Dementia in Patients with MS: Screening, Prevention, Differential Diagnosis, Functional and Safety Assessment, and Interdisciplinary Management

Background:

Symptoms of cognitive dysfunction are highly prevalent in patients with MS. When the cognitive impairment significantly interferes with the individual’s functioning and independence in instrumental activities of daily living, patients may present a diagnosis of Dementia, or Major Neurocognitive Disorder in the DSM-5 classification. The presence of dementia exposes the individual to a number of risks. Since it can occur in the absence of significant physical manifestations, dementia in MS can go under recognized by clinicians and caregivers.

Objectives:

To summarize the literature on MS- dementia, present a case series from our clinic of five patients with MS- related dementia, and provide guidelines for screening, prevention, assessment and interdisciplinary management of these patients.

Methods:

We conducted a PubMed review of articles discussing dementia in MS, summarized and organized the findings. We described five case vignettes of patients with MS and Dementia treated at our center. We combined findings from the MS literature with expert guidelines for the assessment and management of dementia from other etiologies, and proposed initial guidelines for the assessment and management of MS- related dementia.

Results:

There is a solid and growing body of research regarding cognitive disorders in MS, but specific literature on Dementia in MS and its management is limited. Dementia is more likely to occur in patients with progressive illness, brain atrophy, cortical lesions. Comorbidities such as brain vascular disease and depression may contribute. Protective factors such high cognitive reserve may delay its onset. Individual clinical factors such as lack of insight and euphoria may delay the recognition of dementia by clinicians and caregivers. Delay in recognition of dementia may expose patients to greater risk, including risk when driving, financial risk, exploitation by caregivers, and others.

Conclusions:

For patients with MS, periodic cognitive and functional evaluation may assist in earlier recognition of Dementia. Management includes to reduce the burden of contributing etiologies, and to prevent the risks associated with cognitive impairment. Learnings from the Alzheimer’s and other dementias literature and expert guidelines can be adapted to the care of patients with dementia from MS. Implementation of early measures to protect brain health and build cognitive reserve may delay the onset of dementia.