Disease-modifying therapies as cognition-modifying therapies? Treating cognitive impairment in MS

摘要

Multiple sclerosis (MS) is characterized by a plethora of symptoms, including cognitive impairment. The prevalence of cognitive impairment ranges from 40% to 70%,1,2 varying with age, disease duration, physical disability,3 and the number and types of domains tested. Information processing speed has historically been considered the most commonly affected cognitive domain, 1but episodic memory, executive function, and language functions may also be affected. The adverse influence of cognitive impairment is substantial. Affected individuals are less likely to maintain employment or retain the ability to drive, participate in society, or remain independent ; 70% of individuals with MS residing in long-term care facilities have cognitive impairment. 5Current treatment guidelines for MS place a strong emphasis on early diagnosis and early institution of disease-modifying therapies (DMTs). The goals of these therapies include the reduction of relapses, new lesions on MRI, and disability progression. People with MS and clinicians also identify preservation of cognition as an important desired outcome of DMT use.6 Remarkably, although the first DMT was approved 25 years ago, and more than 10 DMTs are available now, we still lack a concrete understanding of whether these therapies reduce the progression of cognitive impairment.