An analysis of 50 studies of relapsing-remitting multiple sclerosis (RRMS) has found about a third of patients experience cognitive impairment – not the 40 to 65 per cent previously estimated.
Neurons in focus: Macquarie University researchers are the first to review evidence of cognitive impairment in cases of the neurodegenerative condition, relapsing-remitting multiple sclerosis (RRMS).
MS is a chronic autoimmune disease that attacks the central nervous system, resulting in a range of possible symptoms including muscle weakness or spasms, difficulty with walking or coordination, extreme fatigue, vertigo, vision disturbances, and cognitive impairment.
About 85 per cent of newly-diagnosed cases of MS fall into the relapsing-remitting category, which involves flare‑ups of the disease followed by periods of remission.
More than 33,000 Australians are currently living with MS, and three-quarters of these are women.
A team of psychology and neuropsychology researchers and clinicians at Macquarie University began looking into the available data on rates of cognitive impairment to see if they could be more accurate on the actual risks.
The study, published in Neuropsychology Review, is the first meta-analysis on the topic, and also the first study to look specifically at RRMMS instead of all types of MS.
Cognitive impacts can have a huge effect on day-to-day functioning, and the ability to keep working.
Macquarie University Associate Professor of Psychology, Milena Gandy, says the findings are valuable for patients.
“MS is the most common neurodegenerative condition in young people, with most people aged between 20 and 40 when they are first diagnosed, at a time when they are establishing their career and potentially planning a family,” she says.
“When someone receive any new diagnosis, it is natural to search for information, and while it’s important to know there is a risk, seeing such a wide‑ranging figure as 40 to 65 per cent hasn’t been helpful because it makes it easy to think the worst.
“Cognitive impacts can have a huge effect on day-to-day functioning, and the ability to keep working.
“This not only gives patients a more realistic idea of their risk level, but also lets them know what to look out for, what can be done, and to plan better for the future.”
Online wellbeing course on the way
More research is needed to determine who is most at risk, but the findings indicate that cognitive impacts are common both the longer someone has had the disease and as they get older.
Most of the cognitive impacts associated with MS affect focus, attention and speed, and while there are interventions available that can help, compensatory strategies have been shown to be consistently beneficial in daily functioning.
These include tactics such as making notes and requesting printed information from consultations with doctors and allied health professionals, using diaries or calendar apps, and being aware that more time could be required for tasks.
Master of Neuropsychology graduate and lead author Wendy Wu says patients with MS should be routinely assessed for cognitive impairment.
“Physical symptoms are more easily observed, but cognitive effects may be harder to detect,” she says.
“Knowing that one in three patients is likely to be impacted, and that the effects can become more pronounced with ageing, is important information for patients, but also for neurologists and neuropsychologists.
“It gives us a sense of how many people might be in need of extra support, and allows for better resource allocation in hospitals and health services.
“We need neuropsychologists not only to do the necessary assessments but to provide interventions that target the specific types of impairment individual patients are experiencing.”
Associate Professor Gandy and her team are currently working on a wellbeing course to help people with neurological conditions manage their mental health while integrating cognitive strategies.
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With funding support from MS Australia, the course is offered online via the Macquarie University eCentreClinic and Royal North Shore Hospital MS Clinic. An in‑person session with a psychologist can be extremely cognitively demanding for people with neurological disorders, but having an online option allows them to work at their own pace and revise as necessary.
Associate Professor Milena Gandy, pictured, is a Senior Clinical Psychologist, a Research Fellow in the School of Psychological Sciences at Macquarie University, and a member of the Macquarie University Lifespan Health and Wellbeing Research Centre.
Wendy Wu is a Clinical Neuropsychology Registrar at Liverpool Hospital and graduate of the Master of Clinical Neuropsychology program at Macquarie University.
Associate Professor Heather Francis is an Associate Professor of Neuropsychology in the School of Psychological Sciences at Macquarie University, and a member of the Macquarie University Lifespan Health and Wellbeing Research Centre.
