Dawn Langdon discusses the cognitive difficulties affecting people with multiple sclerosis and the importance of assessing cognition.
FILMED AT THE EUROPEAN COMMITTEE FOR TREATMENT AND RESEARCH IN MULTIPLE SCLEROSIS (ECTRIMS) ANNUAL MEETING, SEPTEMBER 2016
PLEASE INTRODUCE YOURSELF AND YOUR RESEARCH INTERESTS
00:11 – Hello, my name’s Dawn Langdon. I’m Professor of Neuropsychology at Royal Holloway, University of London. Most of my work concentrates on psychological aspects of MS. So, for example, I’m co-chair of BICAMS, a cognitive assessment, which has 28 countries in the validation pipeline, of whom 10 are published.
HOW DO COGNITIVE DIFFICULTIES AFFECT PEOPLE WITH MULTIPLE SCLEROSIS?
00:34 – Well, they have very wide-ranging difficulties over and above the physical impairments that MS imposes. Many aspects of disease management; participation, including employment; and safety in driving; falls; all kinds of aspects of people’s lives are affected by cognitive impairment. And so, unsurprisingly, there are big impacts on quality of life and life satisfaction.
WHAT ARE THE BEST OPTIONS FOR ASSESSING COGNITION?
01:02 – Well, it really depends why you’re assessing cognition. So I think that if you’re an MS clinic, you’re a healthcare professional, you should be doing annual assessments of cognition on all of your MS patients. When you know that they have a cognitive impairment, you can change the way you interact with them to overcome some of the difficulties that cognitive impairment brings to disease management, medication adherence, symptom management.
01:30 – If somebody comes to you in the clinic with a particular problem in their life, a difficulty which seems to be a cognitive-driven problem, then I think you need a more detailed assessment. You need a neuropsychologist specialist assessment to understand the whole profile of the person’s cognitive difficulties and answer the specific questions. So, for example, in more advanced MS, you may have a patient who is very disinhibited, who is upsetting their family; for that, you probably need a very detailed assessment and specialist input.
WHY DOES ASSESSMENT MATTER?
02:07 – It’s because cognitive difficulties in MS are not well represented by patient self-report. So patient self-report of cognitive deficits is confounded by depression and so, therefore, we do need an objective measure which we can use to be very precise about the difficulties that the person with MS having. And we need to know, for example, that a decrease in function isn’t due to fatigue or depression but is definitely a cognitively-driven difficulty. And that’s why BICAMS, which is a 15-minute assessment available in many countries now, is a good first starting point when you’re trying to see if a person has cognitive impairment. And it allows you, with a very high degree of accuracy, to say whether they have cognitive impairment or not.
HOW OFTEN SHOULD COGNITION BE ASSESSED?
03:02 – I think probably on a routine basis it should be done yearly. And, in fact, the NICE guidelines, which were produced in the UK in 2014, recommended that there should be annual cognitive assessment for people with MS. But obviously, of course, clinical priorities and judgment come into the picture, and so if somebody arrives who’s had a cognitive assessment maybe within the last year, but clearly their difficulties described, which seem to be cognitively driven, then obviously, it’s important to see what’s going on.
03:36 – For example, in rare cases, you might have a focal lesion that, on scan, looks like a tumefactive lesion, and that may have brought on a cognitive relapse in a particular area of cognitive function. And so these kinds of events, which although quite atypical need to be excluded; or if they’ve happened, understood and managed. So clinically-driven but routinely once a year.
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