Monday, 8 July 2013

Cognitive impairment with course of MS

Does anybody have a better term than dementia for progressive MS-related cognitive impairment? #MSBlog #MSResearch

Epub: Brissart et al. Cognitive impairment among different clinical courses of multiple sclerosis. Neurol Res. 2013 Jun.

BACKGROUND: As of yet, no consensus has been reached regarding cognitive impairment profiles in MSers based on the MS type and disease duration. 

OBJECTIVE: The main objective of this study was to describe cognitive impairment at the early stages of MS. Secondary objective was to compare cognitive performances in MSers with relapsing remitting multiple sclerosis (RRMS), secondary progressive (SP) MS and primary progressive (PP) MS.

METHODS: The study included 128 MSers and 63 healthy controls (HC). The study constituted five groups: early RR (ERR) (<3 years); late RR (LRR) (>10 years), SP, PP, and Healthy Controls (HC). A neuropsychological assessment was performed including information processing speed (IPS), working memory, verbal episodic memory and executive functions.

RESULTS: Compared to HC, only impairment in phonemic fluency was observed in ERR. Slowing IPS, impairment in working memory and phonemic fluency were shown in LRR. In progressive forms, deficits were observed in verbal episodic memory, in working memory, in flexibility, in semantic and phonemic fluencies, with a slowing IPS.

CONCLUSION: Verbal fluency is impaired at early stage of RRMS, in this form of MS, impairment increased with MS duration, and distinct cognitive profiles were observed between chronic and progressive forms.


"Cognitive impairment is seen all clinical subtypes of MS and gets worse with disease duration. Dare I say MS-related cognitive impairment is progressive and is largely irreversible once it is established? Therefore it is best to prevent it from occurring in the first place; the only way I know of doing this at present is with the early highly-effective treatments."

12 comments:

  1. Your solution of early highly- effective treatments is fine. But, they only benefit RRMS, they are not currently available, and NICE may not approve them when they are available.

    I don't think you'd make much money as a motivational speaker. I don't suffer from depression but come away pretty down when I red the recent run of posts and the one-trick pony solution. One inspirational boss told me "don't keep bringing me problems, bring me solutions".

    It seems likely the only solution on the horizon is Alemtuzumab. Congrats to Cambridge, but what are all the other MS researchers in the world coming up with. They all turn out in their thousands when there's a conference in a lovely location. There's something rotten in the world of MS research hen the big breakthrough is an old cancer drug. What MS research teams cross the world need to do is really assess what difference they have made to patients lives. The fact that so many symptoms have very limited treatments is a scandal in itself.

    All of us with the disease know how bad it is. We've seen the long term impact in the neuros waiting room. Is there any time line setting out when we are likely to see advances eg neuro protection, remyelination, repair? The myelin repair foundation are seeking to get a remyelination therapy to patients by 2019. I admire their ambition. Does Team G have any targets like this?

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    1. Goals yes. However. When ever i have see dates mentiioned there is always disappointment.

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    2. Six years to do phase i phase ii and two phase iIi and ger regulatory approval. If we have not seen the phase iyet and they toxicology. What is the 2019 deadline.

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    3. Mouse,

      This wasn't a dig at you, but there is a real issue about results from MS research. I think you said you've spent 25 years in MS research. Is there a risk that when you retire, none of your work will have resulted in a treatment for MS? Same for Prof G. The regulators are always blamed for the slow progress, but the researchers have some responsibility. There's an industry of grant applications, trial designs etc etc. it's all dressed up to ensure safety, but in reality apart from anti inflammatories (many of them were designed for other diseases) we haven't seen any advances in protection or repair. I've no doubt that you work hard, but my interest (as with the other 10k sufferers in the UK), is to get get a better quality of life / more hope for the future. Prof G moans about innovation, but he and others should be the change they want to see. The whole system has been set up to ensure failure eg grant applications rejected, prevent those who could benefit from treatments from getting them, or slow things down to a snail's pace.

      The phase I trials start in 2014. I'm sure they'll miss the target of 2019, but what else is there? 2025 is so far away that it will be of no use to me.

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    4. I did not take it as a dig. I was trying to point out the reallity.

      In promise 2010 we were chastised for not delivering stem cells by 2010. We did not even start to do this this was the remitof other groupsbut from that there are a number of avenues beiign developed and some in trial as we speak.

      As for my research I have already had two drugs I worked on go to licence others are in humans. Many people will not get one in their lifetime I have already had a few. Scientists do not have the skill set or the qualifications or cash to develop drugs from the bench to the MSer. Although researchers do live in a bubble you are not really correct to heap the worlds woes on their shoulders as they can do little about it

      Only clinicians can test drugs and probably only MS pharma can get drugs to MSers. This is the system of treacle that has been created...trust me I know.

