Sunday, 1 March 2015

MS as a Dementia.. its all in a word

Westervelt HJ. Dementia in Multiple Sclerosis: Why Is It Rarely Discussed?Arch Clin Neuropsychol. 2015 Jan 24. pii: acu095. [Epub ahead of print]

Cognitive deficits in multiple sclerosis (MS) have been well studied in decades of MS research. Severe deficits are acknowledged, but the frequency is minimized in the literature, and there is a striking lack of discussion of the presence of a dementia state in MS. 

Never one to avoid controversy, ProfG has termed MS as the "shredder" and a "dementia" and has been heavily chastised for this. 

Although MS is often described as a movement problem, it is being increasingly realised that cognitive deficits can be among the earliest symptoms described in people with MS and can be reasonably common.

In this article it argues that whilst some doctors may use“dementia” interchangeably with “cognitive impairment,” its use in circles of MS is relatively rare. One reason, may be that “dementia” is often thought of as being associated with ageing or the aged and is often used among lay people as being synonymous for Alzheimer's Disease.  


Another factor, which likely contributes to the lack of identification of a dementia state in MS is the growing and intense distaste for the term itself. Whilst the label was not intended as derogatory, over time the pejorative connotation has taken hold, and overshadows the intended medical meaning. People do not like to be labelled.
It is argued that replacing the term “dementia” may ultimately be a short-lived prospect. Terminology for conditions affecting intellect, cognitive capacity, psychological well-being, or behavioural control seems ultimately doomed for pejorative misuse in the vernacular, such as  
“imbecile,” “idiot,” and “moron” were once medical terms that became corrupted over time and it would be unthinkable for a neuro to refer to their patient as an "Imbecile". 

It was suggested that descriptive terms that can be shorted to non-catchy acronyms may fare best in regard to avoiding lay corruption (e.g., varying degrees of MS-Associated Neurocognitive Disorder =MSAND).

What do you think?