Neuros are Monkeys when it comes to assessing cognitive problems

Romero K, Shammi P, Feinstein A. Neurologists׳ accuracy in predicting cognitive impairment in multiple sclerosis. Mult Scler Relat Disord. 2015; 4:291-5.

Cognitive impairment affects approximately 40-70% of MS patients. As management of MS typically begins with, and is co-ordinated by neurologists, they are often the first to raise concerns about a patient׳s cognitive functioning. However, it is not known how accurate the neurological examination is in identifying cognitive impairment. To this end, we conducted a retrospective chart review of 97 MS patients referred by neurologists for neuropsychological assessment based on suspected cognitive impairment. Patients were classified as globally-impaired or intact according to failure on 2 or more of 11 cognitive indices comprising the MACFIMS, a recommended neuropsychological battery for MS. 


. Cognitively intact patients when compared to those who were impaired had higher levels of education and were less likely to have mood disturbances. These findings indicate the clinical interview and standard neurological examination are not sufficiently sensitive to detect cognitive impairment in MS, and suggest the need for a brief, accurate cognitive screen to complement routine clinical evaluation.
ProfG and NDG have not commented on this one, so they are clearly expecting some teasing about the ability of Neuros to spot cognitive problems. 

When you are a researcher you are told that MS is a just movement disorder and that it is a white matter disease. However, since attending "MS life" it has struck me how easy it was to spot cognitive/behavioural problems in some people with MS and made me think, how can MS just be considered to be a movement problem? Likewise a few minutes of looking properly and you can easily find grey matter problems, so how to neuros and pathologists get it so wrong. 

In this paper they look at who was sent for cognitive testing and neuros got it wrong about half the time. So maybe they need to listen rather than flip a coin to see who gets MACFIMS Minimal Assessment of Cognitive Function in MS. A 50:50% chance of getting it right or wrong is sometimes called a monkey score as this is what a monkey would get. 

Maybe it is time to have simple tests on computers or smart phones so we can remove the monkey from the neuro.

Would MS specialists get it wrong so
many times?

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