Cognition
Rosti-Otajärvi EM, Hämäläinen PI. Neuropsychological rehabilitation for multiple sclerosis. Cochrane Database Syst Rev. 2011 Nov 9;11:CD009131.
The aim of this review was to evaluate the effects of neuropsychological/cognitive rehabilitation in MS by conducting a systematic review. The review indicates low level evidence for the positive effects of neuropsychological rehabilitation in MS. Interventions included in the review were heterogeneous. Consequently, clinical inferences can basically be drawn from single studies.
He D, Zhou H, Guo D, et al. Pharmacologic treatment for memory disorder in multiple sclerosis. Cochrane Database Syst Rev. 2011; (10):CD008876.
This review aimed to assess the absolute and comparative efficacy, tolerability and safety of pharmacologic treatments for memory disorder in adult patients with MS. It concluded that there is no convincing evidence to support pharmacologic intervention as an effective treatment for memory disorder in MS patients. However, donepezil, Ginkgo biloba, memantine and rivastigmine resulted to be safe and well tolerated as adverse events such as nausea, diarrhoea, somnolence, and constipation were not frequent, while no serious adverse effects were reported.
Reuter F, Zaaraoui W, Crespy L, et al. Frequency of cognitive impairment dramatically increases during the first 5 years of multiple sclerosis. J Neurol Neurosurg Psychiatry. 2011; 82(10):1157-9.
The authors assessed a group of 24 clinically isolated syndrome (CIS) patients with high risk of developing MS. They showed that the frequency of cognitive impairment increases dramatically during the first 5 years following a CIS and that the cognitive status at year 5 was predictable by conventional MRI parameters recorded at baseline.
Motl RW, Gappmaier E, Nelson K, et al. Physical activity and cognitive function in multiple sclerosis. J Sport Exerc Psychol. 2011; 33(5):734-41.
This cross-sectional study examined the associations among physical activity, cognitive processing speed, and learning and memory in 33 persons with MS who underwent neuropsychological assessments and wore a physical activity monitor for 7 days.
Henry A, Tourbah A, Chaunu MP, et al. Social cognition impairments in relapsing-remitting multiple sclerosis. Int Neuropsychol Soc. 2011; 17(6):1122-31.
The aim of this study was to assess Theory of Mind (ToM) abilities and recognition of facial emotional expression in adults with MS. MS patients performed significantly worse than controls in emotion recognition and all ToM tasks
Demers M, Rouleau I, Scherzer P, et al. Impact of the cognitive status on the memory complaints in MS patients. Can J Neurol Sci. 2011; 38(5):728-33.
The objective of this study was to clarify why some patients overestimate while others underestimate their memory deficits. The results explain the contradiction in the literature. It is the mild group who overestimates, maybe because they are overly concerned by their deficits, whereas the cognitive impairments of the moderate/severe group lead them to underestimate and may make their self-assessment unreliable.
Akbar N, Honarmand K, Feinstein A. Self-assessment of cognition in multiple sclerosis: the role of personality and anxiety. Cogn Behav Neurol. 2011; 24(3):115-21.
This study aimed to investigate the role of personality and anxiety to self-report measures of cognition in patients with multiple sclerosis. Overall, patient self-reports of cognition did not correspond well to neuropsychological performance. Anxiety and conscientiousness contributed significantly to patients' perceptions of their cognitive failings and thus should be taken into account when addressing these complaints.
Negahban H, Mofateh R, Arastoo AA, et al. The effects of cognitive loading on balance control in patients with multiple sclerosis. Gait Posture. 2011; 34(4):479-84.
The aim of this study was to compare the effects of concurrent cognitive task (silent backward counting) on balance performance. Three levels of postural difficulty were studied on a force platform, i.e. rigid surface with eyes open, rigid surface with eyes closed, and foam surface with eyes closed.
