The Need for Screening, Assessment, and Treatment for Cognitive Dysfunction in Multiple Sclerosis (original) (raw)
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Recommendations for cognitive screening and management in multiple sclerosis care
Multiple Sclerosis Journal
Purpose: To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management. Methods: The National MS Society (“Society”) convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care. Recommendations: Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society: Increased professional and patient awareness/education about the prevalence, impact, and appropriate management of cognitive symptoms. For adults and children (8+ years of age) with clinical or magnetic resonance imaging (MRI) evidence of neurologic damage con...
Cognitive impairment in multiple sclerosis: diagnosis and monitoring
Neurological Sciences, 2021
Introduction Cognitive impairment (CI) has a prevalence of 45–70% in people with multiple sclerosis (MS), producing a negative impact on their quality of life, personal life, and work. Early detection of CI has become an important aspect to be considered for an adequate follow-up, to optimize social adaptation and to implement specific cognitive rehabilitation strategies. The aim of this work is to propose a suitable cognitive evaluation of patients with MS based on available and efficient tools for diagnosis and monitoring purposes well supported by literature review and clinical experience. Methods A multidisciplinary panel of professionals from the field of neurology, neuropsychology, and neuroimaging performed a literature review of the topic of cognitive impairment assessment. This was combined and completed with their clinical experience to produce a set of recommendations. Results Some limitations to cognitive evaluation are described: shortage of time and resources during th...
International Journal of Clinical Practice, 2018
Background: People diagnosed with Multiple Sclerosis often have cognitive problems. However, it is unclear how cognitive impairment is currently assessed and managed in the UK. Aims: To understand current clinical practice of assessment and management of cognitive impairment in people with MS and to highlight any national variation. Methods: A survey was posted to 150 MS centres and large hospitals and an online version was shared via e-mail and on social media. Results: Responses were analysed from 109 healthcare professionals. Approximately 59% (n=64) reported they used cognitive assessment tools: the Montreal Cognitive Assessment (MoCA) was the most widely used. Assessments were usually done by Occupational Therapists (55%; n=60) or Clinical Neuropsychologists and Psychologists (38%; n=41); 49% (n=53) of respondents developed and implemented a cognitive rehabilitation plan when the assessment indicated that patients had cognitive problems; 16% (n=17) indicated they would refer patients to specialist cognitive rehabilitation for symptom management; 3% (n=3) followed a manual when providing a cognitive rehabilitation programme. Conclusion: Clinical pathways for assessing and managing cognitive problems vary and are dependent on the individual expertise of health professionals, available resources and access to specialist services. Although healthcare professionals highlight the importance of assessment and management, cognitive rehabilitation programmes are not routinely offered in the UK.
International Journal of MS Care, 2017
Background: Cognitive impairments are common in individuals with MS and adversely affect functioning. Early detection of cognitive impairment, therefore, would enable earlier, and possibly more effective, treatment. We sought to compare self-reports with a short neuropsychological test as possible screening tools for cognitive impairment. Methods: One hundred patients with MS were tested with the Minimal Assessment of Cognitive Function in Multiple Sclerosis; z scores were used to derive the Cognitive Index (CI). Receiver operator characteristic curve analyses were performed, with criteria for impairment set at −1.5 and −2.0 SD below the mean. Scores from two self-reports (the Multiple Sclerosis Neuropsychological Screening Questionnaire–Patient Version and the Behavior Rating Inventory of Executive Function–Adult Version [BRIEF-A]) and a neuropsychological test (the Symbol Digit Modalities Test [SDMT]) were entered as test variables. Exploratory regression analyses were conducted w...
Multiple Sclerosis and Related Disorders, 2018
Although cognitive impairment (CI) is common in multiple sclerosis (MS), it is difficult to suspect in patients with low disability and there is a lack of brief and effective CI screening tools with a define cutoff point to be used during routine clinic visits. This study aims to validate the Electronic Screening Cognitive Impairment in Multiple Sclerosis (SCI-MS) test for CI among MS patients. Methods: Cross-sectional, observational study that included adult patients, diagnosed with MS, Expanded Disability Status Scale (EDSS) score ≤6.5, without relapses within the last 2 months and no depression symptoms. The SCI-MS test consists of two modules: questionnaire (SCI-MS-Q) and pictogram matching tool (SCI-MS-P) measured for score and time. At inclusion, patients completed the Beck Depression Inventory (BDI-II test), the Brief Repeatable Battery of Neuropsychological Test (BRB-N) and the SCI-MS. The SCI-MS feasibility, test-retest reliability and predictive validity were assessed. Results: A total of 194 patients (59.3% female) were included: mean (SD) age of 42 (9) years, mean time since diagnosis of 10 (7) years, 89.7% relapsing-remitting MS, and median (Q1-Q3) EDSS of 2.0 (1.0-3.5). According to BRB-N, 26.8% of patients had CI. Internal consistency was high (Cronbach alpha: 0.97). The intra-class correlation coefficient was 0.88 for the SCI-MS-Q, 0.09 for the SCI-MS-P score and 0.48 for the SCI-MS-P time, corresponding to AUC of the ROC curves of 0.571, 0.574 and 0.714, respectively. For a clinically significant cutoff point of ≥60 seconds, the reached CI sensitivity of SCI-MS-P time was 0.75 and the specificity 0.51. Conclusion: SCI-MS showed good psychometric properties. SCI-MS-P time of pictogram completion had an acceptable diagnostic accuracy of CI in MS patients with low disability. SCI-MS-P time of pictogram completion tool is an easy and quick score that can help neurologists to early identify CI in MS patients that should be further assessed to confirm CI diagnosis and to describe its characteristics and mainly affected domains.
