Cognitive Dysfunction: The Dark Side of the Moon

• Published in: Multiple sclerosis and related disorders 2023-03, Vol.71, p.104266, Article 104266
• Main Authors: Khermache, Ali, Bouchenek, Mondher Islem
• Format: Article
• Language: English
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2022.104266

Cognitive dysfunction is a hidden, disabling, and unfortunately an overlooked symptom in patients with multiple sclerosis (MS). Neurologists in Algeria are generally occupied by the management of the sensorimotor symptoms and the evaluation of the Expanded Disability Status Scale (EDSS) as an indicator of the progression of the disease. Impairments in processing speed (PS) rise as the common cognitive dysfunction in patients with MS. The Symbol Digit Modalities Tests (SDMT) is the most sensitive measure to multiple sclerosis (MS)-related cognitive dysfunction. This study aims to shed light on the cognitive dysfunction in Algerian patients with MS, and to identify the clinical and sociodemographic characteristics of those patients. This longitudinal observational study was conducted at the tertiary health care center in Sidi Bel Abbas Teaching Hospital, Algeria, from January 2019 to December 2021. A total of 249 patients (182 female, mean age 38.92 ±11.29 years) diagnosed with clinically definite MS according to the 2015 McDonald's criteria, were administered the SDMT, together with: the Modified Fatigue Impact Scale MFIS for fatigue; the Beck Depression Inventory (BDI) for depression; the Hospital Anxiety and Depression Scale for anxiety. Additionally, clinical data and disability assessed by the EDSS, The timed 25-foot walk test, and the 9-hole Peg Test were recorded. Almost all of our patients had an impaired SDMT score (35.1± 13.76) which contrasted with a relatively preserved EDSS score (3.36±2.01) and a high level of education (one-third of our patients). Half of our patients suffered from unemployment, and two-thirds from depression, anxiety, and fatigue. This study clarified the other hidden aspect of the disability in our patients, along with the severe clinical course in our MS patients. Moreover, it opened the doors for other studies to categorize our MS clinical patterns and adopt accurate normative scores.