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Staging and stratifying cognitive dysfunction in multiple sclerosis.

Curtis Wojcik1, Tom A Fuchs2, Hoan Tran3

  • 1Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|May 6, 2021
PubMed
Summary
This summary is machine-generated.

Processing speed is the first cognitive domain to decline in multiple sclerosis (MS), followed by visual learning, verbal learning, working memory, and executive function. This cognitive staging impacts disability and employment.

Keywords:
Multiple sclerosiscognitioncognitive declinelongitudinalneuropsychologyprobabilistic modeling

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Area of Science:

  • Neuroscience
  • Cognitive Science
  • Clinical Neurology

Background:

  • The temporal sequence of cognitive domain impairment in multiple sclerosis (MS) remains unestablished.
  • It is unknown if processing speed deficits precede other cognitive impairments like memory and executive function.

Purpose of the Study:

  • To determine the order of cognitive domain impairment in MS.
  • To validate these findings against clinical and vocational outcomes.

Main Methods:

  • A longitudinal study involving 1073 MS patients and 306 healthy controls.
  • Neurocognitive tests were administered to measure performance across domains.
  • An event-based staging approach modeled the sequence of cognitive decline.

Main Results:

  • The identified order of impairment was: processing speed, visual learning, verbal learning, working memory/attention, and executive function.
  • Cognitive impairment stage significantly predicted increased neurological disability (β = 0.16, p < 0.001).
  • Cognitive impairment stage predicted a higher probability of unemployment (β = 1.14, p < 0.001).

Conclusions:

  • This study introduces the first cognitive staging and stratification system for MS.
  • The Symbol Digit Modalities Test is recommended for routine cognitive impairment screening.
  • Memory testing is advised for assessing patients later in the disease course.