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

Abstract

Background and Aim: In recent years, cognitive dysfunction (CD) in multiple sclerosis (MS) has received increased attention. Neuropsychological tests have been developed allowing to monitor changes in patients' cognitive functions. Knowledge is lacking, however, about patients' attitudes towards introducing routine cognitive testing. It was the aim of this qualitative study to explore this. Materials and Methods: Based on a literature study, semi-structured interview guides were designed and used in qualitative interviews with 12 Danish patients. Participants were selected to represent different perspectives on CD and included patients with relapsingremitting MS (RRMS) and secondary-progressive MS (SPMS), women and men with varying time since diagnosis and cognitive test scores using the Symbol Digit Modalities Test (SDMT). The data were analysed using a constructivist approach in order to identify significant relations between the quality of life (QoL) impact of CD, and attitudes towards routine cognitive testing. Results: Most participants reported several subtypes of CD, yet objective CD did not coincide with subjective CD nor did it translate directly into poorer QoL. Overall, CD appeared to have larger impact on the QoL of patients with RRMS and higher SDMT scores, compared to patients with SPMS and lower SDMT scores. The QoL impact of CD manifested itself in the encounter between individual symptoms, expectations, coping and meaningful activities. All patients supported an introduction of routine cognitive testing, but patients with RRMS and SPMS had different main reasons to do so. These were related to supporting research, optimising treatment decisions, and providing documentation of this invisible MS symptom. Conclusion: All aspects of MS patients' QoL may be affected by CD. Introducing routine cognitive testing was widely supported by patients in all phases of MS calling for comprehensive care taking both physical and cognitive difficulties into account.

Cognitive assessment in multiple sclerosis clinical care: A qualitative evaluation of stakeholder perceptions and preferences

“…Like in Mortensen et al (2020), we found that routine cognitive screening was seen as valuable for both people with MS and clinicians. Both and subjective cognitive assessments were viewed as appropriate.…”

“…However, few studies have qualitatively evaluated 'how' specific tests or batteries are used. An investigation into patient preference for routine cognitive screening found the people with MS were supportive of routine cognitive screening and for their clinicians to manage both physical and cognitive symptoms (Mortensen et al, 2020). Participants perceived the SDMT to be less demanding and fatiguing than the other brief assessments included in the BICAMS (Brief International Cognitive Assessment for MS).…”

What would improve MS clinic services for cognition? – A stakeholder panel and survey exploration

“…The sources of information that currently exist for PwMS may not adequately address cognition in an accessible way. Qualitative studies have also demonstrated that PwMS want cognition information at diagnosis and feel that documentation of their cognitive difficulties would facilitate communication about their situation with others (Mortensen et al, 2020). PwMS increasingly expect to be fully involved in shared decision making and to be given comprehensive, current information (Yeandle et al, 2018).…”

Managing communication changes in persons with multiple sclerosis: Findings from qualitative focus groups

“…This finding is consistent with previous research that shows that cognitive symptoms can be under‐emphasized in the clinical assessment of MS (Nabavi & Sangelaji, 2015). In the present study, all participants wanted routine assessment and monitoring of their communication skills, which may help to optimize management, enhance the individual's quality of life, and document and raise awareness of this invisible symptom (Mortensen et al., 2020; Nabavi & Sangelaji, 2015). Previous research has shown that PwMS have positive attitudes towards and endorse routine cognitive testing (Mortensen et al., 2020), which was confirmed here.…”

“…In the present study, all participants wanted routine assessment and monitoring of their communication skills, which may help to optimize management, enhance the individual's quality of life, and document and raise awareness of this invisible symptom (Mortensen et al., 2020; Nabavi & Sangelaji, 2015). Previous research has shown that PwMS have positive attitudes towards and endorse routine cognitive testing (Mortensen et al., 2020), which was confirmed here. Baseline and annual screening, and baseline and periodic neuropsychology assessment has been recommended by a multidisciplinary expert panel, particularly in the presence of subjective complaints, positive screening scores or specific social or work situations (Meca‐Lallana et al., 2021).…”