Disease modifying treatments and symptomatic drugs for cognitive impairment in multiple sclerosis: where do we stand?

Abstract

Cognitive dysfunction is frequent in multiple sclerosis patients and has important and negative consequences for daily activities and quality of life of subjects. Disease modifying treatments for multiple sclerosis reduce the incidence of relapses and may prevent disease progression, but the influence on cognitive impairment is unclear, due to several limitations of the available studies. Moreover, symptomatic drugs for the improvement of already established cognitive deficits have been tested in small pilot studies, providing conflicting or mainly negative results. Currently, specific pharmacological therapies for the management of cognitive deficits in MS have not yet been developed. We will provide an updated overview of available evidence of pharmacological approaches for ameliorating cognitive deficits, based either on disease modifying treatments or symptomatic drugs.

Screening of Cognitive Impairment in Patients with Multiple Sclerosis: A Cross-Sectional Study in Georgia

“…By reducing the inflammation and burden of T1 and T2 brain lesions, disease-modifying therapies may have beneficial effects on cognition [ 36 ]. Several studies have demonstrated protective effects of interferons, glatiramer acetate, fingolimod, and natalizumab on cognitive status [ 37 ].…”

Computerized cognitive rehabilitation for treatment of cognitive impairment in multiple sclerosis: an explorative study

“…Pharmaceutical agents and supplements used in dementia have not proven to be efficacious in MS (Amato et al, 2013;He et al, 2013) while there is limited evidence to support that diseasemodifying drugs may have an impact on cognitive functions in MS (Niccolai et al, 2017). It has been suggested that physical exercise may be an alternate approach since, at least in the healthy population, there is some evidence of beneficial effects on cognitive functions (Feinstein, 2011;Sandroff, 2015).…”

<p>Patient Attitudes to Routine Cognitive Testing in Multiple Sclerosis</p>

“…Yet cognition has rarely been the primary outcome in clinical trials, and high-quality studies have often been called for. 1,3,16,17,19,22 Today, there is general agreement that cognitive functioning should be systematically monitored, 1 but knowledge is lacking about MS patients' attitudes towards introducing routine cognitive testing, which is crucial to successful implementation. Exploring patients' views in relapsing and progressive phases on this possibility was therefore the main aim of this qualitative study set in Denmark.…”