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Prof Anthony Feinstein: Cognition and MS
Prof Feinstein discusses cognitive impairment in people with MS. Rates of impairment are approximately 30% early on in the disease state. In relapsing-remitting MS the impairment rates are about 40%, are about 50% in those with primary progressive MS, and as high as 60-70% in those with secondary progressive MS.
The major cognitive problem is a slowing down in processing speed, but memory, learning ability and executive function can also be negatively affected. Language is usually unaffected, and there is little agnosia (the loss of the ability to recognise what objects are and what they are used for) and apraxia (the inability to carry out voluntary and purposeful movements despite the fact that muscular power, sensibility and coordination are intact) in MS patients in general.
Brain imaging studies have shown a link between cognitive impairment and various indices of brain pathology, particularly third-ventricular width as a measure of atrophy in the third ventricle, which correlates strongly with cognitive impairment because of the close association of the thalami to the third ventricles. Generalized cerebral atrophy also correlates with cognitive difficulties and, in general, atrophy is a more significant indicator of impairment than are lesions.
Cognitive dysfunction has a substantial impact on MS patients as it impairs their ability to function at work, in relationships, during recreational activities and in performing everyday living tasks. But treatment is problematic, with little evidence that medications are of benefit. For example, medications for treating Alzheimer’s disease patients do not work in MS patients because of the different pathological processes.
New evidence suggests that cognitive-rehabilitation algorithms may help improve memory in relapsing-remitting MS patients, although they are labour-intensive and not widely available in clinics. Similar data is lacking in primary and secondary progressive MS patients.
Prof Feinstein concluded that ultimately, there is much research to be done on the effect of cognitive rehabilitation on all types of MS to evaluate both short- and long-term benefits.
The interview was recorded at the annual ECTRIMS meeting from 14-17 September 2016 in London, United Kingdom.
Professor Anthony Feinstein, Psychiatry Department, University of Toronto, Canada