Tagcognitive impairment

Swiss-cheese

Barts-MS rose-tinted-odometer: zero-stars What do you say when I colleague chastises you for stating the fact that MS is potentially a ‘preventable dementia’? This particular colleague was clear that there is no need to draw any parallels between MS and other neurodegenerative diseases because of the negative connations that the term dementia has. I had to remind him that MS ticks all...

#ThinkCognition: how precious is my brain?

Barts-MS rose-tinted-odometer: ★ As someone with MS do you worry about how you are going to cope with ageing and old age?  As MS shreds both your brain and cognitive reserve will MS bring forward and accelerate the ageing process and the time when you may develop neurodegenerative diseases such as Alzheimer’s disease? These are all hypotheses but are very relevant to people with MS (pwMS) and...

Grey matter, matters

How big is your grey matter iceberg?  As you are aware, MS is an iceberg, with most of the MS disease activity and resultant damage being hidden. The study below expands the concept of the MS iceberg to the cerebral cortex or grey matter. Most lesions (~80%) found at post-mortem in the grey matter are not detected using specialised MR imaging. Please note that post-mortem MRI imaging in more...

You don’t have to lose your marbles by taking a statin

Barts-MS rose-tinted-odometer ★★★★★  As you know high-dose simvastatin 80-mg per day is being tested in a phase 3  trial in the UK (MS-STAT2). I have referred several patients to participate in this study. Despite this, there has always been a worry about this treatment strategy because statins have been associated with changes in cognition, which is why I have always said that if I needed a...

Chicken or Egg?

Rose-tinted-odometer = ★ Brain Health is a major theme of this blog. Why?  We think that to ‘maximise brain health for the life of a person with MS (pwMS)’ we need to manage MS actively and holistically and promote brain-healthy behaviours. The ‘we’ here is not only HCPs but you and society, which includes regulators, politicians, educationalists, pharma, etc.    Another thing...

My prevention hat

About three years ago I started wearing another hat; a preventive medicine hat. We started the Preventive Neurology Unit within our medical school focusing on MS, Parkison’s Disease and all-cause dementia. The unit is growing rapidly and gaining momentum. It was with great pride that I was able to attend and speak at first symposium. I have uploaded my slides for anyone who wants to download them...

Brain volume loss in MS

Cognition (thinking, memory and learning) is known to be affected in MS. This is more so in progressive MS. In a study last year, it was found that those with more structural damage to the brain at baseline were more likely to have cognitive issues. And more likely that not cognitive issues were encountered if the brain cortex was involved (the area comprised of the surface of the brain where...

#ThinkCognition

If you have MS-related cognitive impairment would you want a treatment to improve your cognitive function?  The study below shows that dalfampridine, or fampridine, improves cognition in particular processing speed in MSers with cognitive impairment. Importantly the improvement on the SDMT (Symbol Digit Modalities Test) was greater than 4 points, which is considered clinically meaningful in that...

Guest-post: MS mindset

Many people with MS experience cognitive difficulties (poor concentration, trouble remembering, “cog fog”…). We know quite a bit about how these difficulties play out on formal tests that psychologists use. But we are less good at understanding the experience of people with MS with cognitive difficulties. There are a number of questionnaires that report cognitive difficulties that have been...

Old age; how is it going to affect me?

Is ageing a disease? It is if you have MS. We have been making the argument for moving our treatment target in MS to focus on old age; i.e. how do we your HCPs get you to old age with enough brain to deal with the ravages of age-related cognitive impairment? Mechanisms of neuronal loss in MS It is clear that your brain and cognitive reserves are what protects you from the ‘normal age-related...

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