MS Research Update: New MS tests could improve predictions of cognitive impairment

May 14, 2013 Pavle Repovic, MD, PhD

Cognitive dysfunction in multiple sclerosis (MS) is a recognized, but poorly understood phenomenon. Detection of cognitive dysfunction is hampered by the fact that cognitive testing is often long, sometimes costly and at times frustrating for patients. A brief, acceptable screening tool for cognitive dysfunction in MS is lacking.

A new study shows potential progress toward such a tool. Authors of a paper published in the Multiple Sclerosis Journal describe a 10-minute battery of computerized tests that was able to identify with fairly good sensitivity those patients who experienced cognitive impairment. This study, like several other similar efforts, awaits verification before they are more broadly accepted. It is hoped that such tools will come at no or minimal cost to the patients.

Identifying cognitive dysfunction early may be important because, according to a second study published in Neurology, early treatment is more likely to succeed. The study followed 35 patients over 1.6 years. Patients with higher cognitive reserve (combination of education, IQ and mentally-stimulating activities done for fun) performed better on initial cognitive tests.

However, the cognitive reserve did not seem to confer protection from decline in cognitive functioning over time. Instead, age and brain atrophy were the best predictors of cognitive decline. Interestingly, at the start of the study, those patients with higher cognitive reserve were still able to overcome the brain atrophy, but that ability was lost over time.

Consequently, it may be possible that "boosting" one's cognitive reserve early on through mentally stimulating activities (crosswords, puzzles, etc.), physical exercise and social engagement may compensate for brain atrophy, up to a point.

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