Cognitive assessment in MS

There are several shortcomings of the Expanded Disability Status Scale (EDSS). So, a comprehensive assessment of MS course is an important topic. Cognitive impairment has a major negative impact on the lives of people with MS. However, the clinical response to patient symptoms is not consistent. Cognitive assessment at the start of the disease is helpful in alerting patients to this aspect of MS and in highlighting the importance of activities promoting brain health.

The most prevalent cognitive problems in MS are memory and information processing speed, while language remains largely intact [1]. Cognition is not closely related to other disease variables, such as EDSS, MRI abnormalities [2], disease duration, and phenotype [3]. “Although some think that monitoring MRI is a way of understanding cognition, there is not a direct correlation”, Prof. Dawn Langdon (Royal Holloway University of London, United Kingdom) mentioned. “Disease duration is also not a good clue.” Furthermore, self-reporting of cognition is heavily confounded by many psychosocial issues, like depression, anxiety, fatigue, conscientiousness, perceived stress, and self-efficacy [4,5]. “Although the patient’s own perception and understanding of their cognitive difficulties is very important, it is not a good guide to their objective level”, said Prof. Langdon. Appropriate tools for cognitive assessment include the BRB-N, MACFIMS, and BICAMS. For the future, Prof. Langdon thinks that cognitive impairment should be quantified.

Value of cognitive assessment

Given the current limitations, what is the value of cognitive assessment? Firstly, healthcare professionals (HCPs) obtain an objective cognitive status, to separate the problems from fatigue and mood and to determine whether the patient truly has a cognitive deficit. This information enables HCPs to educate patients and encourage a positive lifestyle, and adopt an appropriate interaction style in terms of how to convey information and check understanding. It also allows HCPs to be vigilant to the increased risk of unemployment and other participation issues that MS patients with cognitive deficits are more vulnerable to. Furthermore, these patients are more likely to have falls and driving accidents, and to have poor disease management, including adherence to medication. Finally, this information can alert the HCPs to cognitive decline or relapses [6]. Currently, a number of expert committees advocate that there should be yearly assessment of cognition [7,8].

Benefits for MS patients consists of providing them with the opportunity to make positive lifestyle choices. Cognitive assessments inform people with MS about their condition and gives them the opportunity to engage, for example, in the Brain Health agenda.

1. Rao SM, et al. Neurology. 1991;41:685-91.
2. Manca R, et al. J Neurol Sci. 2018;388:115-127.
3. Brochet B, Ruet A. Front Neurol. 2019;10:261.
4. Akbar N, et al. Cogn Behav Neurol. 2011;24:115-21.
5. Beier M, et al. Rehabil Psychol. 2015;60:254-62.
6. Langdon DW, et al. Mult Scler. 2012;18:891-8.
7. Bakirtzis C, et al. Open Neurol J. 2018;12:31-40.
8. Kalb R, et al. Mult Scler. 2018;24:1665-1680.

 



Posted on 8 November 201922 March 2021