      We all think of the the A's from cambridge as being instrucmental in the development of lemtrada, but we have to remember that the Laaistairs/Alsadairs only staged to use this after it had been in phase I in humans after the inspriation of the scientists. It seems to be forgotten that without the likes of Hermann Waldmann and Greg Winters there would have been no CAMPATH-1H.

      Prof G should change what he wants to see ..what and become a white knight

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  2. This research in on quite a small sample. This is interesting, but does it take into account alcohol and cigarette consumption of all groups? Also, does the study include employed and unemployed categories? Is so, would this be significant in the conclusion of this research.

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  3. I am really concerned that the myth of progressive 'dementing' in MS continually perpetuated when the selection of research participants shows to me, a glaring bias.

    I have been looking at selection of participants in a number of studies and seem to see the selection site as MS Societies, and associated bodies where those who appear to have more disability, are not employed are likely to be an easy area to locate research participants. I suggest that if the sample selection continues to come from such places, and patients with aggressive and constantly relapsing forms of the disease continue to be selected such a biased view is possible. What seems to me to be absent from sample selection are the gainfully employed cognitive able people who are not 'dementing' away. I will get my thoughts together after I finished my own academic commitments and critique a couple of recents posts on the basis aforementioned.

    In the mean time, for those who have been depressed by recent posts, I feel you need a 'pick me up' - if we believe "the research" it indicates that, being male, late diagnosed, 'dementing' away in the early years of diagnosis is a recipe for cognitive downfall - well here is an n of 1 whose Wikipedia entry would be the envy of most world leaders, you won't find any mention of his 12 year diagnosis of MS in this 57 year old male's impressive life achievements - other than the fact that he founded and was the original Chairperson of Multiple Sclerosis Research Association in Australia, his primary career was investment banking and philanthrophy, he was the Australian of the Year in 2011, he recent chaired a government health inquiry. This man is no token 'disability person', he is fit, races yachts, and is clearly at the top of a management tree. Of course, it will be claimed that he has huge cognitive reserve, and if this is his 'magic recipe' it has certainly worked. I, of course have a far more simpler explanation - he is Australian where we have blue vitamin D, UVB ray filled sunshine, where physical activity is celebrated - as opposed to those dreary, depressing, S.A.D UK skies - ( sorry guys - gotta pay out on you before the Ashes start!)

    Please read this impressive man's achievements, and I'm here to tell you that I could offer you further Aussie over 50 males who are in positions of power and academics who have had MS for at least 15 years and who were late 30's early 40's when diagnosed!

    http://en.wikipedia.org/wiki/Simon_McKeon

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    1. The evidence that there is cognitive impairment in MS is certainly not a myth. Yes, there will be some that do not display this to any obvious clinically eloquent degree as you indicate but for many (perhaps the majority) there is no doubt that this happens. Also, I suggest that if you subjected your Aussie males to a battery of psychological tests, deficits may be revealed.
      All these posts are suggesting are that if this given prominence, it may speed up treatment for MSers so that hopefully these deficits may not develop.

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    2. Thank you Mouse 2, you are right to take me to task - the term 'myth' was inappropriate in the face of the evidence that has been presented thus far. It was not a good choice of words. I still maintain my point about the selection of MS from a 'biased' pool. Where are the studies of MSers who are in the 'high functioning' - employed full-time in executive positions, professors, doctors - a cohort of this type?

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  4. Dr. G,

    Thanks for asking your question re how to describe cognitive impairment publicly without causing collateral damage to MSers in employment and the economy.

    It's worth thinking about, maybe talking to a marketing person about getting reactions to different descriptions.

    My first thought is something softer than dementia, like 'cognitive slowing'. That's my experience, not less intelligent per se, but slower of speech, slower to react to new information.

    Dementia is a term of art for medical professionals. For most of the rest of us it suggests advanced alzheimers, old people wandering, schizophrenics babbling and violently threatening the rest of us. I don't think that image helps MS'ers.

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  5. I'm sure the marketeers will be talking to him

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  6. Re marketeers, he's talking about a campaign to change the perception of MS among public officials. They will be attuned to the ordinary person's interpretation of words in a way that marketeers are, and scientists are usually not.

    I once had the luxury of disdaining marketing. Then life steered me toward selling my skill retail in the marketplace rather than wholesale to an employer.

    If you sell the world on the idea that MS'ers are demented, don't be surprised when more of us are summarily sacked, when we are shunned socially more than we are now, when we are feared and mistrusted as well as pitied.

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