Tuesday, 7 March 2017

Memory and intellect in MS

J Neurol Neuromedicine. 2016;1(8):10-18.

Feasibility study for remote assessment of cognitive function in multiple sclerosis.

George MF, Holingue CB, Briggs FB, Shao X, Bellesis KH, Whitmer RA, Schaefer C, Benedict RH, Barcellos LF.
Abstract

BACKGROUND:

Cognitive impairment is common in multiple sclerosis (MS), and affects employment and quality of life. Large studies are needed to identify risk factors for cognitive decline. Currently, a MS-validated remote assessment for cognitive function does not exist. Studies to determine feasibility of large remote cognitive function investigations in MS have not been published.

OBJECTIVE:

To determine whether MS patients would participate in remote cognitive studies. We utilized the Modified Telephone Interview for Cognitive Status (TICS-M), a previously validated phone assessment for cognitive function in healthy elderly populations to detect mild cognitive impairment. We identified factors that influenced participation rates. We investigated the relationship between MS risk factors and TICS-M score in cases, and score differences between cases and control individuals.

METHODS:

The TICS-M was administered to MS cases and controls. Linear and logistic regression models were utilized.

RESULTS:

11.5% of eligible study participants did not participate in cognitive testing. MS cases, females and individuals with lower educational status were more likely to refuse (p<0.001). Cases who did complete testing did not differ in terms of perceived cognitive deficit compared to cases that did participate. More severe disease, smoking, and being male were associated with a lower TICS-M score among cases (p<0.001). The TICS-M score was significantly lower in cases compared to controls (p=0.007).


CONCLUSIONS:

Our results demonstrate convincingly that a remotely administered cognitive assessment is quite feasible for conducting large epidemiologic studies in MS, and lay the much needed foundation for future work that will utilize MS-validated cognitive measures.


Here are the facts; roughly 40-70% of PwMS have problems with their memory and thinking abilities (cognition), the domains which are commonly affected are speed of thinking and short-term memory. Normally, we would request a formal study to assess this, which, is usually a one-to-one neuropsychometric assessment performed by a psychologist. It can take half the morning to do and the waiting lists for the service are substantial. There have been suggestions that the single-digit modalities test (SDMT) may be able to provide a rapid fire analysis of cognition, but early on there might be no difference!

Here, George et al. report on a telephone questionnaire (TICS-M) in MS that was originally developed to screen for mild cognitive impairment in Alzheimer's disease. Interestingly, in their study group they found that MS cases compared to controls were more likely to have smoked, have a history of infectious mononucleosis, report of family history of MS, be depressed, more likely to think that there was a problem with cognition and were more likely to be carriers of HLA-DRB1*15:01 (the commonest genetic association with MS) - of note looking at risk factors for MS was not an objective of this study (and therefore may not be powered for this).

Not surprisingly, they found that the results correlated with pre-conceived ideas of cognitive dysfunction, and MS cases were more likely to display problems than control even after considering depression and educational level. Worryingly, there were cognitive issues even in those with MS for less than 5 years. Men also tended to perform badly (strange, but this was not seen in the control group); any link to men being more likely to progress than women?

In The Prince, Machiavelli talks about three classes of intellect: one which comprehends by itself; another which appreciates what others comprehend; and a third which neither comprehends by itself nor by showing of others; the first is most excellent, the second is good, the third is useless.
Are we made lesser individuals by the loss of intellect? People think so, it is probably the most deliberate and the plainest way in which we enslave ourselves; when all we need is to look to better ways of hiding it.

9 comments:

  1. I'm dyslexic and have MS. The dyslexia was diagnosed 10 years before the MS. I also feel I have elements if ADD (without the H). There is dyslexia and suspected Asperger's in my close family but no MS. It's hard to know what cognitive issue is due to my dyslexia or my MS.

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    Replies
    1. Lookup the bio of a gentleman called Guy Hands.

      I met him once...

      Tony Fonda

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    2. Not sure his disastrous takeover of EMI is the greatest advert ;-)

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    3. MD though, who is definitely dyslexic, as many of his posts testify, certainly is ;-)

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  2. Dyslexia should not affect overall intelligence, infancy dyslexics can have very good spatial awareness, memory should also be intact (controlling for what you loose with ageing). If there is these two involved then you're looking at MS being the culprit.

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  3. Hands made his career in bonds, perhaps driven by his own perception of dyslexia. Although I don't think I could be as single minded!

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  4. This is from the BDA (British Dyslexia Association):

    Dyslexia affects the way information is processed, stored and retrieved, with problems of memory, speed of processing, time perception, organisation and sequencing.



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  5. Below is their more extensive blurb (note the word may):
    “Dyslexia is a combination of abilities and difficulties that affect the learning process in one or more of reading, spelling and writing. It is a persistent condition.

    Accompanying weaknesses may be identified in areas of speed of processing, short-term memory, organisation, sequencing, spoken language and motor skills. There may be difficulties with auditory and /or visual perception. It is particularly related to mastering and using written language, which may include alphabetic, numeric and musical notation.

    Dyslexia can occur despite normal intellectual ability and teaching. It is constitutional in origin, part of one’s make-up and independent of socio-economic or language background"

    Often I find those with learning difficulties are misdiagnosed as dyslexics. There's no evidenced base for the classifications (paediatricians work a lot on clinical descriptions alone) so the classification boundaries start to blur. When I see adult dyslexics in clinic, memory problems is not a prominent feature.

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