14.3%) and two from personality disorder (4.7%). In 15 patients (35.7%) the DyA was ego-dystonic and in 27 patients (64.3%) the symptoms of DyA were ego-syntonic. All patients with comorbid psychosis had ego-syntonic DyA. In 14.3% of patients the DyA symptomatology preceded the appearance of MS. It is concluded that the new phenomenological definition of DyA aids in distinguishing this symptom from other psychopathologies and can serve as a tool for neurologists in defining this unique entity.

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Background Multiple sclerosis (MS) may lead to cognitive decline over-time. Objectives Characterize cognitive performance in MS patients with long disease duration treated with disease modifying drugs (DMD) in relation to disability and determine the prevalence of cognitive resilience. Methods Cognitive and functional outcomes were assessed in 1010 DMD-treated MS patients at least 10 years from onset. Cognitive performance was categorized as high, moderate or low, and neurological disability was classified according to the Expanded Disability Status Scale (EDSS) as mild, moderate or severe. Relationship between cognitive performance and disability was examined. Results After a mean disease duration of 19.6 (SD = 7.7) years, low cognitive performance was observed in 23.7% (N = 239), moderate performance in 42.7% (N = 431), and 33.7% (N = 340) had high cognitive performance, meeting the definition of cognitively resilient patients. Within the group of patients with low cognitive performance, severe disability was observed in 50.6% (121/239), while in the group of patients with high cognitive performance, mild disability was observed in 64.4% (219/340). Differences between the group of patients with high cognitive performance and severe disability (4.5%) and the group of patients with low cognitive performance and mild disability (5.0%) were not accounted for by DMD treatment duration. Conclusions The majority of DMD treated MS patients did not have cognitive decline that could impair their quality of life after disease of extended duration.

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