Understanding Cognition and Brain Health in Multiple Sclerosis

Ahmed Obeidat, MD, PhD; Randall Schapiro, MD, FAAN; and Jeffrey Wilken, PhD, comment on early investigations surrounding the impact of multiple sclerosis on cognition and brain health and the current lack of focus regarding its impact on patients.

Ahmed Obeidat, MD, PhD: Speaking about multiple sclerosis and cognition in generally, kind of trying to put the two together—how do we look at this?

Randall Schapiro, MD, FAAN: Well, it’s really an important topic, but it’s an interesting topic to me personally, because we never talked about it until 1983. Did you know that? Never talked about cognition and MS [multiple sclerosis] until 1983. If you look back at the books, the academic textbooks on MS before 1983, it said it didn’t affect cognition. And the reason I can date it to 1983 is that I was involved in a group of people where there were 12 of us in Vancouver, British Columbia, trying to figure out what we were going to do as a research project in multiple sclerosis and this was before we had treatments. It’s before MRIs and before we had all of the fancy stuff that we have today. And we decided that we would treat cognition, but we voted. There were 12 people in the room, and it was 11:1 to understand cognition and multiple sclerosis because we all knew it was involved. I was the one that voted not to study cognition because I was worried that people would say, “I‘m not going to be able to walk. I‘m not going to be able to use my bladder. And I‘m not going to be able to think as well,” but I was wrong because we needed to learn about the cognitive problems, problems with memory, planning, foresight, judgment, and retrieval systems that we all know about multiple sclerosis. And thus, by studying it and learning it, maybe we can do something about it to help people with MS.

Ahmed Obeidat, MD, PhD: And to your point now, even in 2022, I teach in the medical school and when we teach about multiple sclerosis, we say, “Well, cognitive dysfunction maybe is not a typical symptom or it is not like a presenting symptom.” And I always question myself, I’m like, “No, cognitive— it’s there.”

Randall Schapiro, MD, FAAN: It’s there. It may not be the presenting symptom but it’s there.

Ahmed Obeidat, MD, PhD: Not the presenting or the isolated…

Randall Schapiro, MD, FAAN: But we know that 60% of people with MS will have some problems in cognition, based on the testing.

Jeffrey Wilken, PhD: And I think that’s a low number. I think that that’s what the research shows, but in reality, we first learned about it in 1983, and as you’re talking about, we saw some studies from Dr Steve Rao, PhD’s group early on talking about the cognitive problems that are actually there in MS. But I will tell you I’ve been working in this field now for 25 years. People still are ignoring it a lot of the time. They’re still concerned that well, if we know about it, like Dr Schapiro was saying, what are we going to do about it? And people are going to get all worried or, what can happen? What can we do? And people will just get upset or maybe if they hear about it, neurologists for the long haul, because they didn’t know of any treatments that would necessarily help with it. Even what we do know about some of the treatments being a little bit equivocal, they basically still look at it as something that maybe isn’t going to be a primary focus. And I’m seeing that start to change only in the past 5 years. It’s been a long haul and a big struggle to convince people that this is not only a symptom of MS but one of the primary symptoms of MS. And one of the most devastating symptoms of MS.

Ahmed Obeidat, MD, PhD: Exactly.

Transcript Edited for Clarity

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