Cognitive impairment in MS: rehabilitation approaches

Cognitive deficits have been reported in 45%-70% of patients with multiple sclerosis (MS). Like other symptoms of MS, cognitive deficits are highly variable. Slowed information processing and memory and learning dysfunction are regarded as the most frequent cognitive deficits in MS. Both white and gray matter damages have been suggested to contribute to cognitive impairments in MS. There is no direct relationship between cognitive deficits and physical disability, disease duration or course of the disease. In addition to cognitive impairments, neuropsychiatric symptoms are observed in MS, the most common being alterations in mood state. Neurobehavioral deficits have multidimensional effects on the activities of daily living and quality of life. Consequently, attention should be paid to early diagnosis and treatment. Based on studies on cognitive retraining and more multimodal neuropsychological rehabilitation, both approaches show promise in the treatment of cognitive impairments and their harmful effects. This review introduces the frequency and characteristics of cognitive impairments, as well as main findings on the effects of neuropsychological rehabilitation in MS.

Relationship between subjective and objective cognitive performance in multiple sclerosis

OBJECTIVES

Self- and informant reports of patients' cognitive performance are an important source of information for clinicians to consider in neuropsychological evaluation. The aim of the study was to find out whether the relationship between subjective or informant observations of cognitive deterioration and objective cognitive performance differ in patients with relapsing and progressive multiple sclerosis (MS).

MATERIALS & METHODS

One ninety-six MS patients (relapsing-remitting n = 138; progressive n = 58) underwent neuropsychological assessment with the Brief Repeatable Battery of Neuropsychological Tests. Subjective and informant-reported cognitive symptoms, mood, impact of the disease, and quality of life were evaluated with self-reports. According to consistency of evaluations, patients and informants were classified as accurate estimators (consistent subjective and objective cognitive performance), underestimators (subjectively but not objectively cognitively impaired), or overestimators (objectively but not subjectively cognitively impaired).

RESULTS

Patients' and informants' reports on patients' cognitive performance were approximately equally appropriate, slightly over half being accurate. Mood was associated with patients' subjective cognitive complaints. The relapsing group reported more subjective cognitive symptoms than the progressive group, although the objective cognitive performance did not differ between the groups. Overestimation occurred especially among patients with more severe physical disability, progressive phenotype of the disease, more pronounced cognitive impairment, and less education.

CONCLUSIONS

Slightly over half of patient and informant observations of cognitive deterioration were appropriate. Patients with progressive phenotype were more prone to overestimation than patients with relapsing phenotype.

The reliability of the MSFC and its components

BACKGROUND

The Multiple Sclerosis Functional Composite (MSFC) is a multidimensional measurement tool for multiple sclerosis (MS) including a measure of ambulation (Timed 25-foot Walk [TWT]), arm function (Nine-Hole Peg Test [9HPT]) and cognition (Paced Auditory Serial Addition Test [PASAT]).

OBJECTIVES

To assess the reliability and practice effects in the Finnish version of the MSFC and its components.

MATERIALS AND METHODS

Ten relapsing-remitting MS patients and 10 healthy controls underwent five testing sessions with the MSFC over a 4-week period.

RESULTS

The MSFC showed excellent intra- (0.99) and inter-rater (1.0) reliability. The MSFC, especially the 9HPT and the PASAT showed significant practice effects. On the 9HPT the controls remained stable whereas the patients improved their performance; on the PASAT both groups improved.

CONCLUSIONS

The MSFC showed excellent intra- and inter-rater reliability although the 9HPT and the PASAT were prone to considerable practice effects.