The sorry state of treatment of cognitive impairment

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#MSBlog: We need effective treatments for cognitive impairment!

Epub: Amato et al. Treatment of cognitive impairment in multiple sclerosis: position paper. J Neurol. 2012 Nov.

Cognitive impairment in MS is common, debilitating and burdensome. Key evidence from trials was reviewed to enable recommendations to be made to guide clinical practice and research. Behavioural and pharmacological interventions on cognition reported in published studies were reviewed. Most studies evaluating behavioural treatment for impairment in learning and memory, deficits of attention and executive function have demonstrated some improvement. Controlled studies in RRMS indicate interferon (IFN) β-1b and IFN β-1a were associated with modest cognitive improvement. 


“Surprised?”

The effects of symptomatic therapies such as modafinil and donepezil are inconsistent. Most studies yielding positive findings have significant methodological difficulties limiting the confidence in making any broad treatment recommendations. There are no published reports of glatiramer acetate, natalizumab and fingolimod being effective in improving cognition in controlled trials. The effects of disease modifying therapies in other forms of MS and clinically isolated syndrome have not yielded positive results. Data linking behavioural therapy, symptomatic treatment or disease modifying treatment, to either reducing cognitive decline or improving impaired cognition are limited and inconsistent. The treatment and prevention of cognitive impairment needs to remain a key research focus, identifying new interventions and improving clinical trial methodology.


“In addition to progressive MS symptomatic treatments on the next frontier in improving the live of MSers. Top of the pile are fatigue and cognitive impairment. Both of these problems are the main driver of early disability in MSers, these manifest in the unemployment rate and inter-personal relationship breakdowns that are much higher than you would expect for the level of physical disability. We need to focus on the hidden symptoms of MS if we are to make inroads into the socioeconomic impact of this disease.”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

4 comments

  • At the Asian MS gathering lasr summer in Maidenhead I met a guy that had to give up work because of cognative issues, though his physical disabilities were less pronounced. I use crutches and struggle to walk yet my brain cognition is largely uneffected, though I too had to give up work due tp physical disability.

    What I'm trying to say is that MS disables the sufferer in many different ways, some of which aren't recognised.

    • I agree; the issues each individual has differs, but there is a common theme. MS is a bad disease and in general, given sufficient time, it will disable the majority of people with the disease.

  • I also wonder if people with cognition & memory problems have less physical problems and vice-versa. I have more physical issues than cognitive ones I'd say, altough it's difficult to measure I admit.

    • Not sure about this; MS affects the central nervous system in many areas and hence most MSers will develop both cognitive and physical impairments. It is all about time. The challenge we face is preventing this from happening.

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