Motl RW, Sandroff BM, Benedict RH. Cognitive dysfunction and multiple sclerosis: developing a rationale for considering the efficacy of exercise training. Mult Scler. 2011; 17(9):1034-40.
The consideration of exercise training is warranted based on evidence summarized in literature reviews and meta-analyses that (1) aerobic fitness, physical activity, and exercise training are associated with better cognitive function in older adults; and (2) exercise training has comparable effects on mobility and quality of life outcomes in older adults and persons with MS.
Sayao AL, Bueno AM, Devonshire V, et al. The psychosocial and cognitive impact of longstanding 'benign' multiple sclerosis. Mult Scler. 2011; 17(11):1375-83.
Despite remaining benign for 20 years, a significant proportion of patients progressed with further follow up. While neither depression nor patient-reported mental health quality of life was associated with EDSS progression, patients with longstanding 'benign' MS (EDSS ≤3 for 25+ years) had less fatigue, better physical quality of life and employment outcomes and infrequent cognitive impairment. Remaining benign over the long term, as defined by the EDSS, carried some advantages beyond ambulation.
Langdon DW. Cognition in multiple sclerosis. Curr Opin Neurol. 2011;24(3):244-9.
A broad overview of cognition in multiple sclerosis (MS) is provided, taking account of its impact on the lives of patients, how cognitive impairment relates to disease and magnetic resonance variables, which cognitive domains are most vulnerable, the influence of depression and fatigue and what treatment options are available.
McDonnell MN, Smith AE, Mackintosh SF. Aerobic exercise to improve cognitive function in adults with neurological disorders: a systematic review. Arch Phys Med Rehabil. 2011;92(7):1044-52.
This study aimed to evaluate whether aerobic exercise improves cognition in adults diagnosed with neurologic disorders. Of the 67 studies retrieved, less than half included cognition as an outcome, and few studies continued the aerobic exercise program long enough to be considered effective
Feaster HT, Bruce JM. Visual acuity is associated with performance on visual and non-visual neuropsychological tests in multiple sclerosis. Clin Neuropsychol. 2011; 25(4):640-51.
The objective of this study was to examine the relationship between visual acuity and cognition in MS. Poorer high-contrast, near, and low-contrast visual acuity were significantly associated with poorer performance on visual, non-visual, and motor-based neuropsychological tests. Neuropsychologists should be aware that poor corrected vision in MS is associated with poor performance in all cognitive and motor domains.
Honarmand K, Tierney MC, O'Connor P, et al. Effects of cannabis on cognitive function in patients with multiple sclerosis. Neurology 2011; 76(13):1153-60.
This cross-sectional study provides empirical evidence that prolonged use of inhaled or ingested street cannabis in patients with MS is associated with poorer performance on cognitive domains commonly affected in this population. Whatever subjective benefits patients may derive from using street cannabis (e.g., pain and spasticity relief) should be weighed against the associated cognitive side effects.
Arnett PA, Strober LB. Cognitive and neurobehavioral features in multiple sclerosis. Expert Rev Neurother. 2011; 11(3):411-24.
The literature on cognitive and neurobehavioral features in MS is reviewed, a commentary on the state of the literature is provided and suggestions are made for research directions over the next 5 years that would move the field forward significantly.
Cosio D, Jin L, Siddique J, et al. The effect of telephone-administered cognitive-behavioral therapy on quality of life among patients with multiple sclerosis. Ann Behav Med. 2011; 41(2):227-34.
127 participants with multiple sclerosis and depression were randomly assigned to either a telephone-administered CBT (T-CBT) or telephone-administered supportive emotion-focused therapy (T-SEFT) intervention. Patients assigned to T-CBT showed significantly greater improvements in quality of life compared with those assigned to T-SEFT.
Walker LA, Mendella PD, Stewart A, et al. Meaningful change in cognition in multiple sclerosis: method matters. Can J Neurol Sci 2011; 38(2):282-8.
