Addressing Cognitive Impairment in Multiple Sclerosis

John DeLuca, PhD, Kessler Foundation, Rutgers University Medical School

John DeLuca, PhD

John DeLuca, PhD, senior vice president for research and training at the Kessler Foundation, spoke with NeurologyLive in an interview at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) forum held in Dallas, Texas, to discuss the work that the Kessler Foundation has done to help treat cognitive impairment in multiple sclerosis (MS).

The most recent guidelines from the National Multiple Sclerosis Society advise clinicians to conduct annual cognitive assessments with neuropsychological tests to monitor cognitive problems so adequate treatment can be provided. DeLuca stressed the importance of and need for clinicians to add the assessment to standard practice.

The Kessler Foundation has focused on developing individual therapies like cognitive rehabilitation to improve learning, memory, and processing, and lessen cognitive symptoms. While research on drug therapies for cognitive impairment is fairly new, DeLuca explained that there is good data that supports that cognitive rehabilitation can significantly improve not only cognition but also everyday life activities.

According to DeLuca, the idea of medication, cognitive rehab, and exercise might just be the wave of the future for cognitive treatment in MS.

NeurologyLive: What is one area in MS that you think should be getting more attention?

John DeLuca, MD: About 30 years ago, neurologists generally didn't think that cognition was the problem persons within MS—fast forward to today and we know that up to two-thirds of individuals with MS have cognitive problems.

One approach is the medication approach, that's kind of new research and the data is fairly mixed at this point. There is good data though that cognitive rehabilitation can significantly improve not only cognition but also everyday life activities. There's also some data out there that's starting to show that exercise might have a specific effect on cognition, so the idea of medication, cognitive rehab, and exercise might be the wave of the future of how we treat cognitive problems in persons with MS.

Can you talk about some of the research that the Kessler Foundation is conducting?

Persons who have cognitive problems, they affect all aspects of their lives, not just employment, but family life, driving abilities, quality of life, and to really get at the individual level, you have to have a therapy which treats them as an individual and that's what cognitive rehabilitation does.

The work that we've done is to develop specific therapies that teach patients how to utilize techniques in their everyday life, to improve their learning and memory, and to improve their processing speed, and utilize these tools to actually show an improvement in their specific lives, because everybody's is going to be a little bit different whether you're a CEO of a company or you're working at a Starbucks, how it affects you is going be very individualized.

Individual therapies are critically important and that's what we do that's Kessler Foundation, we do the type of work that's going to help individuals in their own everyday life.

What is your hope for the future to address these cognitive problems?

Really what we need to do is make sure that our patients are assessed for their cognitive problems when they go see their neurologists. Right now, the latest research about half of clinics don't even assess cognitive problems in persons with MS—you can't do any treatment unless you know there's a problem.

The latest guidelines from the National Multiple Sclerosis Society just published said that we need to have at least annual cognitive assessments with real neuropsychological tests to monitor cognitive problems so that they can be treated adequately. We really need to make sure that this gets into standard of practice, looking at and assessing cognitive problems and then moving toward its treatment.

Transcript edited for clarity.