Patients and Clinicians Perceive Cognitive Deficits Differently in Multiple Sclerosis

Mark Gudesblatt, MD

New data presented at the 2022 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, June 1-4, in National Harbor, Maryland, identified several different factors for patients with multiple sclerosis (MS) and clinicians that drive the perception of self-reported cognitive impairment.¹

Senior author Mark Gudesblatt, MD, neurology specialist, South Short Neurologic Associates, and colleagues aimed to understand the accuracy of self-reported cognitive impairment in patients with MS and whether the perception differs from clinicians. Previous literature has reported mixed results, with contributing factors such as depression and fatigue not fully included in some of these trials.

In this study, patients with MS took a computerized multidomain cognitive screening battery and reported on several factors, including fatigue, as assessed by Modified Fatigue Impact Scale, depression, assessed using the Beck Depression Inventory-II, and quality of life, using a Likert scale. Physical disability was assessed by the patient’s clinician using the Expanded Disability Status Scale (EDSS), while perceived cognitive deficits among both groups were self-reported using Likert scale.

Using hierarchical regression analyses in the cohort of 202 patients with MS, data reported that fatigue (P <.001) and cognitive (P <.05) scores significantly predicted patient-perceived cognitive deficits, but not depression (P = .377) or physical disability (P = .213). Clinician-perceived cognitive deficits differed from those with MS, mainly by cognitive scores (P <.001), depression (P <.001), physical disability (P <.05), age (P <.05), and self-reported quality of life (P <.05); however, fatigue was not among the significant factors for these deficits (P = .535).

"In patients with MS, cognitive impairment affects real-world ability, and identifying the presence of or a change in cognitive impairment in people with MS should not be left to perception alone,” Gudesblatt et al concluded. “Future studies should explore whether patients or clinicians accurately perceive a patient’s cognitive impairment."

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There has been a limited number of studies that have looked at the clinician vs patient perceptions of cognitive impairment. One notable 2015 retrospective chart review by Kristoffer Romero, et al found that the clinical interview and standard neurological examination are not sufficiently sensitive to detect cognitive impairment in patients with MS, and suggested the need for a brief, accurate screening tool to compliment routine clinical evaluation.²

Romero and his colleagues included 97 patients with MS referred by neurologists for neuropsychological assessment based on suspected cognitive impairment. Each patient were classified as either globally impaired or intact according to failure on 2 or more of 11 cognitive indices comprising the MACFIMS, a recommended neuropsychological battery for MS. At the conclusion of the study, neurologists’ accuracy was not significantly different from chance (X2 = 1.25; P = 0.26), with 44.3% of patients with suspected cognitive impairment showing global impairment on objective testing. Notably, when compared with those who were impaired, cognitively intact patients had higher levels of education and were less likely to have mood disturbances.

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REFERENCES
1. Jackson D, Nicholson R, Bergmann CS, et al. Cognitive impairment in people with multiple sclerosis: factors that drive perception of impairment differ for patients and clinicians. Presented at: CMSC Annual Meeting 2022; June 1-4; National Harbor, Maryland. Abstract QOL10
2. Romero K, Shammi P, Feinstein A. Neurologists’ accuracy in predicting cognitive impairment in multiple sclerosis. Mult Scler & Relat Disord. 2015;4(4):291-295. doi: 10.1016/j.msard.2015.05.009