Multiple Sclerosis - A Practical Guide to Rehabilitation - 28

AIMS

A PRACTICAL GUIDE TO IDIOPATHIC PULMONARY FIBROSIS

interventions seen with MS are similar-more so
than those seen with stroke or degenerative
dementias.

SCREENING FOR COGNITIVE
CHANGES IN MS
The most widely accepted screening batteries for
cognitive change in MS are the Brief Repeatable
Neuropsychological Battery (BRNB) and the
Minimal Assessment of Cognitive Function in
MS (MACFIMS).73,74 These composite measures
are summarized in Table 11. Both are validated
and reliable. A Brief Neuropsychological Battery
for Children (BNBC) is also available to assess
expressive vocabulary, cognitive flexibility,
processing speed, and learning and memory in
pediatric MS. The use of these screening protocols
may be limited in routine clinical practice, as
clinicians may lack access to and experience
with some of the specific tests and normative
data on MS.
Because people with MS may not be aware of
cognitive deficits,76 self-report measures, such as
the Multiple Sclerosis Neuropsychological
Questionnaire (MSNQ), may not be helpful.77

Several studies have found the Montreal
Cognitive Assessment (MoCA) to be useful for
screening patients with MS.78,79,80 Other brief
screening measures used for cognitive changes,
such as the Mini-Mental State Examination
(MMSE), are not sensitive to deficits typically
present with MS.81 A detailed history of vocational
and avocational performance may be informative.
Further, reports from family members or
caregivers are more likely to be accurate than
patient self-reports.82
Whether all individuals who have MS should be
screened for cognitive deficits is a matter of some
debate. However, once a patient presents with
cognitive concerns, comprehensive evaluation is
warranted and may require measures tailored to
the specific clinical issues at hand.
Patients should be referred for evaluation of
cognition in certain circumstances or when
particular symptoms appear. Examples include:
* Behaviors that pose a safety or hazard risk
* Decrease in work performance
* Forgetfulness

Table 11: Brief Neuropsychological Batteries for Assessment of Cognitive Change in MSAdapted from 75
Cognitive Domain

28

MACFIMS

BRNB

Auditory processing speed and
working memory

Paced Auditory Serial Addition
Test

Paced Auditory Serial Addition
Test

Visual processing speed and
working memory

Symbol Digit Modalities Test

Symbol Digit Modalities Test

Auditory/verbal episodic
memory

California Verbal Learning
Test-2nd Edition

Selective Reminding Test

Visual/spatial episodic memory

Brief Visuospatial Memory
Test-Revised

10/36 Spatial Recall Test

Expressive language

Controlled Oral Word
Association Test

Controlled Oral Word
Association Test

Spatial processing

Judgment of Line Orientation

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Executive function

Delis-Kaplan Executive Function
System sorting

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Selected Aspects of Cognition in Multiple Sclerosis



Multiple Sclerosis - A Practical Guide to Rehabilitation

Table of Contents for the Digital Edition of Multiple Sclerosis - A Practical Guide to Rehabilitation

Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 1
Multiple Sclerosis - A Practical Guide to Rehabilitation - 2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 3
Multiple Sclerosis - A Practical Guide to Rehabilitation - 4
Multiple Sclerosis - A Practical Guide to Rehabilitation - 5
Multiple Sclerosis - A Practical Guide to Rehabilitation - 6
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Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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