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Cognitive presentation of multiple sclerosis: evidence for a cortical variant
M Zarei1, S Chandran, A Compston
1Department of Neurology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Journal of Neurology, Neurosurgery, and Psychiatry
|June 18, 2003
Summary
Multiple sclerosis can present with cognitive and neuropsychiatric symptoms, suggesting a distinct "cortical multiple sclerosis" entity. Early recognition is crucial for timely diagnosis and treatment, especially with emerging therapies.
Area of Science:
- Neurology
- Neuropsychology
- Radiology
Background:
- Multiple sclerosis (MS) is typically associated with neurological deficits, but cognitive and neuropsychiatric symptoms are increasingly recognized.
- These symptoms were previously thought to be rare and indicative of subcortical pathology.
Observation:
- Six patients presented with undiagnosed cognitive/neuropsychiatric syndromes, exhibiting progressive dementia with amnesia, dysphasia, dysgraphia, or dyslexia.
- Mood disturbances, including depression, were common, and physical signs of MS developed in all patients.
- A review of 17 cases revealed prominent early memory impairment and depression.
Findings:
- The study identified a distinct clinicopathological entity termed "cortical multiple sclerosis."
- This presentation is characterized by dementia, amnesia, and other cortical neurological signs.
- Depression and mood disturbances are frequent early symptoms.
Implications:
- Recognizing "cortical multiple sclerosis" is vital to avoid diagnostic delays and unnecessary invasive investigations.
- Early identification of neuropsychiatric features is important for managing handicap and considering new treatments.
- This highlights the need to consider MS in patients with unexplained cognitive decline and mood disorders.