Cognitive dysfunction in multiple sclerosis: natural history, pathophysiology and management

Area of Science:

• Neurology
• Neuroscience
• Medical Imaging

Background:

• Cognitive dysfunction is a significant cause of disability in multiple sclerosis (MS), affecting an estimated 45-65% of patients.
• Unlike physical disability, cognitive impairment in MS shows weak correlation with T2 lesion burden but stronger links to magnetisation transfer imaging and brain atrophy.
• Commonly affected cognitive domains include memory, learning, attention, and information processing.

Purpose of the Study:

• To review the current understanding of cognitive dysfunction in multiple sclerosis.
• To highlight diagnostic considerations, including comorbidities like fatigue and depression.
• To outline current and potential treatment strategies for cognitive impairment in MS.

Main Methods:

• Review of natural history studies and neuroimaging correlations.
• Analysis of diagnostic challenges and treatment approaches for MS-related cognitive dysfunction.
• Examination of disease-modifying therapies and symptomatic treatments.

Main Results:

• Cognitive dysfunction in MS is prevalent, persistent, and linked to brain atrophy and magnetisation transfer imaging metrics.
• Effective diagnosis requires addressing comorbidities such as fatigue and depression.
• Disease-modifying agents aim to delay progression, while non-pharmacological therapies are key for symptomatic relief.

Conclusions:

• Cognitive dysfunction is a major, often irreversible, disability in MS.
• Current treatment strategies focus on delaying disease progression and managing symptoms through non-pharmacological means and addressing comorbidities.
• There is an unmet need for approved pharmacological treatments for symptomatic cognitive dysfunction in MS.