BACKGROUND:Cognitive impairment occurs from the early phases of multiple sclerosis (MS), and more frequently affects secondary progressive (SP) subjects than relapsing-remitting (RR).
OBJECTIVE:To investigate relationships between cognitive dysfunctions in newly diagnosed RRMS, and long-term MS-related outcomes.
METHODS:The present 10-year retrospective longitudinal study included 155 RRMS subjects, tested with the Rao Brief Repeatable Battery at MS diagnosis. The reaching of Expanded Disability Status Scale (EDSS) 4.0, and the SP conversion were recorded.
RESULTS: 67 subjects (43.2%) reached EDSS 4.0, and 34 subjects (21.9%) converted to SP during a follow-up period of 10.0±1.8 years. Subjects with cognitive impairment at diagnosis had a rate of reaching EDSS 4.0 more than three times greater (p<0.001; HR=3.183), and a rate of SP conversion more than two times greater, as compared to cognitively preserved subjects (p=0.008; HR=2.535). In particular, better scores in the Selective Reminding Test-Delayed Recall and in the Symbol Digit Modalities Test at baseline were associated with lower SP conversion rates during the follow-up period (p=0.018; HR=0.835; and p=0.001; HR=0.941, respectively).
CONCLUSION: Cognitive impairment, with particular involvement of processing speed and memory, predicts disability progression and SP conversion in newly diagnosed RRMS, highlighting the importance of cognitive assessment from the beginning of MS.
I guess it is not rocket science but this study says if you have cognitive impairment early in disease, you have a poorer outlook for the future, likewise there are many studies saying if people have lots of relapses early in disease had a poorer outlook too.
So during the time UK-based Neuros are “waiting and seeing” to keep NICE happy, its your brain being shredded, especially early when disease is often more active chomping on the cognitive and movement reserve. By the time you notice there is a problem maybe up to 80% of that reserve is gone, whilst waiting for MS to show itself. In the mice the first attack wipes out 15% of the nerves it is hardly noticed second attack another 5% goes as you start to see it another attack and another 5% goes, 40% gone and relapses burn out loose 0.1% now and you know big time as the reserve is gone.
Sadly to me it is economics and not biology due system we have allowed to generate. If there was an effective low cost alternative, to the current block buster, which there could be if people had a spine to stand up to the broken system or the power to change this, which is driving cost-based rationing, then could practice change?
In a couple of years that may change as patents on chemical DMT expire, but Copaxone patents were kept alive for 40 years….hats off to Teva Lawyers.
Are we happy that the UK has almost the worse uptake of DMT in Europe? Should we be more like Australia and now New Zealand and do early and effective and not sit on our bums and wait.
Whats in the brain health policy document, get it on tuesday