Journal of Rehabilitation Research & Development (JRRD). 43(1), 63-72; 2006
Mitchell T. Wallin, MD, MPH; Jeffrey A. Wilken, PhD; Robert Kane, PhD. Washington, DC, Department of Veterans Affairs (VA) Medical Center, Washington, DC; Department of Neurology, Georgetown University, Washington, DC; VA Maryland Health Care System, Multiple Sclerosis Center of Excellence East, Baltimore, MD; Department of Psychology, University of Maryland, College Park, MD
Conclusion: Studies in recent years have clarified the pattern of cognitive dysfunction in MS.
Dissociation often exists between cognitive dysfunction in MS and traditional neurological deficits. Preliminary research with the ANAM indicates that it correctly categorizes MS patients as cognitively intact or impaired. Specifically, a logistic regression indicated that the ANAM accurately predicted the performance of 48 patients as intact or impaired 96 percent of the time [21]. With increasing numbers of imaging and clinical assessment tools, researchers have started to identify risk factors and biological markers of cognitive dysfunction in MS. Correlations between cognitive dysfunction and neuroimaging parameters, however, remain moderate at best. Newer imaging techniques such as diffusion tensor MRI, functional MRI, and MRI spectroscopy will hopefully better clarify structural-functional relationships. Additionally, because cognitive dysfunction assessment in MS has traditionally been time consuming, efforts should be made toward integrating shorter assessment batteries such as the ANAM into routine clinical examinations. The VA MSCoE East (Multiple Sclerosis Center of Excellence) has initiated projects to make these assessments practical and efficient for patients and healthcare providers. Finding and confirming risk factors for cognitive dysfunction will be challenging because MS is a complex, dynamic disease that evolves slowly. Longitudinal MS studies that assess biological markers and temporal trends in cognitive dysfunction are particularly needed. With the recent advances in molecular neuroscience that have contributed to advances in other dementia disorders [51], we remain optimistic about the future. The goal of research efforts is early identification of MS patients who will develop cognitive dysfunction. Ultimately, these patients would receive therapy that would modify the disease course in the pre-symptomatic period.