Multiple sclerosis (MS) is both an inflammatory and neurodegenerative disease, with cognition affected in roughly 50% of patientsCognitive impairment is most commonly detected on tests of mental processing speed and episodic memoryNeuropsychological testing is sensitive to MS cognitive disorder and can be applied in brief, routine evaluationsMale patients with low education or intelligence, early onset of MS, and evidence of cerebral gray matter atrophy seem most prone to impairment, whereas high premorbid intelligence is protectiveTo date, evidence for any particular medical therapy improving cognition in MS has been inconsistent, despite being an area of intense investigationFuture MS clinical trials should include cognitive outcome measures and use neuropsychological tests that are reliable and are known to reveal clinically meaningful changes
Multiple sclerosis (MS) is a demyelinating disease of the CNS that causes a wide array of neuropathological changes, including acute proliferation of T cells surrounding axons, axonopathy to the point of transection, and progressive neuronal degeneration presenting as atrophy on brain imaging.1 Cognitive impairment was reported in patients with MS over a century ago,2 but the topic garnered little interest in the clinical and neuroscience literature until the early 1980s when neuroimaging technology provided metrics of neuropathology, and improved psychometric procedures enabled reliable quantification of cognitive abilities. The quality, severity and frequency of cognitive dysfunction were well-established by the mid-1990s.3 Soon thereafter, the first effective disease-modifying therapies emerged, which improved medical outcomes.4,5,6 A more-favorable prognosis for mortality and preserved physical capacities has led to increasing interest in cognitive outcomes and quality of life in patients with MS.
