Cognitive Health and Brain Health Considerations in RRMS


Heidi Crayton, MD, comments on cognitive and brain health considerations in patients with multiple sclerosis and shares her experiences with both patients and their caregivers.

Heidi Crayton, MD: With our focus on brain health and preservation of brain volume, we're paying a lot closer attention to how patients present, what they report in terms of cognitive dysfunction, and what their caregivers, significant others, and family report. Sometimes that's where we get more information than from the patient, because the patient doesn't have the insight and doesn't know that they are cognitively impaired. A couple of years ago, a woman came to me to confirm her diagnosis, so she was technically a newbie, and I saw her brain MRI, and she had such profound brain atrophy. She had just a little giddy-up in her step, so as far as she was concerned, she just started having symptoms from MS [multiple sclerosis]. That led to her diagnosis, but her brain MRI really told the real story that she'd been having MS degeneration for a long time. She had a very hard time following instructions in my exam, and I asked her husband, “Have you noticed any change over the past years?” And he said, “Yes,” and she was shocked and whipped her head around and said, “What do you mean?” And he mentioned issues with judgment, executive functioning, financial stuff, sequencing, multitasking, taking care of our little kids—and she was a teacher of toddlers. That was a very difficult conversation because she thought she was new to the MS journey, but her MRIs told a different story. We see people that often look fine physically, and they've slipped through the cracks in terms of high-efficacy treatment that their MS warranted, but because they were walking fine—and people put so much emphasis on legs—they were missed, and should have been treated more effectively earlier on because now they've lost brain volume.

Transcript Edited for Clarity

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