Reports of Cognitive Decline in Patients With MS Require Multidisciplinary Assessment

Just two-thirds of patients with multiple sclerosis (MS) who reported cognitive decline actually showed cognitive impairment in extensive neuropsychological testing, according to a study published in the Journal of Clinical Medicine.

“Enrollment in our study was based on complaints of cognitive difficulties. However, only 67.7% showed some decline at neuropsychological evaluation, further supporting the need for a multidisciplinary assessment for anyone complaining of cognitive impairment to confirm or exclude cognitive impairment in patient-reported outcomes,” wrote a research team from Italy.

The retrospective analysis focused on 65 patients with MS who reported cognitive decline during an annual follow-up and subsequently underwent a battery of neuropsychological tests. All patients were aged younger than 65 years and had at least 10 years of disease duration. 

According to the study, 32.3% of patients had no cognitive impairment, while 26.2% had mild cognitive impairment and 41.5% had severe cognitive impairment. 

Older, less educated patients with higher scores on the Expanded Disability Status Scale, longer duration of disease, and higher white matter lesion load were more likely to develop cognitive impairment, researchers reported. On the other hand, disease-modifying therapy was protective against cognitive impairment.

Additionally, the study found that participants who were older with a progressive phenotype were less likely to be fully ambulatory at the most recent appointment. 

“In conclusion, our data confirm the importance of investigating cognition with extensive neuropsychological evaluation, particularly in old patients with a long disease duration,” researchers wrote. “Disease-modifying therapy exposure is protective not only on motor disability but also on cognition, and we support the role of white matter lesion load, particularly infratentorial inflammatory lesions, as well as clinical and demographic characteristics, as early predictors of cognitive and motor long-term disability in the MS population.”

Reference:
Virgilio E, Vecchio D, Sarnelli MF, Solara V, Cantello R, Comi C. Early predictors of disability and cognition in multiple sclerosis patients: a long-term retrospective analysis. J Clin Med. Published online January 15, 2023. doi:10.3390/jcm12020685