The Need for Screening, Assessment, and Treatment for Cognitive Dysfunction in Multiple Sclerosis

Abstract

Cognitive dysfunction is observed in about half of people with multiple sclerosis (MS), and MS health-care professionals face the challenge of screening, assessing, and treating patients for cognitive problems. Considering the inconsistent or limited empirical evidence to assist in this task, a multidisciplinary consensus conference of MS experts, sponsored by the Consortium of Multiple Sclerosis Centers (CMSC), was held on September 24, 2010, to address these issues. Key articles from the literature on these topics were distributed prior to the meeting, and CMSC member professionals were surveyed on clinical practices related to screening, assessment, and treatment for cognitive problems. The purpose of the meeting was threefold: 1) to achieve a multidisciplinary perspective on practices for screening, monitoring, evaluating, and treating MS patients for cognitive problems; 2) to propose consensus candidate measures for screening and/or monitoring for cognitive problems in MS that neurologists or nurses might administer on a regular basis; and 3) to propose consensus treatment approaches from a multidisciplinary perspective. This article summarizes the conclusions of the conference participants and provides preliminary suggestions for screening and brief assessment. Int J MS Care. 2012;14:58-64. Multiple sclerosis (MS) is an immune-mediated demyelinating disease of unknown etiology in which there is a T cell-mediated attack on oligodendrocyte and myelin epitopes in the central nervous system (CNS). As a result, MS patients may have localized areas of demyelination in the CNS, as well as damage to or loss of proximal gray matter. The symptoms of MS run a wide gamut, depending on the location of the lesions. One category of symptoms affecting a large portion of the MS population is cognitive dysfunction, with estimated rates ranging from 43% to 70%. 1,2 Cognitive dysfunction in MS spans the domains of visuospatial processing, information processing speed, working memory, executive functioning, verbal and visual learning, and episodic memory.Symptoms of cognitive dysfunction can appear early, even before patients have reached the full criteria for MS. 3 Even with mild cognitive impairment, patients can have significant functional disability. 4 Cognitive dysfunction can interfere broadly with patients' lives, causing a decrease in quality of life, 2 impairments in social functioning, 5 and problems with employment. 6 Thus, it is necessary to develop widely used screening tools, assessments, and interventions that have demonstrated reliability and validity. However, existing literature on CONSENSUS STATEMENT

Research-to-Practice Gaps in Multiple Sclerosis Care for Patients with Subjective Cognitive, Mental Health, and Psychosocial Concerns in a Canadian Center

“…However, including subjective concerns correctly reflected the practice of MS clinic staff in determining which patients might warrant attention and reflects the widespread practice of not using validated measures. 24,33 Regardless, this approach produced far fewer concerns than expected in the literature, which supports the observation that concerns are being underidentified in routine care. Rates of cognitive, mental health, and psychosocial concerns may have been greater with a longer review period.…”

Assessment and Treatment of Psychiatric Distress, Sexual Dysfunction, Sleep Disturbances, and Pain in Multiple Sclerosis

“…The questionnaire used was based on a similar study 28 that surveyed CMSC members' screening and assessment methods for cognitive dysfunction. All the responses were anonymous, and no patient-protected information was collected.…”

A Framework of Care in Multiple Sclerosis, Part 2

“…Cognitive impairment occurs in approximately half of patients with MS (range, 43%-70%) and is the major reason people with MS leave the workplace. 11,47,48 Fortunately, most people with MS have mild-to-moderate impairment, with only approximately 10% with signifi-The Framework Taskforce put forth in this article recommendations and practical strategies for symptomatic care in MS. Understanding and defining symptoms is a critical initial step. Using pharmacologic therapies for symptomatic care is emphasized, but considering nonpharmacologic interventions is essential.…”