Person receiving an MS memory test
#Cognition #Early Damage #Imaging

"[Cognitive impairment] is…a very frequent clinical manifestation in [multiple sclerosis] MS and requires, from clinicians, at least the same attention that is directed towards the involvement of other functional systems." ‑Gaetani 20191

  • Evaluation of cognitive impairment, along with monitoring of physical function, may help comprehensively map a patient’s progress from the earliest stages of disease1,2
  • Cognitive dysfunction is one of the most prevalent symptoms of MS, affecting up to 70% of patients2-5
  • Cognitive impairment has been observed in the earliest stages of disease and can have a detrimental effect on patients’ ability to function in their personal and professional lives1,3,6-8
  • Cognitive impairment can be monitored through patient-driven assessment, as well as through brain imagery and laboratory tests1,9
  • Research has found that cognitive impairment is associated with White Matter (WM) and Grey Matter (GM) atrophy3,5

The Prevalence of Cognitive Impairment in Multiple Sclerosis

Cognitive changes are highly prevalent in patients with MS, estimated to affect up to 70% of patients.2-5 Yet, the most common evaluation of disease progression is focused on the physical function of a patient, specifically the gait.6,10,11 With such a high prevalence, early evaluation of cognitive impairment, along with monitoring of physical function, may help give a better picture of a patient’s progress from the time of diagnosis.


of patients have cognitive impairment in MS2-5

Cognitive Impairment in Early Stages of Multiple Sclerosis

The effect of MS on the cognition of patients has been observed from the earliest stages of the disease.6

  • In one study (n=67), more than half of patients with probable MS presented with cognitive problems12
  • In another study (n=30), patients with clinically isolated syndrome, the precursor to MS, were found to have significant impairment in verbal memory, visuospatial learning and memory, and verbal fluency compared with healthy controls3
  • A recent study (n=183) evaluated the cognitive function of patients at different time points and found that decline in cognitive abilities was evident between the first assessment point of 2 to 3 years and the second assessment at 4 to 5 years2

So, not only has cognitive impairment been observed at the earliest stages of disease, but researchers are also starting to evaluate how this common symptom of MS develops as the disease progresses.

Life With Cognitive Impairment

Patients who experience cognitive impairment feel the effects in their personal and professional lives. Cognitive dysfunction can be a greater obstacle to occupational stability than physical decline.7 In a study of 101 patients with multiple sclerosis, cognitive impairment was found to be a critical predictor of unemployment status.13 Cognitive impairment makes itself evident in memory, attention, information processing, and executive functioning.11,14 Graphic for elements that go into cognitive impairment Meanwhile, social cognition can also deteriorate, causing emotional changes and affecting a patient’s interpersonal skills.8 Thus, while the physical symptoms of MS are evident on the surface, the underlying effects of cognitive impairment can be equally debilitating for the day-to-day life of a patient with MS.

Assessing Cognitive Impairment

There are many ways to monitor cognitive impairment in patients with multiple sclerosis, including patient-driven assessment, brain imagery, and laboratory tests:

  • The Symbol Digit Modalities Test (SDMT) is a screening of cognitive function that can be taken in 5 minutes9
  • Magnetic resonance imaging (MRI) can be used to monitor White Matter and Grey Matter atrophy, which have been shown to be connected with cognitive deficits3,5,15
  • Cerebrospinal fluid (CSF) neurofilament light chain (NfL) can be used to detect axonal damage, which may help determine cognitive impairment1

Also, researchers are studying ways for patients to assess their cognitive status and practice cognitive rehabilitation at home.16

In Summary

With the prevalence and effect of cognitive impairment among patients with multiple sclerosis, it should be considered early in the progression of the disease.2

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