University Hospital Catania, Multiple Sclerosis Centre Sicilia Region, First Neurology Clinic, Neuroscience Section, GF Ingrassia Department, Via Santa Sofia 78, 95123 Catania, Italy.
Expert Opin Investig Drugs. 2012 Nov;21(11):1679-99. doi: 10.1517/13543784.2012.716036. Epub 2012 Aug 9.
Identifying and treating cognitive impairment in patients with multiple sclerosis (MS) is increasingly recognized as a crucial step in selecting the most appropriate treatment for the individual. Currently, the neuropsychological tests used to assess patients are time-consuming and require specialist training to administer; consequently, cognitive impairment in MS is underdiagnosed. Many treatments are available for MS, including disease-modifying drugs (DMDs) and symptomatic therapies, but what are their effects on cognitive performance?
This article will review published studies describing the cognitive effects of DMDs and symptomatic treatments for MS.
Some DMDs may improve cognitive performance in patients with MS. None of the symptomatic drug treatments reviewed showed positive effects on cognitive performance, with the possible exception of L-amphetamine, which may improve memory in patients with existing deficits, and methylphenidate, on which more data are needed. Cognitive rehabilitation can improve cognitive performance, but experience with these techniques is limited. Treatment for patients with MS and cognitive impairment should, therefore, include a DMD in combination with a pharmacological or perhaps non-pharmacological cognitive-enhancement strategy. However, the methods used to diagnose cognitive impairment, and to assess the effect of treatment on function over time and need to be refined.
识别和治疗多发性硬化症（MS）患者的认知障碍，正日益被视为为个体选择最合适治疗方法的关键步骤。目前，用于评估患者的神经心理学测试既耗时又需要专业培训来实施；因此，MS 的认知障碍被漏诊了。有许多治疗方法可用于 MS，包括疾病修正药物（DMD）和对症治疗，但它们对认知表现有何影响？
本文将综述描述 DMD 和 MS 对症治疗对认知影响的已发表研究。
一些 DMD 可能改善 MS 患者的认知表现。综述中评估的对症药物治疗均未显示对认知表现有积极影响，可能有例外的是 L-苯丙胺，它可能改善存在缺陷的患者的记忆力，而关于哌甲酯还需要更多的数据。认知康复可以改善认知表现，但这些技术的经验有限。因此，MS 合并认知障碍的患者的治疗应包括 DMD 与药物或非药物认知增强策略相结合。然而，用于诊断认知障碍的方法以及评估治疗对功能的影响，需要随时间推移进行改进。
