Assessment and management of cognitive problems in people with multiple sclerosis: A National Survey of Clinical Practice

Abstract

Summary 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. Aim The aim of this study was to understand the 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 email and on social media. Results Responses were analysed from 109 healthcare professionals. Approximately 59% (n = 64) reported that 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 neuropsychologist 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 that they would refer patients to specialist cognitive rehabilitation for symptom management; 3% (n = 3) followed a manual when providing a cognitive rehabilitation programme. Conclusions 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.

Cognitive impairment is associated with mitochondrial dysfunction in peripheral blood mononuclear cells of elderly population

“…Thus, the monitoring of cognitive impairment is essential. The MoCA is an assessment tool for MCI, and it is valid for patients with various diseases such as cerebrovascular diseases 20 , multiple sclerosis 21 , and aging 5 . Although MoCA is a screening tool for MCI or dementia, it cannot use for definite diagnosis.…”

Introducing Multiple Screener: An unsupervised digital screening tool for cognitive deficits in MS

“…Still baseline and follow-up measurements of cognitive functioning are often lacking in clinical practice because objective cognitive assessment is time consuming and requires specialized personnel. This is definitely the case in the Netherlands, but also applies to other countries as was demonstrated in a recent investigation across the UK (Klein et al, 2018). This is in conflict with international recommendations for cognitive screening and cognitive management in MS that recommend baseline measurement and annual follow-up on cognitive functioning in stable patients (at least with SDMT and ideally using BICAMS) (Kalb et al, 2018).…”

Developing a clinical pathway to identify and manage cognitive problems in Multiple Sclerosis: Qualitative findings from patients, family members, charity volunteers, clinicians and healthcare commissioners

“…Travelling to hospital requires time, effort and planning 7 . Digital technologies are also needed to access cognitive screening 8 . Further time commitments may be necessary from those attending multiple rehabilitation sessions 9 .…”

“…Despite these calls to action, UK MS services do not have an established care pathway which integrates these recommendations. A UK-wide survey of clinicians found variation in cognitive assessments used, often with inappropriate screening tools used rather than the recommended tests [8] . We also found a lack of consistency in reporting cognitive rehabilitation interventions, particularly regarding the content of interventions and their underlying framework [9] .…”