Cognitive decline in early MS

Cognitive impairment in early MS. Time is brain. #MSBlog #MSResearch

Epub: Hankomäki et al. The progress of cognitive decline in newly diagnosed MS patients. Acta Neurol Scand. 2013 Jun 15.

OBJECTIVES: Cognitive impairment occurs in multiple sclerosis already in the early stages of the disease. Less is known about the evolution of cognitive decline, especially in newly diagnosed MSers. The results of existing studies are contradictory in that both cognitive preservation and progressive deterioration have been reported. The purpose of this study was to examine how cognitive impairment evolves over time in the early stages of MS.

MATERIAL AND METHODS: At baseline, the participants were 36 newly diagnosed MSers and 37 controls. A group of 30 MSers were followed longitudinally at a mean test-retest interval of 6.1 years. The test battery covered attention, information processing, memory and learning, verbal and motor functions and reasoning.

RESULTS: There was a significant decline in divided attention (dual task) and information-processing speed (SDMT) at follow-up, but no significant deterioration in overall cognitive performance.

CONCLUSIONS: Overall cognitive functioning remained quite stable during the 6-year follow-up, whereas divided attention and processing speed deteriorated. However, deterioration in performance on the SDMT and the dual task does not seem to indicate more extensive cognitive deterioration. Given the impact of cognitive impairment on MSers’ quality of life, early detection of its occurrence in MS is extremely important.

“This small study reiterates that cognitive impairment is there early and that if you institute early treatment you can delay the onset of progressive cognitive impairment. Fortunately Finland does not have a problem with access to DMTs early in the course of the disease and most MSers with CIS get offered treatment. Unlike the UK where you have to have at least 2 clinical attacks or relapses in a 2 year period before accessing first-line treatments. Current Department of Health guidance does not allow us to take into account sub-clinical disease activity on MRI. This is a great pity as we know that this activity is associated with a poor outcome. Time is Brain.”

CoI: multiple

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.


  • "Unlike the UK where you have to have at least 2 clinical attacks or relapses in a 2 year period before accessing first-line treatments."

    Wow, I didn't realize you could have a brain full of lesions and still not get a first line DMT in the UK (I'm in the US). I thought the issue was that it was hard to escalate to second-line drugs. No wonder this is your battle cry. That's crazy. Nobody should have to wait around to see what their next attack is going to be.

    • Exactly, Cat. Which is why we're doing our damnedest to change the situation before it's too late for another cohort of MSers.

    • Well, forgive me if I get carried away here, but in the US, letters to my senator and petitions are easily ignored. What works far better is a good investigative piece of journalism or a documentary film.

      For example, I live in a state that is in the midst of a new oil boom. And although the film Gasland was not about my state, or even about oil, it is cited frequently as we try to address the environmental consequences of hydraulic fracturing as a means resource extraction. Gasland informed and sparked the backlash here. Otherwise, the oil companies would be framing the entire discussion about fracking today (and that's bad).

      I think you're in an excellent position to get the attention of a journalist with this story.

      You can provide expertise, and you can probably provide one or two excellent subjects for the emotional tug stories like this need to get people's attention. You likely have good contacts in other countries who can show how care works effectively in other countries.

      You can help the journalist tie it to a bigger picture of people all over the UK not getting the care they need because bean counters are driving policy from way behind the front lines. And point out the irony that it's actually more expensive to everyone when you treat people who have progressed.

      Have you all talked about taking a media approach to this? Journalists are always hungry for a meaty story, at least in the US.

      I'm a freelance writer, working for software, academic (social science), and advertising clients. If I can work with you to write you up a news release or something to try to get some attention to the cause, let me know.

  • wow..take Cat up on this or let us broadcast this wider to get attention Please!I am now a board member of Shropshire Disability Network and would be happy to test opinion.
    I am biased as I am a 56 yr old MSer who was told I had it at 30 and nothing given to me, resulting in increasing disability from age 52. This has to be done to stop further inactivity affecting another generation

By Prof G



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