The Impact of Polypharmacy on Cognitive Health in MS

Ahmed Obeidat, MD, PhD; Randall Schapiro, MD, FAAN; and Jeffrey Wilken, PhD, discuss the impact of polypharmacy on cognitive health and share their thoughts on deciding when to cease treatments in patients with multiple sclerosis.

Ahmed Obeidat, MD, PhD: That’s polypharmacy. That’s one of the things when we kind of see patients in clinic and we have all these kinds of complaints, and we say, “Let’s look at the medication list. Maybe there is something we can take away.”

Randall Schapiro, MD, FAAN: And we’re all guilty of that. I can tell you, numerous times I’ve looked at that list and said to that patient, “This is horrendous. We need to stop some of these medicines.” And I started them. Thus, I stopped them, and I’ll be damned if they needed the medicine. There was a reason for that medicine.

Jeffrey Wilken, PhD: It’s hard. I have patients that come into my office with a list a mile along. And hence, it’s a dicey discussion with the neurologist about which of these is needed and which isn’t because some of these are causing some fatigue here. I also have some sleep specialist colleagues who insist that along with every other thing you need to do with a patient with MS [multiple sclerosis], you need to get a sleep study because the sleep disorders are just—

Ahmed Obeidat, MD, PhD: They’re common and they can affect.

Randall Schapiro, MD, FAAN: One more point that I’d like to make is that multiple sclerosis means multiple scars and they’re all over the central nervous system. And when you get multiple abnormalities in the brain itself, you get an unusual neurologic picture that we call pseudobulbar affect and it has been advertised. And thus, people know about it more than they used to know about it. PBA, I don’t like that term particularly, but pseudobulbar affect where people are inappropriately laughing and crying and have the wrong emotions for the situation and are cognitively impaired. And we do see that in people sometimes with multiple sclerosis.

Ahmed Obeidat, MD, PhD: In advanced cases, and sometimes even early on, and this is—

Jeffrey Wilken, PhD: And I’ve read some articles talking about unusual psychology presentations like that, like the bipolar disorder, which you see in MS. But you see it more than in a general population, but not as much as depression and anxiety, but those are the people more at risk for some of the cognitive issues.

Transcript Edited for Clarity

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