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Cognitive Loss in Multiple Sclerosis: Case Reports and Review of the Literature

Cognitive Loss in Multiple Sclerosis: Case Reports and Review of the Literature Abstract • Neuropsychological and neuroradiologic evidence of cerebral lesions is described for 12 patients with multiple sclerosis in whom cognitive disability was far greater than any other neurologic disability. Cognitive dysfunction resulted in significant functional impairment at work or home in three fourths (9 of 12) of the patients described here, despite mild physical disability (mean Kurtzke Expanded Disability Status Scale score, 3.2). A unique feature of the neurologic examination in these patients was the presence of prominent frontal release signs (gait apraxia and placing response) in the lower extremities. Two new scales, a Cognitive Function Scale and a Frontal Release Scale, were adapted for the investigation of these patients. The extensive literature relating to cognitive dysfunction in multiple sclerosis is reviewed and discussed with regard to its clinical relevance. References 1. Heaton RK, Nelson LM, Thompson DS, et al: Neuropsychological findings in relapsing/remitting and chronic/progressive multiple sclerosis . J Consult Clin Psychol 1985;53:103-110.Crossref 2. Peyser JM, Edwards KR, Poser CM, et al: Cognitive function in patients with multiple sclerosis . Arch Neurol 1980;37:577-579.Crossref 3. Rao SM, Hammeke TA, McQuillen MP, et al: Memory disturbance in chronic/progressive multiple sclerosis . Arch Neurol 1984;41:625-631.Crossref 4. Lyon-Caen O, Jouvent R, Hauser S, et al: Cognitive function in recent onset demyelinating diseases . Arch Neurol 1986;43:1138-1141.Crossref 5. Gilbert JJ, Sadler M: Unsuspected multiple sclerosis . Arch Neurol 1983;40:533-536.Crossref 6. Franklin GM, Heaton RK, Filley CM, et al: Correlation of neuropsychological and magnetic resonance imaging (MRI) findings in chronic/ progressive MS . Neurology 1988;38:1826-1829.Crossref 7. Reitan RM, Davison L: Clinical Neuropsychology: Current Status and Applications . Washington, DC, V. H. Winston, 1974. 8. Kurtzke JF: Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS) . Neurology 1983;33:1444-1452.Crossref 9. Hauser SL, Dawson DM, Lehrich JR, et al: Intensive immunosuppression in progressive multiple sclerosis: A randomized, three arm study of high dose intravenous cyclophosphamide, plasma exchange, and ACTH . N Engl J Med 1983;308:173-180.Crossref 10. Canter AH: Direct and indirect measures of psychological deficit in multiple sclerosis . J Gen Psychol 1951;44:3-50.Crossref 11. Ross AT, Reitan RM: Intellectual and affective functions in multiple sclerosis . Arch Neurol Psychiatry 1955;73:663-677.Crossref 12. Jambor KL: Cognitive functioning in multiple sclerosis . Br J Psychiatry 1969;115:765-775.Crossref 13. Beatty PA, Gange JJ: Neuropsychological aspects of multiple sclerosis . J Nerv Ment Dis 1977;164:42-50.Crossref 14. Trimble MR, Grant I: Psychiatric aspects of multiple sclerosis , in Benson DF, Blumer D (eds): Psychiatric Aspects of Neurologic Disease . New York, Grune & Stratton, 1982, vol 2, pp 279-299. 15. McFarlin DE, McFarland HF: Multiple sclerosis . N Engl J Med 1982;307:1183-1188,1246-1251.Crossref 16. McKhann GM: Multiple sclerosis . Annu Rev Neurosci 1982;5:219-239.Crossref 17. Kahana E, Leibowitz U, Alter M: Cerebral multiple sclerosis . Neurology 1971;21:1179-1185.Crossref 18. Kurtzke JF, Beebe GW, Nagler B, et al: Studies on the natural history of multiple sclerosis: 6. Clinical and laboratory findings at first diagnosis . Acta Neurol Scand 1972;48:19-46.Crossref 19. Crisp DT, Kleiner JE, DeFillip GJ, et al: Clinical correlations with magnetic resonance imaging in multiple sclerosis . Neurology 1985;35( (suppl 1) ):137. 