Self-reports of executive functioning in multiple sclerosis: to trust or not to trust.

Abstract

Cognitive impairment is a disabling symptom in multiple sclerosis (MS), occurring in 45–65% of the patients [1]. It involves information processing speed, complex attention, (episodic) memory and executive functions. In early relapsing–remitting MS, the incidence of cognitive symptoms is 30%, and 4 years after diagnosis one out of three relapsing–remitting MS patients has cognitively declined. In this relatively young patient group, it has been shown that worsening of cognitive symptoms and a decline on neuropsychological testing over time are predictive of a deterioration in employment status. The morbidity associated with MS will gradually increase as a result of these cognitive deficits, with adverse effects relating to the patient’s ability to perform basic daily tasks, to work, socialize, form relationships and pursue recreational activities [2]. Therefore, early, accurate detection of cognitive dysfunction is imperative, enabling strategies to be put in place to compensate these associated limitations. The best way to elicit cognitive difficulties is with neuropsychological testing. However, neuropsychological assessment is time consuming and may not always be easily accessible. A screening tool would be ideal to assess which patients need more extensive neuropsychological assessment [2,3]. The question is whether self-reports of cognitive performance can be useful to address this issue. How accurate are patients with MS when it comes to assessing their own cognition? In the literature, there is a debate on whether self-reports are adequate for assessing cognitive impairment in MS patients. The relationship between subjective (self-reported) cognitive performance and objective or informant-rated cognitive performance may be mediated by psychological factors such as depression, other neuropsychiatric symptoms and coping mechanisms [3]. Whereas underestimated cognitive performance has been associated with depressive symptoms, over estimation, however, has been linked with less depression, conscientiousness, an increase of cognitive impairment, disinhibited euphoric behavior and underemployment. From a group of 718 patients we selected 128