Investigated whether different methods of evaluating cognitive change over time yield measurably different outcomes. Twelve cognitively impaired patients with clinically definite MS underwent neuropsychological testing. When tests were grouped according to theoretical constructs, analyses revealed change in processing speed. It was concluded that methodology has a significant impact on interpretation of longitudinal data.
Melanson M, Grossberndt A, Klowak M, et al. Fatigue and cognition in patients with relapsing multiple sclerosis treated with interferon beta. Int J Neurosci 2010; 120(10):631-40.
The effects of interferon beta on fatigue and cognitive deficits were assessed in 50 patients with relapsing multiple sclerosis. The data suggest that interferon beta may reduce fatigue and cognitive deficits in patients with relapsing multiple sclerosis
Demakis GJ, Buchanan RJ. Rated cognition in nursing home residents with multiple sclerosis: cross-sectional and longitudinal analyses. Disabil Rehabil 2010; 32(17):1438-46.
Results showed that nursing home residents with MS have significantly better cognitive functioning than non-MS residents and, over the first year of a nursing home stay, higher education and pain, but lower activities of daily living, predict poorer cognitive functioning.
Schultheis MT, Weisser V, Ang J, et al. Examining the Relationship Between Cognition and Driving Performance in Multiple Sclerosis. Arch Phys Med Rehabil 2010; 91(3):465-473.
Identifies cognitive predictors of driving performance after multiple sclerosis (MS). Concludes that information processing and visuospatial skills are predictive of driving performance among persons with MS. Furthermore, the findings raise questions regarding the appropriateness of the behind-the-wheel evaluation to evaluate driving difficulties accurately among individuals with MS.
Ouellet J, Scherzer PB, Rouleau I, et al. Assessment of social cognition in patients with multiple sclerosis. J Int Neuropsychol Soc 2010; 16(2):287-296.
Examined the capacity of patients with multiple sclerosis (MS) to attribute mental states to others and to identify cognitive abilities that subserve theory of mind (ToM). Results of the study provide some preliminary information on the effect of MS-related cognitive deficits on the ability to attribute mental states to others.
Stoquart-ElSankari S, Bottin C, Roussel-Pieronne M, et al. Motor and cognitive slowing in multiple sclerosis: An attentional deficit? Clin Neurolo Neurosurg 2010; 112(3): 226-232.
Action slowing is frequently observed in multiple sclerosis (MS) patients. Several factors may account for response slowing: motor, perceptual, cognitive deficits, global mental slowing. This study examined mechanisms accounting for action slowing in MS patients and showed that it is mainly related to (1) attentional deficit resulting in inability to maintain high level of rapid actions, and (2) subtle motor slowing even in patients without motor deficit on clinical examination.
Smestad C, Sandvik L, Landrø NI, et al. Cognitive impairment after three decades of multiple sclerosis. EurJ Neurol 2010; 17 (3): 499-505.
Study evaluated long-term outcome and the predictors of cognitive impairment in a cohort of patients with MS. After three decades of disease, half of the MS patients experienced reduced cognitive functioning; however, nearly one-third of the patients were only mildly disabled based on the EDSS. Younger onset age was associated with higher prevalence of cognitive impairment. A thorough evaluation of cognitive function in addition to EDSS is essential for evaluating long-term impairment in patients with MS.
Lyros E, Messinis L, Papageorgiou SG, et al. Cognitive dysfunction in multiple sclerosis: The effect of pharmacological interventions. Int Rev Psych 2010; 22 (1): 35-42.
Reviews studies on cognitive effects of pharmacological treatments in MS. There is evidence for a possible beneficial effect of immunomodulatory treatments, particularly of interferons, and also of acetylcholinesterase inhibitors on cognition in MS, which, however, requires evaluation in larger, multi-centre, longitudinal studies. Methodological issues and future prospects regarding the investigation of this issue are also discussed.
Messinis L, Kosmidis MH, Lyros E, et al. Assessment and rehabilitation of cognitive impairment in multiple sclerosis. Int Rev Psych 2010; 22 (1): 22-34.
