Saving Brain: cognitive decline in MSers 18-year follow-up

Saving Brain: is it time to shift our treatment goals in MS? #MSBlog #MSResearch

"It is about a year since I started the campaign to rebrand MS as a dementia; i.e. a preventable dementia. The reason for doing this was to make people, in particular the regulators and payers, about the hidden burden of this disease and shift the focus to preventing progressive cognitive impairment in MS. I think this campaign has been successful because it has generated debate, which is what I wanted it to do, and it coincided with the beginning of a shift in the way regulators are thinking about MS. For example, it is very reassuring to have a very effective DMT available as a first-line agent for those MSers with active disease who want maximum disease control early on the course of the disease. A year ago this position was unimaginable in Europe."

"The main concern that has arisen with rebranding MS a dementia is that the community thinks it will be stigmatizing. I agree with them, but I still think we need to keep cognitive impairment high-up on the MS agenda. Cognitive impairment is the main reason why MSers have difficulty keeping their jobs earlier in the disease and it is the main driver of mental fatigue. The following study is small, but illustrates the problem of cognitive impairment in MSers. At the start of interferon-beta-1a (Avonex) therapy only 41% of MSers were cognitively impaired. However, after 18 years of follow-up on treatment that number increased to 59%. I wonder how much higher than 59% it would have been without interferon-beta-1a treatment? Interferon-beta-1a has been shown, albeit is a small sub-study, to delay the progression of cognitive impairment in MS. Data has recently emerged that cognitive impairment correlates with brain atrophy or brain volume loss. It would have been nice to see this included in this study."

"This study demonstrates how important it is for us to be focusing on Saving Brain and preventing progressive cognitive impairment in MS. To do  this we need to refocus our treatment goals to include cognitive impairment. Why wouldn't we?"


Brains are beautiful!

Strober LB et al. Cognitive impairment in multiple sclerosis: An 18 year follow-up study. MSARDS epub

Background: Cognitive impairment occurs in 40–65% of MSers. Less is known about the rate and pattern of cognitive decline over the course of the illness.

Objective: To examine long-term changes in cognition among patients enrolled in the phase III clinical trial of intramuscular interferon beta-1a (IM IFNβ-1a).

Methods: Twenty-two MSers underwent a longitudinal investigation comparing neuropsychological test performance at study entry and 18-year follow-up.

Results: Over the 18 year interval, significant declines were observed on measures of information processing speed, simple and complex auditory attention, episodic learning and memory, and visual construction. Nine MSers (41%) were found to be cognitively impaired at study entry. At follow-up 13 MSers (59%) were cognitively impaired. While both the impaired and unimpaired patients at baseline experienced declines on these measures, only one measure, the Symbol Digit Modalities Test (SDMT), demonstrated a group (cognitively impaired versus intact at baseline)×time interaction. This interaction was characterized by a steeper decline in the unimpaired than the impaired group at baseline.

Conclusions: Over an 18 year period, our results suggest that cognitive impairment in MS progresses, with declines being most evident on measures known to be most sensitive to MS-related cognitive difficulties both cross-sectionally and longitudinally.

CoI: multiple

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