There are four clinical courses of MS, Relapsing-remitting MS (RRMS), Secondary-progressive MS (SPMS), Progressive-relapsing MS (PRMS) and Primary-progressive MS (PPMS) (Sand & Lublin, 2013). The majority of individuals diagnosed with MS have RRMS. The RRMS disease course consists of periods of new symptoms or exacerbated recurrent symptoms (relapses) that can arise over days or weeks and eventually subside with partial or complete symptom recovery. Approximately, 40-60 percent of individuals with RRMS eventually progress to SPMS (Chiaravalloti & DeLuca, 2008). This is a stage in the disease course where there is a steady progression of symptoms with decreasing periods of remission. During this stage, symptoms gradually worsen and include problems with mobility and gait. Progressing-relapsing MS is characterized by progressive decline after onset of the disease, with some acute periods of symptom relapse (Chiaravalloti & DeLuca, 2008). The PPMS course involves a steady decline in signs and symptoms without any relapses.
Cognitive impairment has a 43%-70% prevalence rate with MS at both early and late stages of the disease course (Chiaravalloti & DeLuca, 2008). MS affects multiple domains of cognitive function such as processing speed, working memory, executive functioning and attention. The domains that suffer the most in all stages of MS include processing speed, visual learning and memory. Areas of cognition that remain intact include simple attention, verbal skills (such as naming and comprehension) and general intelligence (Chiaravalloti & DeLuca, 2008). A carefully constructed neuropsychological test battery is necessary for assessing cognitive functioning in the MS population because the cognitive deficits in MS can be subtle and vary considerably among patients (Chiaravalloti & DeLuca, 2008). Past MS specific neuropsychological batteries were criticized for being either too comprehensive or brief to accurately assess cognition (Chiaravalloti & DeLuca, 2008). The International Conference of MS Experts created the Minimal Assessment of Cognitive Function in MS. The battery is comprised of seven tests that assess verbal memory, visuo-spatial memory, word fluency, visuo-spatial ability, working memory, processing speed and executive functioning (Chiaravalloti & DeLuca, 2008).
Chiaravalloti, N. D., & DeLuca, J. (2008). Cognitive impairment in multiple sclerosis. The Lancet Neurology, 7(12), 1139-1151.
Multiple sclerosis (MS) is a progressive disease of the CNS that is characterized by widespread lesions in the brain and spinal cord. MS results in motor, cognitive, and neuropsychiatric symptoms, all of which can occur independently of one another. The common cognitive symptoms include deficits in complex attention, efficiency of information processing, executive functioning, processing speed, and long-term memory. These deficits detrimentally affect many aspects of daily life, such as the ability to run a household, participate fully in society, and maintain employment—factors that can all affect the overall quality of life of the patient. The increased use of neuro-imaging techniques in patients with MS has advanced our understanding of structural and functional changes in the brain that are characteristic of this disease, although much remains to be learned. Moreover, examination of efforts to treat the cognitive deficits in MS is still in the early stages.
The Multiple Sclerosis Association of America (MSAA) offers numerous educational resources regarding MS. “The Art of Symptom Management – Multiple Sclerosis in the 21st Century” is a six part web series on managing symptoms of MS.
MS Discovery, the podcast of the MS Discovery Forum, features interviews with multiple researchers (Dr. Gavin Giovannoni, Dr. Helmut Butzkueven, Dr. Gisela Kobelt and Dr. Jeremy Hobart) who discuss the evidence and recommendations for MS, ranging from early diagnosis to treatment. Additional topics include depression and MS (Dr. Adam Kaplin), adverse MS drug reactions (Dr. Kaarina Kowalec) and information and decision tools for newly diagnosed MS (Dr. Alessandra Solari).
Baughman, B. C., Basso, M. R., Sinclair, R. R., Combs, D. R., & Roper, B. L. (2015). Staying on the job: The relationship between work performance and cognition in individuals diagnosed with multiple sclerosis. Journal of clinical and experimental neuropsychology, 37(6), 630-640.http://www.ncbi.nlm.nih.gov/pubmed/26149071
Chiaravalloti, N. D., & DeLuca, J. (2008). Cognitive impairment in multiple sclerosis. The Lancet Neurology, 7(12), 1139-1151.http://www.ncbi.nlm.nih.gov/pubmed/22513513
Christodoulou, C., MacAllister, W. S., McLinskey, N. A., & Krupp, L. B. (2008). Treatment of cognitive impairment in multiple sclerosis. CNS drugs, 22(2), 87-97. http://www.ncbi.nlm.nih.gov/pubmed/18193921
Goodin, D. S. (2014). The epidemiology of multiple sclerosis: insights to disease pathogenesis. Handb Clin Neurol, 122, 231-266.http://www.ncbi.nlm.nih.gov/pubmed/24507521
Katz, S. I., & Lublin, F. D. (2013). Diagnosis and differential diagnosis of multiple sclerosis. Continuum (Minneapolis, Minn.), 19(4 Multiple Sclerosis), 922-943. http://www.ncbi.nlm.nih.gov/pubmed/23917094
Khan, F., & Amatya, B. (2016). Rehabilitation in Multiple Sclerosis: a Systematic Review of Systematic Reviews. Archives of Physical Medicine and Rehabilitation. http://www.ncbi.nlm.nih.gov/pubmed/27216225
Mitolo, M., Venneri, A., Wilkinson, I. D., & Sharrack, B. (2015). Cognitive rehabilitation in multiple sclerosis: A systematic review. Journal of the neurological sciences, 354(1), 1-9. http://www.ncbi.nlm.nih.gov/pubmed/25998261
O’Carroll, C. B., Woodruff, B. K., Locke, D. E., Hoffman-Snyder, C. R., Wellik, K. E., Thaera, G. M., ... & Wingerchuk, D. M. (2012). Is Donepezil Effective for Multiple Sclerosis-related Cognitive Dysfunction?: A Critically Appraised Topic. The neurologist, 18(1), 51-54. http://www.ncbi.nlm.nih.gov/pubmed/22217618
Patti, F., Amato, M. P., Trojano, M., Bastianello, S., Tola, M. R., Picconi, O., ... & COGIMUS Study Group. (2011). Quality of life, depression and fatigue in mildly disabled patients with relapsing–remitting multiple sclerosis receiving subcutaneous interferon beta-1a: 3-year results from the COGIMUS (COGnitive Impairment in MUltiple Sclerosis) study. Multiple Sclerosis Journal, 17(8), 991-1001. http://www.ncbi.nlm.nih.gov/pubmed/21502310
Sandvig, I., Barlinn, J., Nedregaard, B., & Skjeldal, O. H. (2015). Multiple sclerosis in children and adolescents. An important differential diagnosis of acute neurological disease. European Journal of Paediatric Neurology, 19(2), 211-217. http://www.ncbi.nlm.nih.gov/pubmed/25596063