An Overview of Cognitive Disturbances in Multiple Sclerosis, Progression and Management
2020
This review will concentrate on discovery of cognitive disability in MS and available treatment options to decrease symptoms. We performed a search using electronic databases; MEDLINE, and EMBASE, through October, 2019. Search strategies used following MeSH terms in searching: “Multiple Sclerosis”, “Cognitive”, “screening”, “management”. Cognitive dysfunctions are constant signs and symptoms of multiple sclerosis (MS) and occur in up to 65% of individuals. Especially memory, attention, executive and visual constructive functions suffer. These problems strongly impact individuals' capacity to work, social relationships, and quality of life. Signs and symptoms of physical disabilities can occur separately. Cognitive disorders are clear indicators of MS progression, since they stand for highly complicated features that depend on the integrity of the neuronal networks. Yet, severe dementia is relatively uncommon. GJMR-F Classification: NLMC Code: WL 360 AnOverviewofCognitiveDisturba...
Cognitive impairment in multiple sclerosis: Evidence-based analysis and recommendations
Journal of Clinical Neuroscience
Cognitive impairment is common in multiple sclerosis (MS), occurring at all stages of the disease, and can be a major source of vocational disability, social impairment, and impoverished quality of life. Dysfunction in free recall from long-term memory, speed of information processing, working memory, and abstract reasoning are frequently observed in MS. Despite weak correlation with disease duration and physical disability status, the degree of cognitive impairment in MS has been related to the extent of topographically specific neuronal tissue damage and loss. Additional clinical factors including disease course, fatigue, affective disturbance, and medication can impact on the degree of MS-related cognitive impairment. We suggest that the symbol digits modalities test, paced auditory serial addition task, the clock drawing test and the MS neuropsychological screening questionnaire be considered as valid and relevant screening tests for cognitive impairment in MS.
Assessment of cognitive functions in patients with multiple sclerosis
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Background About 40–70% of patients with multiple sclerosis (MS) develop cognitive impairment (CI) throughout their life. We aim to study the influence of MS on cognitive changes. This is a case–control study of fifty patients with MS who met the revised 2017 Mc Donald Criteria and fifty age- and sex-matched healthy subjects. The Expanded Disability Status Scale (EDSS) was used to assess the degree of disability, and the Montreal Cognitive Assessment (MoCA) scoring system was used to assess cognitive function. Results MS patients show low total MoCA score than the controls. Total MoCA scores were lower in patients with CI versus those with intact cognition. CI was higher in those with a longer duration of illness and a high EDSS. MoCA was positively correlated with education level but negatively with EDSS and disease duration. Conclusion MoCA scale has optimal psychometric properties for routine clinical use in patients with MS, even in those with mild functional disability. The lon...
The Montreal Cognitive Assessment (MoCA) in Multiple Sclerosis: Relation to Clinical Features
Journal of Multiple Sclerosis, 2015
Background: The Montreal Cognitive Assessment (MoCA) is quickly becoming the most common clinical screen for cognitive impairment. Cognitive impairment is a frequent symptom of multiple sclerosis (MS) and can be difficult to detect in routine evaluation. Although specific screening measures have been studied and established for use in MS, MS cognitive screening tools may not be implemented in a general neurology setting. Method: The present study sought to characterize the use of the Montreal Cognitive Assessment (MoCA) a brief measure employed in general neurologic practice for the detection of cognitive impairment in MS. The MoCA, along with other clinical measures, was administered to consecutively-recruited outpatients diagnosed with MS (N=259) to describe the findings and determine the frequency of detection of impairment. A subgroup (n=28) was also administered the oral version of the Symbol Digit Modalities Test (SDMT) as a measure of information processing speed. Results: Participants' mean age was 45.8 ± 13.3 years and were diagnosed with relapsing-remitting MS (66%), secondary-progressive MS (18%), primary progressive MS (10%), clinically isolated syndrome (6%) or radiologically isolated syndrome (<1%). Median EDSS score was 2.5. A total of 41% of the sample scored in the impaired MoCA range (cutoff score of 26) with a mean of 25.86 ±2.92 points. EDSS was the clinical variable that most strongly predicted MoCA score. The combined SDMT and MoCA score led to the strongest prediction of EDSS score. Conclusion: In an outpatient setting where MS-specific cognitive screening is not implemented, the MoCA can be a helpful to identify those MS patients who warrant full neuropsychological evaluation.
Applied neuropsychology. Adult, 2016
This study investigates the utility of the Portuguese version of Montreal Cognitive Assessment (MoCA) as a screening-method for identifying cognitive dysfunction (CD) in multiple sclerosis (MS). The 118 participants with comprehensive neuropsychological assessment were divided into two subgroups: (I) MS group (n = 59) and (II) control group (n = 59). The MS patients were classified as cognitively intact (n = 26) or impaired (n = 33, 56%). The results indicated that the MoCA is a psychometrically valid instrument in assessment of MS patients. The Multiple Linear Regression analyses highlighted the significant influence of Modified Fatigue Impact Scale and Irregular Word Reading Test on MoCA performance. The MoCA total score showed a good discriminative capacity between cognitively impaired and cognitively intact subjects. In addition, there were significant differences in MoCA cognitive domain scores between groups. The MoCA total score cut-off point for identifying CD in MS patients...