Recommendations for cognitive screening and management in multiple sclerosis care

Kalb, Roland; Beier, Meghan; Benedict, Ralph H. B.; Charvet, Leigh; Costello, Kathleen; Feinstein, Anthony; Gingold, Jeffrey N.; Goverover, Yael; Halper, June; Harris, Colleen; Kostich, Lori; Krupp, Lauren; Lathi, Ellen; LaRocca, Nicholas G.; Thrower, Ben; DeLuca, John

doi:10.1177/1352458518803785

Cited by 315 publications

(378 citation statements)

References 152 publications

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“…When patients report a cognitive problem, they tend to describe a change in function from a previous level of function. 32 This statement also applies to patients diagnosed with NMOSD and their family members. 65 Clinicians and researchers examining single time points might fail to detect changes that do not cross a set threshold for "cognitive impairment."…”

Section: Resultsmentioning

confidence: 99%

“…32 Education regarding cognition and repeated assessment of cognitive function will improve comprehensive care for MS and NMOSD. 32 Education regarding cognition and repeated assessment of cognitive function will improve comprehensive care for MS and NMOSD.…”

Section: Resultsmentioning

confidence: 99%

“…23 A relationship can be observed between cognitive impairment and time since diagnosis, although disease duration and physical disability do not necessarily predict the presence of cognitive impairment. 31,32 In fact, cognitive impairment predicts limitations in patients' workplaces and social settings independently of their level of physical disability. [24][25][26] Furthermore, patients with neuropsychological dysfunction have been reported to be at a higher risk of progressing from clinically isolated syndrome to clinically definite MS and the secondary progressive phase.…”

Section: Cognition In Msmentioning

confidence: 99%

“…6 Some patients with MS suffer from cognitive impairment in early stages of the disease, and early cognitive impairment has been reported to be associated with a higher risk of disease progression in the subsequent years and poor clinical outcome. 32 Furthermore, it was reported that cognitive impairment was detected in approximately 45% of patients with benign MS. 30 Therefore, it would be wise to reconsider the concept of "benign MS." 26,27 Taken together, systematic evaluation and monitoring of cognition in clinical practice is highly recommended to better understand the activity and severity of the disease, and inform patient counseling and management strategies.…”

Section: Cognition In Msmentioning

confidence: 99%

“…Therefore, it has been challenging to translate changes in cognitive test scores into clinical meaningfulness. 32 65 As result, it is recommended that neurologists reassess patients "with the same instrument" on an annual basis.…”

Section: Cognition In Msmentioning

confidence: 99%

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Cognitive impairment as one of the important non‐motor symptoms in multiple sclerosis and neuromyelitis optica spectrum disorders

Niino

Miyazaki

2019

Clinical & Exp Neuroim

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Cognitive impairment is one of the most important non-physical symptoms of patients with multiple sclerosis (MS), and few studies have reported on cognitive impairments in patients with neuromyelitis optica spectrum disorders. Adequate batteries are required to assess cognitive function in MS, and cognitive impairments in patients with MS are likely not adequately evaluated. As cognitive impairment usually affects employment status and activities of daily living in patients with MS and neuromyelitis optica spectrum disorders, the effect of this symptom on daily activities should be closely examined. The present review focuses on the prevalence and characteristics of cognitive impairments in patients with MS and neuromyelitis optica spectrum disorders, as well as the methods used to evaluate cognitive function in such patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Cognition In Msmentioning

confidence: 99%

Section: Cognition In Msmentioning

confidence: 99%

Section: Cognition In Msmentioning

confidence: 99%

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Cognitive impairment as one of the important non‐motor symptoms in multiple sclerosis and neuromyelitis optica spectrum disorders

Niino

Miyazaki

2019

Clinical & Exp Neuroim

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Domain‐specific cognitive impairment in multiple sclerosis: A systematic review and meta‐analysis