20. McLardy T, Sinclair A: A case of pre-senile fulminating multiple sclerosis . Confin Neurol 1964;24:417-424. 21. Messert B, Baker NH: Syndrome of progressive spastic ataxia and apraxia associated with occult hydrocephalus . Neurology 1966;16:440-452.Crossref 22. Bartolini S, Inzitari D, Castagnoli A, et al: Correlation of isotopic cisternographic patterns in multiple sclerosis with CSF IgG values . Ann Neurol 1982;12:486-489.Crossref 23. Volpi G, Inzitari D, Fratigliani L, et al: CT periventricular hypodensity in multiple sclerosis: Isotope cisternography and clinical correlations . Ann Neurol 1986;20:146. 24. Bergin JD: Rapidly progressing dementia in disseminated sclerosis . J Neurol Neurosurg Psychiatry 1957;20:285-292.Crossref 25. Koenig H: Dementia associated with the benign form of multiple sclerosis . J Trans Am Neurol Assoc 1968;93:227-228. 26. Young AC, Saunders J, Ponsford JR: Mental change as an early feature of multiple sclerosis . J Neurol Neurosurg Psychiatry 1976;39:1008-1013.Crossref 27. Grant I, McDonald WI, Trimble MR, et al: Deficit learning and memory in early and middle phases of multiple sclerosis . J Neurol Neurosurg Psychiatry 1984;47:250-255.Crossref 28. Van den Burg W, van Zomeren AH, Minderhoud JM, et al: Cognitive impairment in patients with multiple sclerosis and mild physical disability . Arch Neurol 1987;44:494-501.Crossref 29. Jacobs L, Kinkel PR, Kinkel WR: Silent brain lesions in patients with idiopathic optic neuritis . Arch Neurol 1986;43:452-455.Crossref 30. Stevens JC, Farlow MR, Edwards MK, et al: Magnetic resonance imaging: Clinical correlation in 64 patients with multiple sclerosis . Arch Neurol 1986;43:1145-1148.Crossref 31. Rao SM: The neuropsychology of multiple sclerosis: A critical review . J Clin Exp Neuropsychol 1986;8:503-542.Crossref 32. Filley CM, Heaton RK, Nelson LM, et al: A comparison of dementia in Alzheimer's disease and multiple sclerosis . Arch Neurol 1989;46:157-161.Crossref 33. Rao SM, Glatt S, Hammeke TA, et al: Chronic/progressive multiple sclerosis: Relationship between cerebral ventricular size and neuropsychological impairment . Arch Neurol 1985;42:678-682.Crossref 34. Rabins PV, Brooks BF, O'Donnell P, et al: Structural brain correlates of emotional disorder in multiple sclerosis . Brain 1986;109:585-597.Crossref 35. Huber SJ, Paulson GW, Rammohan K, et al: Magnetic resonance findings, disability, and cognitive factors in multiple sclerosis . Ann Neurol 1986;20:170. 36. Schiffer RB, Caine ED, Bamford KA, et al: Depressive episodes in patients with multiple sclerosis . Am J Psychiatry 1983;140:1498-1500. 37. Schiffer RB, Babigian HM: Behavioral disorders in multiple sclerosis, temporal lobe epilepsy and amyotrophic lateral sclerosis: An epidemiologic study . Arch Neurol 1984;41:1067-1069.Crossref 38. Whitlock FA, Siskind MM: Depression as a major symptom of multiple sclerosis . J Neurol Neurosurg Psychiatry 1980;43:861-865.Crossref 39. Kellner CH, Davenport Y, Post RM, et al: Rapidly cycling bipolar disorder and multiple sclerosis . Am J Psychiatry 1984;141:112-113. 40. Ben-Yishay Y, Diller L: Cognitive remediation , in Rosenthal M, Griffith ER, Bond MR, et al (eds): Rehabilitation of the Head-Injured Adult . Philadelphia, FA Davis Co Publishers, 1983, pp 367-380. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Cognitive Loss in Multiple Sclerosis: Case Reports and Review of the Literature

