Drs Frederick Foley and John DeLuca share clinical insights for the assessment and treatment of cognitive dysfunction in multiple sclerosis.
Professor Emeritus, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York; Director of Neuropsychology and Psychosocial Research, Multiple Sclerosis Center, Holy Name Medical Setting, Teaneck, New Jersey Senior Vice President for Research and Training, Kessler Foundation, West Orange, New Jersey My name is Dr Fred Foley, I'm a clinical psychologist; professor emeritus at Ferkauf Graduate School of Psychology of Yeshiva University in the Bronx, New York; and the director of neuropsychology and psychosocial research at Holy Name Medical Center's, including how to monitor it, screen for it, assess it, and treat it, with Dr John DeLuca.
Dr DeLuca, would you like to introduce yourself? Thank you, Dr Foley. Yes. My name is Dr John DeLuca. I'm a neuropsychologist. I'm the senior vice president for research and training at the Kessler Foundation and a research professor in the Department of Physical Medicine and Rehabilitation at Rutgers New Jersey Medical School. of adults with MS have documented cognitive problems, and about one-third of children under age 18 have cognitive problems as well. These cognitive problems have a huge impact on everyday life. They affect the perceived quality of life, of course, but also, they affect things like employment status, the ability to function at school, interpersonal relationships, money management skills, driving ability, and participation in everyday activities. These are some of the common things that cognitive problems interfere with. It certainly is a big problem, and if you listen to the patients, they'll tell us that. If it's such a big problem, then how should cognition be assessed in clinical practice?Good question, John. We first begin with screening. It's important to screen every person with MS for cognitive problems using validated screening tools. There are a number of them out there. Perhaps the most common one is the, which screens for information processing speed. This is the most common cognitive problem in MS and sentinel to other kinds of cognitive problems in MS, because it can affect memory and other aspects of cognition. We should be screening patients, initially, with a validated test when they come into the practice, when they're clinically stable, and then monitoring them by screening them at least once a year when they're coming back in for clinic visits to evaluate whether or not they're cognition is stable, worsening, or improving. If they test positive for cognitive issues on a screening test, then it's important to do a little bit more of an assessment. There are a number of assessment batteries out there that have been validated in MS, such as theIt's important that screening is done regularly and routinely with valid tests in the office. If there is a positive result on the test or a change in the screening test of a patient, indicating that performance has deteriorated on that test, then they need to be referred to an expert in assessment ofcognitive problems in MS. for cognitive care that the National Multiple Sclerosis Society put out, by Kalb and colleagues, where they're recommending exactly what you just said. You do an assessment early in the disease, followed by an annual reassessment. It’s also important to do an annual assessment forThat is correct. Depression can affect cognition in MS. In itself, it's a serious problem in MS because depression is associated with a host of problems as well, such as patients not keeping up with their disease-modifying therapy or physical rehabilitation or other kinds of recommendations that are made by their healthcare practitioners. Screening for depression, fatigue, and sleep problems, all of these things can interact and affect cognition in MS. Also, it's important to recognize that children under age 18 can have cognitive problems, and it's important to screen them on a regular basis and monitor their cognition on an ongoing basis. is to educate the healthcare staff on the frequency, severity, and types of cognitive problems that occur in MS; to advise on the best practices for screening, monitoring, assessment, and treatment; and also to provide the assessments themselves and perhaps the treatments as well. Dr DeLuca, as an expert in cognitive rehabilitation in neurological disease, especially MS, can you tell me what kinds of programs are out there for cognitive rehabilitation in MS? Fred, unfortunately, I think that the number of programs out there is fairly small. This is an example whereby the research data are far greater than the clinical implementation. The data are very clear. Cognitive rehabilitation can have a significant impact onThe data show that we can improve not only cognitive performance but we can also improve everyday life. We do so through, so that is the best approach. It's typically done on an individual or one-to-one basis. There are some data onas well, but unfortunately, there's not enough implementation in the community for patients to get the care that they need. Actually, there are no approved medications, disease-modifying therapies in particular, to treat cognition in persons with MS., the data are very mixed, number one. When there are some data, the effect size is very small. The real effects of medications for improving cognition is not very good, and it should not be the sole treatment. showed that the percentage of physicians who refer people with MS for medication is actually reduced from assessments in 2010 vs 2020, realizing that cognitive rehabilitation is really the way to help patients. We need to get the word out to MS professionals and to speech pathologists and neuropsychologists on how to conduct these rehabilitation approaches in MS.I think it's really incumbent upon the neurologists and the neurology MS centers to find experts in their community who can provide these cognitive rehabilitation services, because the data support doing it. It may not always be easy, but it's really incumbent upon the professionals to find the help that the patients deserve.Fast Five Quiz: How Do You Manage Multiple Sclerosis Symptoms? 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Multiple Sclerosis Center Of Excellence Multiple Sclerosis Multiple Sclerosis (MS) Cognition Preventive Screening Screening Depression Fellowship Fellows Residency Residents Disease-Modifying Therapy Disease-Modifying Therapy (DMT) Memory New Jersey Physical Medicine And Rehabilitation Physiatry PM&R Physical Medicine And Rehabilitation (PMR) Clinical Guidelines
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