Drs Ahmed Obeidat, Randall Schapiro, and Jeffrey Wilken, provide insight on how to initiate and frame conversations surrounding cognition and brain health with patients with multiple sclerosis.
Ahmed Obeidat, MD, PhD: When you go back to the clinic, that’s one of the things where sometimes we meet the patients for the first time, and sometimes they’re following up with us, of course. How do we approach cognition? How do we talk about cognition? Do you ask your patients, “Are you having any memory issues, any attention issues?” Or do you wait for them to bring this up to you in the clinic? And how do you do that?
Randall Schapiro, MD, FAAN: I believe if you’re an MS [multiple sclerosis] center, particularly, but even if you’re not, we need to score people. We need to have numbers on their neurologic examination so that we can follow them from visit to visit to visit. Some of that scoring comes from asking questions. Some of it’s from actual testing that we do. The EDSS [Expanded Disability Status Scale] scale is a good mobility scale. It doesn’t really do a lot for cognition, but it’s really important that along with asking about ambulation, that we ask about cognition, you have to ask in order to find. Rarely unless a family member is telling you something, will the person come in and say, “My cognition isn’t so good.” Their ego is getting in the way. Thus, you need to ask about it. Doing the testing that we talked about is important up front, to have a conversation, but not too aggressively so that the person feels depressed about it. But I think it needs to be looked at on every visit.
Ahmed Obeidat, MD, PhD: Yes, to reassess when you see them again. Are you the same?
Jeffrey Wilken, PhD: Yes, and I think one of the things in addition to asking is also talking to a caregiver of some sort. If it’s not a caregiver, a friend, a family member, spouse, child, parent.
Randall Schapiro, MD, FAAN: That’s easy to say, but when they are there in the same room, they don’t want to talk about it.
Jeffrey Wilken, PhD: But what I do, if they come in with me, usually I can get permission to talk to them separately because I have the time.
Randall Schapiro, MD, FAAN: But you’re there for that specific reason. That makes sense to me. I agree with you. It’d be nice to do that, but I don’t think it’s practical from a sense, but if they’re there when you’re asking the question, you can kind of look at them.
Ahmed Obeidat, MD, PhD: That’s right.
Jeffrey Wilken, PhD: Usually, you get them shaking their head no.
Ahmed Obeidat, MD, PhD: Sometimes, exactly, you get this, and then they give them the look.
Randall Schapiro, MD, FAAN: “You’re not going to be with me when I leave.”
Jeffrey Wilken, PhD: If you can get a chance to talk to a person they’re with, if the situation works out OK, there’s pretty good research showing that the person who watches the person with MS is a little more accurate about their cognitive function than the person with MS.
Randall Schapiro, MD, FAAN: No doubt.
Ahmed Obeidat, MD, PhD: I often ask them, “How is this impacting your work?” If my patient is employed, or they’re running their own business or their own kind of organization, I ask, “Is this really interfering with your duties? Are you taking longer to do the things you used to do faster before?” Hence, this will be giving me some hints, to think, maybe they need to see you. Something like this where I’m going to have to refer. These are sometimes important, but sometimes patients themselves, they cannot tell you actually, or their family member, to your point, may mention this. These are some of these aspects.
Transcript Edited for Clarity