Provides an overview of the current state of knowledge related to cognition in MS and on the optimal approach to neuropsychological assessment of this population. It then focuses on the pharmacological and other treatment options available for MS patients with, or at risk for developing, cognitive impairment.
Flavia M, Stampatori C, Zanotti D, et al. Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis. J Neurol Sci 2010; 288(1-2):101-105.
Evaluate effectiveness of a computer-based intensive training program of attention, information processing and executive functions in patients with clinically-stable relapsing-remitting (RR) multiple sclerosis (MS) and low levels of disability. Concludes that intensive neuropsychological rehabilitation of attention, information processing and executive functions is effective in patients with RR MS and low levels of disability, and also leads to improvement in depression.
Johnson KL, Bamer AM, Yorkston KM, et al. Use of cognitive aids and other assistive technology by individuals with multiple sclerosis. Disabil Rehabil: Assistive Technology 2009; 4 (1):1-8.
Investigates the use of assistive technology AT, unmet needs for AT, and examine correlates of use of memory aids and cognitive strategies among individuals with multiple sclerosis MS. Concludes that use of AT for memory is widespread and further research should be conducted on efficacy of AT. Healthcare providers are urged to ask about memory AT and make appropriate referrals.
Patti F, Amato MP, Trojano M, et al. Cognitive impairment and its relation with disease measures in mildly disabled patients with relapsing-remitting multiple sclerosis: Baseline results from the Cognitive Impairment in Multiple Sclerosis (COGIMUS) study. Mult Scler 2009; 15(7): 779-788.
Studies the prevalence of cognitive impairment and its relation with MRI disease measures in mildly disabled patients with RRMS. A total of 550 patients were enrolled, 327 of whom underwent MRI assessments. Concludes that cognitive impairment occurs in approximately one-fifth of mildly disabled patients with MS and is associated with specific MRI disease measures. Assessment of cognitive function at diagnosis could facilitate the identification of patients who may benefit from therapeutic intervention with disease-modifying therapies to prevent further lesion development
Harel Y, Appleboim N, Lavie M, et al. Single dose of methylphenidate improves cognitive performance in multiple sclerosis patients with impaired attention process. Journal of the Neurological Sciences 2009; 276 (1-2): 38-40.
Twenty-six people with MS with impaired attention were randomly assigned to receive a single dose of 10 mg methylphenidate or placebo. Attention was assessed using the paced auditory serial addition test for 3 and 2 s (PASAT3″ and PASAT2″) at baseline and 1 h after drug/placebo administration. Results indicated that administration of a single dose of methylphenidate significantly improved attention in MS patients with considerable attention deficit.
Prakash RS, Snook EM, Lewis JM, et al. Cognitive impairments in relapsing-remitting multiple sclerosis: A meta-analysis. Mult Scler 2008; 14(9):1250-1261.
Meta-analysis that quantified the overall magnitude of cognitive impairment in individuals with RRMS and identified the domains of cognition and clinical/demographic variables that were moderators of the overall effect. Overall, there was a moderate decline in cognitive functioning in individuals with RRMS compared with healthy controls. Larger effects were observed in cognitive domains of motor functioning, mood status and memory and learning.
Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis Lancet Neurol 2008; 7(12):1139-1151.
Reviews the current knowledge on cognitive impairment in multiple sclerosis and discusses how the use of neuroimaging techniques in patients with MS has advanced our understanding of structural and functional changes in the brain that are characteristic of this disease.
Amato MP, Zipoli V, Portaccio E. Cognitive changes in multiple sclerosis Expert Rev Neurotherapeutics 2008; 8(10):1585-1596.
Reviews the current knowledge on cognitive dysfunction in MS and highlight areas of special importance for future research in the field.