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1989.00520380066014
Publisher site
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Abstract

Abstract • Neuropsychological and neuroradiologic evidence of cerebral lesions is described for 12 patients with multiple sclerosis in whom cognitive disability was far greater than any other neurologic disability. Cognitive dysfunction resulted in significant functional impairment at work or home in three fourths (9 of 12) of the patients described here, despite mild physical disability (mean Kurtzke Expanded Disability Status Scale score, 3.2). A unique feature of the neurologic examination in these patients was the presence of prominent frontal release signs (gait apraxia and placing response) in the lower extremities. Two new scales, a Cognitive Function Scale and a Frontal Release Scale, were adapted for the investigation of these patients. The extensive literature relating to cognitive dysfunction in multiple sclerosis is reviewed and discussed with regard to its clinical relevance. References 1. Heaton RK, Nelson LM, Thompson DS, et al: Neuropsychological findings in relapsing/remitting and chronic/progressive multiple sclerosis . J Consult Clin Psychol 1985;53:103-110.Crossref 2. Peyser JM, Edwards KR, Poser CM, et al: Cognitive function in patients with multiple sclerosis . Arch Neurol 1980;37:577-579.Crossref 3. Rao SM, Hammeke TA, McQuillen MP, et al: Memory disturbance in chronic/progressive multiple sclerosis . Arch Neurol 1984;41:625-631.Crossref 4. Lyon-Caen O, Jouvent R, Hauser S, et al: Cognitive function in recent onset demyelinating diseases . Arch Neurol 1986;43:1138-1141.Crossref 5. Gilbert JJ, Sadler M: Unsuspected multiple sclerosis . Arch Neurol 1983;40:533-536.Crossref 6. Franklin GM, Heaton RK, Filley CM, et al: Correlation of neuropsychological and magnetic resonance imaging (MRI) findings in chronic/ progressive MS . Neurology 1988;38:1826-1829.Crossref 7. Reitan RM, Davison L: Clinical Neuropsychology: Current Status and Applications . Washington, DC, V. H. Winston, 1974. 8. Kurtzke JF: Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS) . Neurology 1983;33:1444-1452.Crossref 9. Hauser SL, Dawson DM, Lehrich JR, et al: Intensive immunosuppression in progressive multiple sclerosis: A randomized, three arm study of high dose intravenous cyclophosphamide, plasma exchange, and ACTH . N Engl J Med 1983;308:173-180.Crossref 10. Canter AH: Direct and indirect measures of psychological deficit in multiple sclerosis . J Gen Psychol 1951;44:3-50.Crossref 11. Ross AT, Reitan RM: Intellectual and affective functions in multiple sclerosis . Arch Neurol Psychiatry 1955;73:663-677.Crossref 12. Jambor KL: Cognitive functioning in multiple sclerosis . Br J Psychiatry 1969;115:765-775.Crossref 13. Beatty PA, Gange JJ: Neuropsychological aspects of multiple sclerosis . J Nerv Ment Dis 1977;164:42-50.Crossref 14. Trimble MR, Grant I: Psychiatric aspects of multiple sclerosis , in Benson DF, Blumer D (eds): Psychiatric Aspects of Neurologic Disease . New York, Grune & Stratton, 1982, vol 2, pp 279-299. 15. McFarlin DE, McFarland HF: Multiple sclerosis . N Engl J Med 1982;307:1183-1188,1246-1251.Crossref 16. McKhann GM: Multiple sclerosis . Annu Rev Neurosci 1982;5:219-239.Crossref 17. Kahana E, Leibowitz U, Alter M: Cerebral multiple sclerosis . Neurology 1971;21:1179-1185.Crossref 18. Kurtzke JF, Beebe GW, Nagler B, et al: Studies on the natural history of multiple sclerosis: 6. Clinical and laboratory findings at first diagnosis . Acta Neurol Scand 1972;48:19-46.Crossref 19. Crisp DT, Kleiner JE, DeFillip GJ, et al: Clinical correlations with magnetic resonance imaging in multiple sclerosis . Neurology 1985;35( (suppl 1) ):137. 