Sunday, 4 November 2012

How do MSers perceive their cognitive slowing?

EpubRoberg et al. How Patients With Multiple Sclerosis Perceive Cognitive Slowing. Clin Neuropsychol. 2012 Nov 1. 

Background: Slowed processing speed is the primary cognitive deficit in MS. However, no studies have examined how MSers perceive this deficit. 

Objective: The purpose of this paper is to examine perceived processing speed difficulties in clinical and community samples of MSers. 

Results: As expected, MSers reported more processing speed difficulties than controls. Perceived processing speed difficulties were significantly associated with impulsivity, slowed motor speed, greater anxiety, and increased introversion. In contrast, perceived processing speed did not correlate well with objective measures of processing speed. 

Conclusions: These findings show that MSers perceive their thinking to be significantly slowed. Perceived cognitive slowing is most closely related to performance on motor tasks and elevated anxiety. Evaluation of anxiety and MSers education about objective measures versus subjective perceptions of slowed processing speed may be helpful to MSers who report significant cognitive slowing.



"In my experience MSers are aware of their cognitive slowing and simply adapt to it. However, a small proportion of MSers lose insight and have no idea how bad their cognition is and this impacts on their ability to work and function socially. Unfortunately, we have no medication to improve cognitive slowing and have to rely on simple behavioural changes."

"Again, I would like to use this post  to remind you that it is better to prevent cognitive impairment than to try and treat it. Can we prevent it form occurring? Yes, there is some data suggesting that DMTs delay the onset and progression of cognitive impairment. To have their maximum effect you need to treat early and aggressively. At the moment we can't repair what is lost."
"If you are interested, I would suggest using the Staying Smart online programme from the MS Trust. MSers in my clinic who have used think it is very helpful. Have you tried it?"


The number of other posts on this blog in relation to cognition tells a story of how important this issue is to MSers and Researchers in the field:


31 Oct 2012
Rivastigmine fails to show effects on cognition. Epub: Mäurer et al. Randomised multicentre trial on safety and efficacy of rivastigmine in cognitively impaired multiple sclerosis patients. Mult Scler. 2012 Oct. BACKGROUND: ...
02 Nov 2012
Background: Cognitive dysfunction affects half of MSers. Although brain atrophy generally yields the most robust MRI correlations with cognition, significant variance in cognition between individual MSers remains unexplained ...
17 Oct 2012
Posted by Gavin Giovannoni at 01:30 · Email ThisBlogThis!Share to TwitterShare to Facebook. Labels: cognition, Cognitive impairment, ECTRIMS. No comments: Post a Comment. Newer Post Older Post Home. Subscribe to: ...
02 Oct 2012
Lisdexamfetamine dimsylate improves cognition in MS. Epub: Morrow et al. Lisdexamfetamine dimesylate improves processing speed and memory in cognitively impaired MS patients: a phase II study. J Neurol. 2012 Sep 23.

12 Sep 2012
BACKGROUND: Many MSers experience cognitive difficulties. Armodafinil has shown promise as a cognitive enhancer in other patient populations. No studies have examined whether armodafinil improves cognition in MSers ...
29 Jul 2012
"I personally believe there is a time when all MSers need to know about the potential impact MS has can have on their lives and this includes the effect on cognition. Why? This information may help you when making a ...
30 Sep 2012
Understanding the exact relationship between atrophy and cognition requires further investigation. The aim of this study was to investigate the relationship between subcortical GM atrophy and cognition in early relapsing ...
18 May 2012
Background: Cognitive impairment may result in significant disability in MSers. Previous MRI studies on cognition in MS were mainly based on measures of gross brain involvement. This study, using voxel-based morphometry ...

17 Aug 2012
A cognition-score was calculated, and normalized grey and white matter volumes were determined. RESULTS: Patients had lower grey and white matter volumes than HC, male patients had lower cognitive performance than ...
20 Oct 2012
Natalizumab may reduce cognitive changes and brain atrophy rate in relapsing-remitting multiple sclerosis: a prospective, non-randomized pilot study. Eur J Neurol. 2012 Oct 11. doi: 10.1111/j.1468-1331.2012.03882.x.
10 Nov 2011
Correlations between DTI-metrics and cognition were explored in regions demonstrating significant differences between the RRMS patients and the control group. Lower DTI measurements were found in RRMS participants ...
11 Sep 2011
Background: Self-report measures of cognition have consistently been shown to correlate better with depressed mood than neuropsychological test performance in MS'ers, with few studies focusing on the role of anxiety and ...

25 Aug 2011
"It is clear that this poll was quite divisive with some favouring cognition and others physical disability." "The issue here is that early in MS when the accumulation of physical disability is too slow to be used in clinical trials we ...
09 Jun 2012
Cognitive dysfunction have been traditionally described as heterogeneous, but more recent studies suggest that there is a specific pattern of MS-related cognitive dysfunction. With the advent of disease-modifying medications ...
31 Jul 2011
Results: In this study a significant correlation was found between total lesion volume (normal and abnormal appearing tissue) and general cognitive dysfunction, verbal intelligence, mental processing speed, visual problem ...
12 Aug 2011
Objective: This study assessed whether abnormalities on functional magnetic resonance imaging (fMRI) are related to cognitive function in people at presentation with clinically isolated syndrome (CIS) suggestive of MS.

