National Multiple Sclerosis Society, New York, NY, USA.
Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mult Scler. 2018 Nov;24(13):1665-1680. doi: 10.1177/1352458518803785. Epub 2018 Oct 10.
To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management.
The National MS Society ("Society") convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care.
Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society: Increased professional and patient awareness/education about the prevalence, impact, and appropriate management of cognitive symptoms. For adults and children (8+ years of age) with clinical or magnetic resonance imaging (MRI) evidence of neurologic damage consistent with MS: As a minimum, early baseline screening with the Symbol Digit Modalities Test (SDMT) or similarly validated test, when the patient is clinically stable; Annual re-assessment with the same instrument, or more often as needed to (1) detect acute disease activity; (2) assess for treatment effects (e.g. starting/changing a disease-modifying therapy) or for relapse recovery; (3) evaluate progression of cognitive impairment; and/or (4) screen for new-onset cognitive problems. For adults (18+ years): more comprehensive assessment for anyone who tests positive on initial cognitive screening or demonstrates significant cognitive decline, especially if there are concerns about comorbidities or the individual is applying for disability due to cognitive impairment. For children (<18 years): neuropsychological evaluation for any unexplained change in school functioning (academic or behavioral). Remedial interventions/accommodations for adults and children to improve functioning at home, work, or school.
增进对多发性硬化症（MS）认知障碍的了解，推荐最佳的筛查、监测和治疗策略，并解决管理障碍。
国家多发性硬化症协会（“协会”）召集认知功能障碍方面的专家（临床医生、研究人员和多发性硬化症患者），审查已发表的文献，就筛查、监测和治疗认知变化的最佳策略达成共识，并提出解决最佳护理障碍的策略。
基于现有证据，协会提出以下建议，得到多发性硬化症中心联合会和国际多发性硬化症认知协会的认可：提高专业人员和患者对认知症状的普遍性、影响和适当管理的认识/教育。对于有临床或磁共振成像（MRI）证据显示与 MS 一致的神经损伤的成人和儿童（8 岁以上）：最低限度，在患者临床稳定时，使用符号数字模态测试（SDMT）或类似验证测试进行早期基线筛查；每年使用相同的仪器重新评估，或根据需要更频繁地评估，以（1）检测急性疾病活动；（2）评估治疗效果（例如开始/改变疾病修正疗法）或疾病复发恢复；（3）评估认知障碍的进展；和/或（4）筛查新出现的认知问题。对于成年人（18 岁以上）：对任何初始认知筛查呈阳性或表现出明显认知下降的人进行更全面的评估，尤其是如果有共病或个人因认知障碍申请残疾的担忧。对于儿童（<18 岁）：对于任何学校功能（学业或行为）无明显原因的变化，进行神经心理学评估。为成年人和儿童提供补救干预/适应措施，以提高家庭、工作或学校的功能。
