Dr DeLuca shares his advice and recommendations from National MS Society on providing cognitive care for patients suffering from MS.
John DeLuca, PhD: The National Multiple Sclerosis Society in the United States has come out with guidelines for cognitive care, and those guidelines explicitly state that patients need to know about cognitive problems. They need to be educated, as well as the providers. Providers need to know more about cognition, cognitive impairment, and its relationship with everyday life, and there needs to be a conversation between the provider and the clinician. Sometimes it’s a tough discussion, but it’s a discussion that needs to happen.
If 2 out of every 3 patients are showing cognitive impairment even early on, it’s time to think about the assessment of that cognitive problem. Once again, that assessment can’t simply be patient self-report. There has to be objective testing. On objective testing, even if it’s a screen like the Symbol Digit Modalities Test, there needs to be a determination as to whether there should be a larger examination. The critical point here is, if you find early in the disease that there are cognitive problems, that is a significant marker for decline later on, not only in cognition but also in physical disability. Cognitive problems early in the disease predict later cognitive decline, physical disability, and also loss of brain tissue. So the decision at that point is which medication might a clinician decide to utilize. A high efficacy medication that has data on processing speed, such as ozanimod, would be one example.
However, medication alone is not going to be the issue that’s going to significantly help patients. We know that there are almost 100 studies now on cognitive rehabilitation showing that cognitive rehabilitation can significantly improve cognition and everyday life performance. The most recent Cochrane Review published just a few months ago showed that there’s significant evidence for memory rehabilitation in persons with MS [multiple sclerosis]. Studies also show that patients like cognitive rehabilitation, they enjoy it. They find it helpful. So clinicians today really need to address cognitive problems. They need to address that with their patients, and there are tools available that can potentially help these patients with their cognition. Because over the long term, if patients are showing cognitive problems, the data show they are more likely to decline and see effects in everyday life.
Getting back to the guidelines from the National MS Society, the guidelines for cognitive care specify there should be objective testing early in the disease, particularly at the time of diagnosis or soon thereafter. The guidelines also recommend that there should be an annual reevaluation of cognition, as well as including measures of depression. The reason for that is, once again, patient self-report may be more aligned with emotional distress than actual cognitive problems. So the clinician gaining information from objective cognitive testing, and at least examining questions about depression, can give the clinician an idea, should we go through more cognitive testing, or should we be addressing other issues going on in a person’s life? It’s really needed. It’s time for patients to get the care they need, it’s time for cognitive assessment to be the standard of care, and that should be throughout the rest of their care with their physician.
Transcript Edited for Clarity