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Home > MSAA Publications > The Motivator > The Motivator: Winter/Spring 2009 > Cover Story - Symptom Management Update > SECTION 11: COGNITIVE FUNCTION
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SECTION 11: COGNITIVE FUNCTION

The term "cognition" refers to a group of mental processes that include functions such as memory, decision making, and concentration, which is the ability to focus on specific tasks and planning. Since other symptoms of MS can affect concentration, and drugs used to treat some symptoms can affect how quickly thoughts may be processed, it is important that any cognitive symptoms be evaluated carefully in the overall context of your MS management. The relationship between fatigue and cognition is significant, and there is a clear association between feelings of tiredness, difficulty concentrating, and memory issues. For this reason, symptoms of cognitive difficulties are often improved by the strategies discussed in the Fatigue section, beginning on page 6.

COGNITIVE TESTING AND REHABILITATION

A baseline cognitive evaluation is important and can serve as the basis for a comprehensive management strategy by identifying the areas of difficulty. This testing procedure is generally administered by a neuropsychologist or other specialist.

A variety of strategies have been designed to help improve cognitive function. These range from keeping simple task lists, to planning how you use your time to take on more complex tasks when you are at your best, to more advanced computerized programs designed to improve memory and other cognitive issues.

The results of a study on cognition were reported at the AAN's annual meeting in 2008. This study measured improvements in general memory, working memory, and processing speed in people who participated in a targeted cognitive rehabilitation program, compared to those who did not participate in a program. The results suggested a clinically statistical improvement. A recent study from Israel suggested that a computer-based cognitive training program (MindFit ®) led to an improvement in memory skills in people with MS.

Disease Modifying Therapies

A number of studies suggest that the disease-modifying therapies (DMTs) delay or improve cognitive problems. The approved DMTs for MS include: Avonex ® (interferon beta 1-a); Betaseron® (interferon beta 1-b); Rebif® (interferon beta 1-a); Copaxone® (glatiramer acetate); Novantrone® (mitoxantrone); and Tysabri®(natalizumab).

PHARMACOLOGIC MANAGEMENT

Several drugs may be effective in reducing the cognitive symptoms of MS.

Anti-Fatigue Agents
including Provigil®(modafinil) and amantadine

Separating the effects of fatigue and cognition can often be difficult, but there is ample evidence that fatigue worsens the effect of cognitive difficulties, and that fatigue-management strategies are often effective in decreasing cognitive symptoms. Please see page 7 for details.

Aricept®(donepezil)

This is an oral medication in tablet form. The dose normally ranges from 5 to 10 mg per day.

Aricept®is one of a group of cholinesterase inhibitors that were originally developed for use in Alzheimer 's disease. It prevents the breakdown of one of the main neurotransmitters in the brain, acetylcholine, thus increasing its levels in the brain and improving the function of those neurons that are dependent on this substance for normal functioning. Preliminary studies suggest that they may improve learning and memory.

MS trials using drugs for Alzheimer's disease need more rigorous results before they can gain wider acceptance and are FDA-approved for the cognitive symptoms sometimes experienced with MS. Several small clinical trials have shown a modest improvement in memory as measured by test scores, and up to two-thirds of the participants reported improvement.

Side effects may include gastrointestinal problems, painful or difficult urination, seizures, fatigue, or sleep difficulties.

Other Alzheimer's disease treatments

Other pharmacologic agents approved for treating Alzheimer's disease are used in some patients. The effects are usually not dramatic.

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Last Updated on Friday, 10 May 2013 10:22