Lugosi,

Engh,

Huszár

et al. 2024

Ann Clin Transl Neurol

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ObjectiveMethods of cognitive measurements in multiple sclerosis (MS) are not standardized. We aimed to identify the prevalence of cognitive domain‐specific impairment (DSI) in MS by using subtests of the Brief Repeatable Battery of Neuropsychological Tests (BRB‐N) with analyzing different cutoff values.MethodsThe systematic review and meta‐analysis were registered on PROSPERO (ID: CRD42021287004). The systematic literature search was performed via PubMed, Embase, and CENTRAL on 24 October 2021. Inclusion criteria were adults of different MS subtypes (CIS, RRMS, PPMS, and SPMS) with the condition of distinct DSI measured by BRB‐N. Pediatric MS, computerized versions of BRB‐N, and patients receiving steroids were excluded. Primary outcome was pooled prevalence rates of impaired patients within each cutoff and MS subtype, with 95% confidence interval, I‐squared statistics for heterogeneity, and chi‐squared test for subgroup differences. Risk of bias was assessed using the “JBI Quality Assessment Tool for Prevalence Studies.”ResultsIn 48 eligible observational studies (n = 3431 patients), the three most prevalent thresholds were the 2.0 SD and 1.5 SD below the mean of normative values, and the score below the fifth percentile of the normative values. A progressively increasing worsening of the overall DSI was observed from CIS, moving toward RRMS, PPMS, and SPMS.InterpretationCognitive impairment is observed in all MS phenotypes, with varying degrees. Due to several potential influencing factors, our comprehensive literature review has not revealed consistent findings, and we, therefore, recommend considering a more sophisticated, “individual referencing” approach, acknowledging the diverse clinical and sociodemographic characteristics among populations and disparities in cognitive testing.

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Brain atrophy patterns in multiple sclerosis patients treated with natalizumab and its clinical correlates

et al. 2022

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Background: Multiple sclerosis (MS) is defined as a demyelinating disorder of the central nervous system, witnessing over the past years a remarkable progress in the therapeutic approaches of the inflammatory process. Yet, the ongoing neurodegenerative process is still ambiguous, under-assessed, and probably under-treated. Atrophy and cognitive dysfunction represent the radiological and clinical correlates of such process. In this study, we evaluated the effect of one specific MS treatment, which is natalizumab (NTZ), on brain atrophy evolution in different anatomical regions and its correlation with the cognitive profile and the physical disability. Methods:We recruited 20 patients diagnosed with relapsing-remitting MS (RR-MS) and treated with NTZ. We tracked brain atrophy in different anatomical structures using MRI scans processed with an automated image segmentation technique. We also assessed the progression of physical disability and the cognitive function and its link with the progression of atrophy.Results: During the first 2 years of treatment, a significant volume loss was noted within the corpus callosum and the cerebellum gray matter (GM). The annual atrophy rate of the cortical GM, the cerebellum GM, the thalamus, the amygdala, the globus pallidus, and the hippocampus correlated with greater memory impairment. As for the third and fourth years of treatment, a significant atrophy revolved around the gray matter, mainly the cortical one. We also noted an increase of the thalamus volume. Conclusion:Atrophy in RR-MS patients treated with NTZ is regional and targeting highly cognitive regions mainly of the subcortical gray matter and the cerebellum. The cerebellum atrophy was a marker of physical disability progression. NTZ did not accelerate the atrophy process in MS and may play a neuroprotective role by increasing the thalamus volume.

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Recommendations for cognitive screening and management in multiple sclerosis care

Cited by 315 publications

References 152 publications

Cognitive impairment as one of the important non‐motor symptoms in multiple sclerosis and neuromyelitis optica spectrum disorders

Cognitive impairment as one of the important non‐motor symptoms in multiple sclerosis and neuromyelitis optica spectrum disorders

Domain‐specific cognitive impairment in multiple sclerosis: A systematic review and meta‐analysis

Brain atrophy patterns in multiple sclerosis patients treated with natalizumab and its clinical correlates

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