Is it not time to start measuring cognition in routine clinical practice? #ClinicSpeak #AAN2017
As promised to several people who have come up to me at the AAN; the following are my slides from the satellite symposium on MS and cognition. In my talk, and slides, I make a strong case for measuring cognition in routine clinical practice. If you don’t measure and monitor it how can you address it in clinical practice?
To help I have also asked Biogen to make available their iPad based Processing Speed Test (PST), which is a 2 minute version of the SDMT (single digit modality test), which is rapidly becoming the mainstay of cognitive testing in MS. This could be the game changer we need.
One commentator made the point that if you measure cognition and its getting worse what can you do about it? Several things; firstly you can assess whether or not it is related to MS disease activity, which may require starting or switching therapy. Secondly, it may be related to some reversible factor, for example a concomitant medications that affects cognition, e.g. anti-cholinergics, or even a cognitive relapse. Thirdly, if you do detect worsening cognition you can also counsel patients and offer them help, for example cognitive rehabilitation. People with MS who have worsening cognition may factor in this information into certain life choices, for example, whether or not to register for a particular educational course or not to apply for a specific job. Some patients may use the knowledge to change their work and life status.
I also made the point that why should we treat cognition differently to other MS outcomes, for example the EDSS and walking speed. PwMS know that they are physically deteriorating, why shouldn’t they have the option of knowing that their cognition is deteriorating? To make the latter point an Italian colleague of mine sent me the following quotes:
‘Omnia metire quaecumque licet et immensa ad mensuram tempestive redige’ or ‘measure what is measurable and render measurable what is not’, which has been attributed to Galileo. The phrase is the motto of Franz Halberg, the father of modern Chronobiology and sounds very similar to Lord Kelvin’s: ‘When you can measure what you are speaking about, and express it in numbers, you know something about it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind; it may be the beginning of knowledge, but you have scarcely, in your thoughts advanced to the stage of science’.