Cognitive Dysfunction in MS: Bridging the Gap Between Neurocognitive Deficits, Neuropsychological Batteries and MRI

Erica Grazioli; Ann E Yeh; Ralph HB Benedict; Joy Parrish; Bianca Weinstock-Guttman

Disclosures

Future Neurology. 2008;3(1):49-59. 

In This Article

Therapeutic Interventions for Cognitive Impairment in MS

Early treatment with disease-modifying therapies may reduce cognitive impairment or slow down the progression of cognitive deficits in MS patients. This parallels the beneficial effects of these therapies on physical and MRI parameters.[87] Positive results have been documented on memory and attention with interferon (IFN) therapy, primarily with weekly IFN-ß 1a, although certain benefits were seen also with IFN-ß 1b.[88,89,90] However, no clear benefit on cognitive status was seen with other immunomodulatory interventions known to positively influence the MS disease process, such as glatiramer acetate and intravenous immunoglobulin.[91,92]Differences in study design as well as patient heterogeneity may have influenced the study results.[93]

At present, little information concerning the efficacy of symptomatic treatment for cognitive deficits in MS is available. Early pilot studies, conducted on small cohorts of MS patients, have shown that physostigmine may improve memory.[94,95] In two other studies, the acetylcholinesterase inhibitor donepezil was shown to improve learning and memory in MS patients.[96,97]

With regard to complementary and alternative medicine, an exploratory pilot study of 22 MS patients taking gingko biloba (GB) demonstrated benefits primarily on fatigue.[98] A more recent, larger study of GB showed a treatment effect on the Stroop test, suggesting that GB may have beneficial effects on mental flexibility and interference susceptibility.[99]

Studies regarding cognitive rehabilitation in MS, including cognitive retraining and psychological intervention, are limited. Various studies have reported improvement of cognitive performance as a result of specific attention-training tasks or NP counseling.[100,101] These studies support the idea that a specific cognitive intervention is superior to a nonspecific treatment.

In 2006, the National MS Society task force on Cognition in MS recommended instituting compensatory strategies for pre-existing NP deficits in MS. This may include cognitive structuring, substitution strategies, memory strategies and organizational strategies, among others.[102] Although there is conflicting evidence regarding the benefits of compensatory and restorative cognitive therapy in MS, the majority of studies show at least short term benefit from the use of these strategies.[103]

Cognitive rehabilitation should be one part of a comprehensive treatment strategy that begins immediately with MS diagnosis. Practitioners should inquire about potential contributors to cognitive impairment, such as sedating medications, sleep disorders and other underlying medical conditions, such as infections or thyroid disorders, and address these issues if present. Cognitive therapy should focus primarily on the patient, but it should also include family members and caregivers. Rehabilitation should embrace cognitive strategies, pharmacologic treatment, treatment of psychopathology and help with psychosocial difficulties.[102]

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