Modern neuropsychological assessment methods for cognitive impairments in multiple sclerosis: a literature review

Abstract

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease that according to the Atlas of MS of the Multiple Sclerosis International Federation affects nearly 3 million people worldwide, predominantly young adults (70—80 %) and 3—5 % of children. Motor impairments are among the leading MS symptoms as well as cognitive impairments (CI) which occur in 40—60 % of MS patients. However, due to their minimal impact on the overall EDSS score, disorders of cognitive functions are often overlooked, negatively affecting patients' quality of life and work capacity. Diagnosing CI is a crucial aspect of providing proper care, improving social adaptation, and expanding cognitive rehabilitation opportunities. This review aimed to systematize current knowledge about neuropsychological diagnostic methods for CI in patients with MS. We conducted a computerized search in PubMed, Scopus, and Web of Science using the keywords «multiple sclerosis», «cognitive impairment», and «assessment». In neuropsychology, CI is usually defined as performance falling more than 1.5 standard deviations below normative expectations, adjusted for demographic variables such as age and educational level. When diagnosing CI in MS, it is essential to consider comorbid psychiatric conditions, adverse effects of pharmacological treatment, and MS-related symptoms that may negatively influence cognitive function. Despite the wide range of existing methods for assessing CI in patients with MS, there is no consensus or clear recommendation regarding the use of specific tests, as no single tool provides comprehensive coverage of the patients’ cognitive profile. The existing batteries of tests are well-constructed, yet have their limitations and challenges as long duration, necessity of experienced well-trained personnel or restricted coverage of cognitive domains. Further research is needed to identify the optimal assessment approach.