Cognitive impairment in MS is very relevant to treatment decisions & management. It may be a presenting clinical feature of natalizumab-associated PML ; conversely improvement in cognition may be seen in treatment of MS. There is some evidence for the Montreal Cognitive Assessment as a screening tool in MS.
MoCA was performed as a cognitive baseline for PML surveillance for patients on natalizumab. 83 natalizumab-treated patients were identified. Moca scores were available for 72 patients. Scores ranged from 15 -30 (Score is out of 30 and the cut off for ‘normal’ is >/=26). Average score 25.7. Age range 18–69, average age 47.
30 patients (41.7%) scored below cut off. Subsection scores were available for 27 patients. These will be described in more detail. Patients with low scores were often observed to have frequent DNA letters on file. Two patients had longitudinal data.
This audit suggests a high prevalence of cognitive impairment in line with reports which in some cases seems quite severe. MoCA seems to be a usefool screening tool and alerts us to the need for detailed consent & follow-up as well as indicating qualitative aspects of cognitive dysfunction to enable practical strategies to be employed.
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