Perceived and objective cognitive impairment in newly diagnosed versus established multiple sclerosis: impact of disease
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ORIGINAL ARTICLE
Perceived and objective cognitive impairment in newly diagnosed versus established multiple sclerosis: impact of disease duration Nuala McNicholas 1,2
&
Niall Tubridy 1,2 & Michael Hutchinson 1,2 & Chris McGuigan 1,2
Received: 9 July 2020 / Accepted: 15 October 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background Cognitive impairment (CI) is common in multiple sclerosis (MS), including newly diagnosed MS, where it is particularly underrecognised. Determining the presence of CI in the outpatient clinic often relies on patient-reported complaints, with limited time and resources in this setting. Prior studies have shown that self-reported cognition relates poorly to formal neuropsychological testing in the MS population and correlates more with factors such as anxiety, depression and fatigue. Aims In this study, we assess the prevalence of perceived cognitive dysfunction in newly diagnosed MS patients and compare results with an established MS cohort. Results Thirty-nine patients with newly diagnosed MS (12 months following diagnosis) and 24 patients with an established diagnosis (3 years) were included. Similar levels of perceived and objective CI were seen in both groups. There was a strong correlation of perceived cognitive dysfunction with anxiety, mood and fatigue. Perceived cognition did not correlate with objective CI, assessed using the Brief International Cognitive Assessment in MS (BICAMS), in either group. Conclusions Study findings add to the literature of perceived cognition in MS, in a newly diagnosed cohort. Findings are consistent with previous research using detailed neuropsychological assessments, confirming the sensitivity of BICAMS, applicable in a routine clinical setting. Keywords BICAMS . Cognition . Multiple sclerosis
Introduction Cognitive impairment (CI) is a well-recognised, common and disabling disorder in multiple sclerosis (MS), affecting 40– 70% of the total patient population. CI is typically underrecognised at initial presentation in MS. At diagnosis, CI is present in between 25 and 57% of the patient population [1]. It is a significant determinant of quality-of-life factors, including employment status, social interactions and functional independence in MS [2]. Domains affected by CI in MS most commonly include information processing speed, verbal and visual memory, attention and executive functioning.
* Nuala McNicholas [email protected] 1
Department of Neurology, St. Vincent’s University Hospital, Elm park, Dublin 4, Ireland
2
School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
Routine clinical assessment by the neurologist lacks sensitivity in accurately identifying CI in MS, where cognitive assessment is often limited to patient-reported cognitive complaints, due to both time restraints and limited resources [1]. It is established that self-reported cognition in the MS population does not relate to objective CI by formal neuropsychological testing. Self-reported cognition may, in fact, be more
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