The research fellow at the Amsterdam University Medical Center provided thoughts on the possibilities of assessing cognitive decline in clinical settings for patients with multiple sclerosis. [WATCH TIME: 5 minutes]
Fuchs, MD, PhDWATCH TIME: 5 minutes
"We’re learning that as much as 50% of the [accrued] disability [in MS] has nothing to do with relapse and little to do with white matter lesions. It’s the things that we’re not measuring. It’s the cortical atrophy, the spinal cord atrophy, and perhaps we’re not controlling the disease-modifying therapies being used in our patients."
In multiple sclerosis (MS), the irreversible accumulation of disability may occur at any stage of the disease and through 2 main mechanisms: relapse-associated worsening and progression independent of relapse activity (PIRA). Despite improvements in the efficacy and safety of newer disease-modifying therapies, the role of PIRA in early MS still remains a challenge. Additionally, the long-term disability outcomes, including the effect on cognition, of patients who present with PIRA are still largely unknown.
As relapses become more managed, the conversation in the MS community has shifted towards a greater focus on disability progression, especially for patients with more progressive forms of the disease. At MSMilan 2023, the joint ECTRIMS-ACTRIMS meeting, held October 11-13, in Milan, Italy, Tom Fuchs, MD, PhD, presented in a scientific session on the effects of MS on cognition, including cognitive progression independent of relapse activity. In his presentation, he talked about the role of PIRA and how it accounts for a higher proportion of disability accrual than initially perceived.
Following his presentation, Fuchs, a fellow at the Amsterdam University Medical Center, sat down with NeurologyLive® to discuss the possibility of measuring PIRA-related cognitive decline in clinical settings. He spoke on the need for expansion of widely-used cognitive measures and the feasibility of monitoring patients over a long-term period. Furthermore, he gave final remarks on the importance of not only studying PIRA, but having healthy conversations with patients about where their disability may be coming from and how much of it is related to relapses.