20. McLardy T, Sinclair A: A case of pre-senile fulminating multiple sclerosis . Confin Neurol 1964;24:417-424. 21. Messert B, Baker NH: Syndrome of progressive spastic ataxia and apraxia associated with occult hydrocephalus . Neurology 1966;16:440-452.Crossref 22. Bartolini S, Inzitari D, Castagnoli A, et al: Correlation of isotopic cisternographic patterns in multiple sclerosis with CSF IgG values . Ann Neurol 1982;12:486-489.Crossref 23. Volpi G, Inzitari D, Fratigliani L, et al: CT periventricular hypodensity in multiple sclerosis: Isotope cisternography and clinical correlations . Ann Neurol 1986;20:146. 24. Bergin JD: Rapidly progressing dementia in disseminated sclerosis . J Neurol Neurosurg Psychiatry 1957;20:285-292.Crossref 25. Koenig H: Dementia associated with the benign form of multiple sclerosis . J Trans Am Neurol Assoc 1968;93:227-228. 26. Young AC, Saunders J, Ponsford JR: Mental change as an early feature of multiple sclerosis . J Neurol Neurosurg Psychiatry 1976;39:1008-1013.Crossref 27. Grant I, McDonald WI, Trimble MR, et al: Deficit learning and memory in early and middle phases of multiple sclerosis . J Neurol Neurosurg Psychiatry 1984;47:250-255.Crossref 28. Van den Burg W, van Zomeren AH, Minderhoud JM, et al: Cognitive impairment in patients with multiple sclerosis and mild physical disability . Arch Neurol 1987;44:494-501.Crossref 29. Jacobs L, Kinkel PR, Kinkel WR: Silent brain lesions in patients with idiopathic optic neuritis . Arch Neurol 1986;43:452-455.Crossref 30. Stevens JC, Farlow MR, Edwards MK, et al: Magnetic resonance imaging: Clinical correlation in 64 patients with multiple sclerosis . Arch Neurol 1986;43:1145-1148.Crossref 31. Rao SM: The neuropsychology of multiple sclerosis: A critical review . J Clin Exp Neuropsychol 1986;8:503-542.Crossref 32. Filley CM, Heaton RK, Nelson LM, et al: A comparison of dementia in Alzheimer's disease and multiple sclerosis . Arch Neurol 1989;46:157-161.Crossref 33. Rao SM, Glatt S, Hammeke TA, et al: Chronic/progressive multiple sclerosis: Relationship between cerebral ventricular size and neuropsychological impairment . Arch Neurol 1985;42:678-682.Crossref 34. Rabins PV, Brooks BF, O'Donnell P, et al: Structural brain correlates of emotional disorder in multiple sclerosis . Brain 1986;109:585-597.Crossref 35. Huber SJ, Paulson GW, Rammohan K, et al: Magnetic resonance findings, disability, and cognitive factors in multiple sclerosis . Ann Neurol 1986;20:170. 36. Schiffer RB, Caine ED, Bamford KA, et al: Depressive episodes in patients with multiple sclerosis . Am J Psychiatry 1983;140:1498-1500. 37. Schiffer RB, Babigian HM: Behavioral disorders in multiple sclerosis, temporal lobe epilepsy and amyotrophic lateral sclerosis: An epidemiologic study . Arch Neurol 1984;41:1067-1069.Crossref 38. Whitlock FA, Siskind MM: Depression as a major symptom of multiple sclerosis . J Neurol Neurosurg Psychiatry 1980;43:861-865.Crossref 39. Kellner CH, Davenport Y, Post RM, et al: Rapidly cycling bipolar disorder and multiple sclerosis . Am J Psychiatry 1984;141:112-113. 40. Ben-Yishay Y, Diller L: Cognitive remediation , in Rosenthal M, Griffith ER, Bond MR, et al (eds): Rehabilitation of the Head-Injured Adult . Philadelphia, FA Davis Co Publishers, 1983, pp 367-380.

Journal

Archives of NeurologyAmerican Medical Association

Published: Feb 1, 1989

References