Effect of MS treatment on cognitive dysfunction – ECTRIMS 2018
Highlights from the 34th congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), OCTOBER 10-12, Berlin, Germany – The U.S. National MS Society is recommending that everyone with MS have their cognitive ability checked at least once a year to identify any problems that may be developing (Kalb et al. Mult Scler 2018; epublished October 10, 2018).
“Cognition” includes the mental processes of thinking, planning and memory. Cognitive problems can develop in people with MS because of the inflammation and tissue damage in the brain that develop as part of the disease process. Estimates vary widely but at least 1 in 3 people with MS will develop some cognitive problems, most commonly affecting their information-processing speed, memory, planning ability, verbal fluency (finding the right word when speaking).
Cognitive difficulties can have a major impact on a person’s life and can affect interactions with family and friends, how the person manages money, whether they can continue at their job. Mental processes can also be affected by MS fatigue and depression, so annual screening for symptoms of depression is also being recommended. Not everyone with MS will develop cognitive problems; for those who do, the problems will not necessarily get worse over time.
The National MS Society noted that ongoing screening for cognitive problems is important because accommodations could be implemented to prevent job loss; problems with driving a vehicle can be addressed early to improve safety; and steps can be taken to provide assistance to people who are having difficulties taking care of themselves.
Achieving better control of the disease process with medications is believed to help preserve cognitive function although few studies of MS medications have specifically looked at this issue. An early study, called COGIMUS, found that mental functioning remained stable for five years among people taking Rebif (Patti et al. PLoS One 2013;8:e74111). A separate study found that about 1 in 4 people with cognitive problems showed some improvement during a 1-year course of treatment with Tysabri (Rorsman et al. Acta Neurol Scand 2018;137:117-124).
At ECTRIMS 2018, the largest MS conference of the year, Italian researchers reported on people treated with Tecfidera (Zipoli et al. ECTRIMS 2018; abstract P457). For the full group, one-half did not develop cognitive impairment during Tecfidera treatment. About one-third of people showed some cognitive impairment before they started therapy; just over one-half of this group had no further cognitive worsening after starting Tecfidera. The researchers concluded that treatment may delay the development of cognitive problems. Part of this effect may be attributable to the drug’s impact on traditional measures of disease activity: over the two-year period, about 80% of people experienced no MS relapses and 94% had no worsening of their physical disabilities. There were also improvements in people’s MS fatigue and symptoms of depression with treatment.
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