15 Aug 2011
I think that cognitive impairment is largely ignored in MS studies and research but I don't think it's helpful to try to promote the importance of one set of symptoms over another. If it were possible to choose only cognitive or ...
24 Aug 2012
Facing the Cognitive Challenges of Multiple Sclerosis is a courageous and compelling personal account of one man's anguishing struggle with this aspect of the disease. It was written for the silent majority of MS patients who ...
01 Sep 2012
METHODS: A cross-sectional study was undertaken in which a consecutive sample of 68 MSers completed neuropsychological testing with the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery.
19 Jul 2012
An international expert consensus committee recently recommended a brief battery of tests for cognitive evaluation in multiple sclerosis. The Brief International Cognitive Assessment for MS (BICAMS) battery includes tests of ...

20 Jun 2012
BACKGROUND AND PURPOSE:Cognitive impairment is a common, disabling symptom of MS. We investigated the impact of cerebral perfusion and brain and lesion volumetry on cognitive performance in 45 patients with ...
08 Jul 2012
ACD are known for their deleterious cognitive effects in older individuals; however their potential impact on cognition has received less attention in the context of MS. Objective: To explore possible detrimental effects of ...
17 Jul 2012
In response to the lack of awareness in relation to MS-related cognitive impairment (see the results on the right of the current poll) we are participating in a new study to standardise the Brief International Cognitive Assessment ...
23 Oct 2012
... years) and 45 benign MS patients (EDSS ≤ 3.0, disease duration ≥ 15 years, normal cognition) for 6 years, with EDSS evaluations every 6 months and brain magnetic resonance imaging (MRI) at baseline and then yearly.

23 Jun 2011
One of the most commonly prescribed drugs for overactive bladders is oxybutynin; this drug is an old generation drug that penetrates into the brain and affects cognition. Oxybutynin has been been shown consistently to impact ...
09 Sep 2012
"It is clear that ginkgo does not help MSers with cognitive impairment. Therefore if you are taking ginkgo for cognition problems you should seriously consider stopping; it will save you money." Other posts on nutriceuticals you ...
07 Sep 2011
Global cortical thickness was lower in RRMS'ers with epilepsy (2.12±0.19 vs 2.35±0.14mm; p<0.001), and this group also showed a decline in cognition (cognitive score 10.9±6.3 vs 6.2±3.5; p<0.001). 4. After 3years the ...
10 Nov 2011
Using a data driven approach based on the strength of a salient pattern of cognitive pathology, we identified distinct brain networks that exhibit increases in functional connectivity despite the presence of strong and diffuse ...

29 Oct 2012
Background: Self-report measures of cognition have consistently been shown to correlate better with depressed mood than neuropsychological test performance in MS'ers, with few studies focusing on the role of anxiety and .
27 Dec 2011
Objective: To recommend a brief cognitive assessment for MS that is optimized for small centers, with one or few staff members, who may not have neuropsychological training and constructed to maximize international use.
19 Jul 2011
We use the test to assess the impact of treatments on cognition. The test is part of a battery of tests that form the MS functional composite or MSFC. The MSFC is another measure we use to assess disability progression or ...
06 Feb 2012
OBJECTIVE: To evaluate cognitive changes in a cohort of radiologically isolated syndromes (RIS) suggestive of MS and to assess their relationship with quantitative MRI measures such as white matter (WM), lesion loads, and ...

1 comment:

  1. Prof G, with all due respect, you seem to be one of those doctors that advocates taking a pill for all that ail an individual. One of the biggest problems we have as a society is that of popping pills at will because doctors believe to be normal.

    I bet if an MSer comes to you because they're feeling blue, the first thing you'd do is prescribe them anti-ds. Wouldn't getting outside or being with family be a better prescription?

    DMTs are still unproven to stop progressive MS. You even admitted cases of RRMSers on Alemtuzumab developing SPMS. We are years away from government greenlighting aggressive early treatment for MS. Jesus Christ, the Scottish parliament won't even dispense vitamin D tablets to kids even though the case for doing so is potent, not to mention cheap as chips.

    Early aggressive treatment with expensive DMTs will never happen in Britain. The costs are way too much and Government does not think long term. Government has a very blunt way of doing things and merely thinks on 5 year time spans

    Now let’s say some clever man discovers a remyelination drug that actually works. There is every possible chance that such a treatment will only be given to progressive MSers and not RRMSers. Why? Well, because they already have drugs and aren’t thought to be actively demyelinating. There are more RRMSers in Britain than progressive, therefore, the costs of giving it to everyone will unsustainable, even though it’s the right thing to do.

    I actually think that those in MS administration need to think long and hard about the future. All indications point to great discoveries being made in terms of treating all forms of MS. Many will benefit from combination therapies and you need a plan allowing that to happen. We need drugs to control immunological activity, slow/ stop progression and activate remyelination. These drugs should be in conjunction, not either or.

    In the meantime, we need a reality check on access to drugs for MS. They are simply not good enough, not even the newer one which can be deadly. Early aggressive treatment will not be a reality; therefore, what is your plan B? Also, stop handing out medicine like it’s candy. Drugs are not always the answer, especially not in MS.

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