Treatment of Cognitive Changes
THE IDEA THAT we should try to do something about cognitive changes in MS is almost revolutionary. It is, however, one of the fastest growing areas of MS treatment. Here is a brief survey of some of the options.
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| Multiple Sclerosis Treatment Guidelines |
Symptomatic Medications
THERE IS AS yet no "memory pill" that can improve cognitive function in MS. A class of drugs called potassium channel blockers (4-aminopyridine (4-AP) and 3, 4 diaminopyridine) have been studied for several years. The potassium channel blockers increase the speed of nerve conduction in demyelinated nerve fibers, leading investigators to think that they might improve neurologic function and cognition. Unfortunately, these drugs can put one at risk for seizures because they speed up nerve conduction. A sustained-release version of 4-AP is currently under study. At this time, however, these drugs are not FDA-approved for general use.
Donepezil hydrochloride (Aricept) has been approved by the FDA for the treatment of memory disorders in Alzheimer's disease. A recent study of' 69 MS patients with memory deficits showed that Aricept had modest benefits for verbal memory - in this case, the ability to remember a list of words. A larger, multi-center trial of Aricept has begun, and should provide more definitive evidence concerning the effectiveness of this drug.
Disease Modifying Agents
FlVE DRUGS ARE now approved by the FDA for the treatment of MS - the interferon-beta medications (Avonex, Betaseron, and Rebif), glatiramer acetate (Copaxone), and mitoxantrone (Novantrone) - and many more are in clinical trials. Avonex has demonstrated the most positive benefits on cognition. Results with getaseron have been mixed, while the results with Copaxone were negative. No studies examining the impact of Rebif on cognitive functions have been reported to date.
Although none has shown dramatic benefits for slowing the progression of cognitive dysfunction or reversing its effects, investigators remain optimistic. While many of the earlier clinical trials did not adequately assess cognitive function, recent clinical trials are paying closer attention to cognitive problems. If a treatment is capable of slowing or halting the process of demyelination, it should help preserve cognitive function in people who have MS. The jury is still out on this question, but an educated guess is that the verdict is likely to be positive.
Cognitive Rehabilitation
COGNITIVE REHABILITATION IS a systematic program designed to improve cognitive function; it is conducted individually and/or in groups by a psychologist, speech pathologist, or occupational therapist. Such programs have been common in head injury and stroke for many years, but are just coming into their own in MS.
If an MS specialist is not available, a clinician with experience treating mild head injury would be a reasonable alternative since many of the problems are similar.
Compensatory Strategies
COGNITIVE REHABILITATION SESSIONS generally combine exercises and drills to challenge and improve cognitive functions (e.g., memorizing lists of words) with the design and implementation of compensatory strategies for dealing with cognitive changes (e.g., use of a notebook as a memory aid). Like fitness programs, cognitive rehabilitation works best when you have a "personal trainer" to direct and encourage you. However, there are many things you can do on your own to improve your situation.
If your memory is weak, substitute organization. Set up a family calendar and put everyone's activities on it. Buy a loose-leaf organizer (e.g., Day-Runner, Day-Timer) and set up sections for appointments, things to do, names, addresses, phone numbers, driving directions, and so forth. Set up a home filing system to keep track of all personal papers. Process incoming mail and other papers quickly to avoid accumulations. Set up checklists for repetitive tasks, such as a packing list for travel or a master grocery list for checking off needed items. Set up a distraction-free "zone" in the house and make sure family members respect it. Establish a fixed storage place for frequently used items like eyeglasses and scissors so you can always find them. Involve the entire family so that everyone assists in the organizational changes.
MULTIPLE SCLEROSIS IS a complex disease with many ramifications for the psychological life of the individual and the family. Adjusting successfully to MS requires understanding and addressing these psychological changes along with the physical ones. There are many resources available for education, evaluation, and treatment. By using these resources to the fullest, the family living with MS can succeed in living more comfortably with an unwelcome but persistent intruder. To find out more, you can check out Multiple Sclerosis Treatment Guidelines.