O'Brien AR, Chiaravalloti N, Goverover Y, et al. Evidenced-Based Cognitive Rehabilitation for Persons With Multiple Sclerosis: A Review of the Literature Arch Phys Med Rehabil 2008; 89(4):761-769.
Evidence-based review of cognitive rehabilitation intervention research conducted in persons with multiple sclerosis (MS), to classify level of evidence, and to generate recommendations for interventions in this area. Concludes that cognitive rehabilitation in MS is in its relative infancy. More methodologically rigorous research is needed to determine the effectiveness and efficacy of various cognitive rehabilitation interventions. Specific recommendations for future research are given.
Marcotte TD, Rosenthal TJ, Roberts E, et al. The contribution of cognition and spasticity to driving performance in multiple sclerosis. Arch Phys Med Rehabil 2008; 89 (9): 1753-1758.
In this preliminary study, cognitive and physical impairments associated with MS were related to deficits in specific components of simulated driving. Assessment of these factors may help guide the clinician regarding the types of driving behaviours that would put people with MS at an increased risk for a car crash.
Diamond BJ, Johnson SK, Kaufman M, et al. Relationships between information processing, depression, fatigue and cognition in multiple sclerosis. Arch Clin Neurpsychol 2008; 23 (2): 189-199
Study set out to determine the extent to which cognition affects information processing speed and how clinical depression and fatigue mediate this relationship. Forty-eight participants with confirmed MS participated. Slower processing was correlated with higher levels of depressed mood, fatigue, lower verbal fluency, fewer words and digits recalled and poorer recall of visual-spatial information. Depression and physical fatigue had the greatest influence on the association between processing speed and more effortful tasks.
Simioni S, Ruffieux C, Bruggimann L, et al. Cognition, mood and fatigue in patients in the early stage of multiple sclerosis Swiss Medical Weekly 2007; 137 (35-36): 496-501
In this early MS group one third of the patients already exhibited cognitive deficits, which were usually apparent in an effortful learning situation and were generally mild. Mood disorders, fatigue, handicap and decreased QoL were all associated with the occurrence of cognitive deficits. Results confirm the existence of an interplay between cognitive, affective and functional changes and fatigue in early MS
Basso MR, Lowery N, Ghormley C, et al. Self-generated learning in people with multiple sclerosis. J Int Neuropsychol Soc 2006; 12(5):640-8.
Tests of people with MS found that they remembered more information, particularly in relation to names, appointments and locations if they generated their own prompts rather than were presented with pre-set ideas. This finding held true through mild to moderate-severe memory impairment. Self-generated prompts also improved their performance in self-care and activities of daily living
Shevil E, Finlayson M. Perceptions of persons with multiple sclerosis on cognitive changes and their impact on daily life. Disabil Rehabil. 2006 Jun 30;28(12):779-88.
Qualitative, descriptive study of four people wtih MS to explore the impact of cognitive changes on their lives. Participants described the cognitive changes and how these affect their ability to participate and engage in desired activities and maintain their primary roles, and how these affect their quality of life. The study highlights the importance of addressing cognitive issues in rehabilitation.
Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database Systematic Review. 2006;(1):CD004431.
Comprehensive review of the literature suggests some benefit from cognitive rehabilitation, and for depression, cognitive behavioural therapy. Suggests cognition impairment has been shown to affect functional impairment and therefore has implications for ataxia, balance, exercise and mobility.
Birnboim S, Miller A. Cognitive strategies application of multiple sclerosis patients. Multiple Sclerosis 2004;10(1):67-73.
Comparison study of 76 people with MS with healthy subjects on ability to adapt and develop working strategies when faced with new tasks. Around three-quarters of people with MS were found to have impairments that did not correlate with depression, fatigue, disability level or ability to perform activities of daily living. May have implications for people with MS’s ability to cope with routine daily tasks.
Foley G, McDermott M.Cognition and multiple sclerosis: a literature review. Irish J Occup Ther 2001;31(1-2):47-52.
Discusses studies to date and implications for therapists.