![]() Recognition of recently learned information is generally impaired to a much lesser extent than free recall. Implicit memory, or the ability to learn new information or skills without explicitly attending to it, is also preserved. For example, the rate of learning, the likelihood of remembering a specific item based on when it was presented, and the ability to detect semantic characteristics of the material to be learned are preserved in all but the most impaired MS patients. Although memory deficits are common, certain processes remain intact. 3 Depending on sample selection methods and criteria used to define impairment, approximately 20 to 42 percent of MS patients have some deficit in their free recall of recently learned verbal and visual material (reviewed in 1994 by Fischer et al. Poor memory is a common complaint among MS patients. 41 Once cognitive impairment is present, it does not often remit (reviewed in 1999 by Fischer 54 ). 54 Performance accuracy is less affected, but it appears affected if timed tests are used. ![]() Learning, recall of new information, and speed of information processing are affected most often deficits in visuospatial abilities and executive functions such as reasoning, problem solving, and planning are also common. ![]() Paradoxically, as we are learning to separate and more effectively measure the cognitive changes and the affective changes, this separation has made it possible to learn how they are so often linked (Jock Murray, personal communication).Ĭognitive changes in MS generally are not global, but are most often circumscribed to specific processes. Rao, LaRocca, Fischer, Peyser, and many others have recently made considerable progress in adapting tests that can detect the specific changes seen in this disease, 54, 57, 130 yet much more remains to be done. Standard psychological tests, however, are not very effective in identifying the type of changes that occur in MS. The conviction that cognitive changes must be selectively analyzed and distinguished from other phenomena such as depression and fatigue has emerged only in the last few decades. 143 By the 1990s, those views had changed, and in 1992, the MS Society and the International Federation of Multiple Sclerosis Societies jointly held a symposium on “Neurobehavioral Disorders in MS: Diagnosis, Underlying Pathology, Natural History and Therapeutics.” Cognitive changes are now estimated to occur in about 43 percent of MS cases. At the time, it was estimated that only 5 percent of MS patients might incur cognitive change, and it was argued that cognitive change was relatively unimportant in MS. Donald Paty (personal communication) noted that there was a negative reaction to his suggestions in the 1970s that cognitive dysfunction should be a focus of study by the National MS Society. 143 Just as clinicians passed off the frequent symptoms of pain and fatigue as features of the disease, they also ignored the often seen emotional and cognitive changes (Jock Murray, personal communication). 140Įarly writers on MS often commented on cognitive and emotional changes, but in the mid-twentieth century, a pattern of denial of these features developed in the medical literature. Cognitive dysfunction is one of the most disabling features of MS and, even when subtle, can begin to limit a person's ability to cope, to stay employed, and to carry out family responsibilities and enjoy life. 146įear of mental change is one of the greatest concerns of MS patients when they learn they have the disease. They are presented roughly in order of the importance that MS patients assign to them as determinants of overall quality of life, although it should be noted that this ranking is based on a small survey and that individual variability is a prominent feature of all aspects of MS. 146 Nine of the most prominent symptoms are described in this chapter. ![]() This is different from neurologists' beliefs about the most important determinants of health-related quality of life for patients with MS or the beliefs of members of the general public about their own quality of life. In general, MS patients report mental health as more important than physical impairment and bodily pain in determining their quality of life. The majority of fleeting cerebral abnormalities seen on magnetic resonance imaging (MRI) cannot be correlated with any symptoms even chronically demyelinated areas of the optic nerve and spinal cord can be symptom free. Some symptoms such as dizziness, tingling sensations on the skin, or visual tracking disturbances are easily forgotten and are often hard for patients to describe. ![]() The signs and symptoms of multiple sclerosis (MS) are generally related to the most heavily myelinated parts of the central nervous system (CNS), but they are notoriously variable. ![]()
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