Recommendations for Cognitive Screening and Management in Multiple Sclerosis Care
Multiple Sclerosis Journal
Kalb, R., Beier, M., et al. (2018).
Multiple Sclerosis Journal, 24(13), 1665-1680.
This consensus-based guideline provides recommendations on cognitive screening and management for individuals with multiple sclerosis (MS).
National MS Society
<div>Recommendations for comprehensive MS care include improved education for both healthcare providers and individuals with MS about the high prevalence of cognitive symptoms and the need for early screening and ongoing assessment. This education should also include information about cognitive changes and their impact on activities of daily living (e.g., work/school, driving, money management, and medical decision-making). Additionally, clinicians need information regarding referral resources available in the community.</div>
<p>Baseline screening with a validated screening tool (e.g., The Symbol Digit Modalities Test, the Processing Speed Test, the Computerized Speed Cognitive Test, or the Multiple Sclerosis Neuropsychological Screening Questionnaire) is recommended for:</p>
<ul>
<li>all individuals 8 years of age or older with a diagnosis of MS;</li>
<li>any individual with changes in cognitive functioning at work or school; and</li>
<li>any adult with a new clinical event or MRI evidence consistent with a diagnosis of MS.</li>
</ul>
<p>Annual re-assessment with the same tool is recommended for all individuals 8 years of age or older to:</p>
<ul>
<li>detect acute disease;</li>
<li>assess effects of treatment or for recovery;</li>
<li>evaluate the progression of cognitive impairment; or</li>
<li>screen for onset of new cognitive problems.</li>
</ul>
<p>A more comprehensive cognitive assessment (e.g., the Brief International Cognitive Assessment for Multiple Sclerosis, the Brief Repeatable Neuropsychological Battery, or the Minimal Assessment of Cognitive Function in MS) is recommended for:</p>
<ul>
<li>any individual who tests positive on initial cognitive screening;</li>
<li>any individual who demonstrates a significant cognitive decline;</li>
<li>children under 18 who exhibit significant decline in academic or behavioral functioning;</li>
<li>adults who report poor performance at work; and</li>
<li>any individual who is applying for private disability due to cognitive impairment.</li>
</ul>
<div>It is recommended individuals with MS receive interventions to improve functioning at home, work, or school. Treatment modalities may include cognitive rehabilitation, exercise, or pharmacological management. It is also important to consider the interaction mood, fatigue, and sleep have with cognitive functioning. Cognitive therapy may include contextualized treatments (e.g., self-generated learning paired with spaced learning strategies or modified story generating technique) or non-contextualized treatment (e.g., spaced testing, computer-based cognitive rehabilitation, or, for children, accommodations in the school setting).</div>
