Cognitive impairment in M.S.

    
      Re: Cognitive impairment in M.S.
    


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Posted by CCF Neuro MD on April 24, 1997 at 11:32:04:

In Reply to: Cognitive impairment in M.S. posted by Tony Wilgus on April 12, 1997 at 10:55:39:

: Recently, my 43 year old wife has begun to demonstrate
  more pronounced symptoms of cognitive impairment in
  addition to short-term memory loss, difficulties in
  problem solving, word-search problems.  There have been
  some gaps in her long-term memory along with a tendency
  to repeat stock phrases.  She will also talk to herself
  even in the presence of others, seemingly unable to
  control this type of speech (of which she is aware).  
  She has the chronic progressive form of M.S. which has
  intensified in the last 4 years.  I am wondering if
  the symptoms of cognitive shifts are consistent with
  the research on these types of impairments in M.S.
  Also, some of the symptoms are suggestive of dementia
  and/or Alzheimer's from what I have been able to
  decipher from my own research.  It would be helpful to
  review some of the latest research on M.S. and the
  more severe forms of cognitive impairment which might
  include some of the symptomatology associated with what
  I have described.  Thanks for the info.
======================================================================================
Hello Tony,
As you may or may not know cognitive problems are quite common in multiple sclerosis.  They are especially more common in patients who have the chronic progressive form of MS.  The development of cognitive problems do not seem to correlate with the disease duration or with the severity of other neurologic defecits (disability).  It has been obsevered by some investigators that the extent of damage of the white matter (that part underlying the outer most layer of the brain the cortex or gray matter) as seen on the MRI brain scan has correlated with the presence of cognitive defecits.  Depression is a common psychiatric disorder seen in MS however relatively little is known of the specific neurobehavioral features of MS.   Current knowledge indicates that the common areas of cognitive dysfuntion in MS include problems with attension, recent memory, information processing, and visiospatial perception.  In contrast such things as intelligence, language, and other aspects of memory are perseved.  So the fact
that your wife has problems with some features of language as well as speaking to herself and having long term memory problems seem atypical to the usual cognitive dysfunction seen in MS.  The other features you discuss in your letter seem quite consistent with the cognitive problems in MS.  A neuropsychiatric test battery maybe useful in differentiating the so called "subcortical dementia" seen in MS from the "cortical demtentias" seen in other neurologic disorders such as Alzhiemers disease.  There are some symptomatic therapies as well as cognitive rehabilitation that might be helpful in your wifes case.  If you are interested in discussing this issue in more detail and interested in seeing a neurologist at the Cleveland Clinic.  I would refer you to the Mellen Center neurologist at the Cleveland Clinic.  You can ask for an appointment by calling 216-444-5559.  Good luck!