Cognitive Relapse in Multiple Sclerosis: New Findings and Directions for Future Research

Abstract

Multiple sclerosis (MS) is a chronic inflammatory, demyelinating disease of the central nervous system, often presenting with brain atrophy and cognitive impairment (CI). In the relapsing–remitting phenotype, cognitive performance is increasingly recognized to decline acutely during MS relapse, with varying degrees of recovery afterwards. Therefore, CI in MS may result from incomplete recovery from episodes of so-called “cognitive relapse”, gradual neurodegeneration, or both. Among a variety of validated measures of cognitive performance, the Symbol Digit Modalities Test (SDMT) represents the most sensitive measure of cognitive decline and is easily translated to clinical practice. In fact, cognitive relapse identified using the SDMT has been reported in clinically relapsing cohorts as well as in individuals with no other neurological signs, suggesting that routine cognitive assessment may be necessary to fully appreciate the extent of a patient’s disease activity. The aim of this narrative review is as follows: (1) to provide the historical context for neuropsychological assessment in MS, (2) to provide a summation of key studies describing the cognitive relapse phenomenon, and (3) to discuss current gaps in our knowledge and highlight avenues for future research.

Understanding who benefits most from cognitive rehabilitation for multiple sclerosis: A secondary data analysis

“…A recent review posited that cognition declines acutely during a relapse and that cognitive impairment in people with MS may result from incomplete recovery of these relapses. 21 However, there is a lot we still do not understand about the neuropathology driving cognitive relapse and recovery; thus, these results need to be interpreted with caution.…”

Auditory Test of Processing Speed: Preliminary validation of a smartphone-based test of mental speed

“…[1][2][3] Although cognitive symptoms vary among PwMS, deficits in processing speed, learning, and memory are the most common 4,5 and are associated with declines in vocational status, 6 functional independence, 7 and quality of life. 8 Sudden cognitive decline, regardless of other relapse signs or symptoms, can reflect acute disease activity, 9 whereas gradual cognitive worsening may indicate a progressive disease course. 10 Therefore, routine cognitive screening of PwMS is a key component of comprehensive clinical assessment and decision-making.…”