Abstract
About half of patients with multiple sclerosis exhibit cognitive impairment which negatively affects their quality of life. The assessment of cognitive function in routine clinical practice is still undervalued, although various tools have been proposed for this reason. In this article, we describe the potential benefits of implementing cognitive assessment tools in routine follow -ups of MS patients. Early detection of changes in cognitive performance may provide evidence of disease activity, could unmask depression or medication side-effects and provide suitable candidates for cognitive rehabilitation. Since apathy and cognitive deficiencies are common presenting symptoms in Progressive Multifocal Leukoencephalopathy, we discuss the utility of frequent monitoring of mental status in multiple sclerosis patients at increased risk. In addition, we propose a relevant algorithm aiming to incorporate a systematic evaluation of cognitive function in every day clinical practice in multiple sclerosis.
Highlights
Multiple Sclerosis (MS) is a chronic demyelinating disease of the central nervous system
Both the British National Institute for Health and Care Excellence (NICE) [82] and Academy of Neurology (AAN) [4] suggest at least an annual routine assessment for these patients, but considering the cost, a fast screening by the treating physician could provide an alternative to patients who cannot afford a full neuropsychological evaluation
More frequent assessment should be reserved for patients with high progressive multifocal encephalopathy (PML) risk or high disease activity, keeping in mind that practice effects may be augmented by frequent testing
Summary
Multiple Sclerosis (MS) is a chronic demyelinating disease of the central nervous system. The American Academy of Neurology (AAN) underlines the fact that clinicians are often unable to detect cognitive deficits in everyday clinical practice [4] and emphasizes the importance of cognitive assessment as part of the everyday clinical examination - something that neurologists tend to forget or underestimate. The Expanded Disability Status Scale (EDSS) is widely used in order to assess the neurological symptoms of an MS patient. In this scale, a sub score of cognitive function is included. A recent study has demonstrated that in a significant proportion of patients, the score of cognitive function in EDSS and subsequently the total EDDS score changes, after examination with a brief cognitive assessment battery [5]. The use of assessment tools for cognitive function, could provide a more accurate evaluation of disease severity. Identifying them in the frame of neurological examination could be as useful as identifying other neurological symptoms for the holistic treatment of the patient
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