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MS PATIENTS SHOULD BE INFORMED ABOUT THE POTENTIAL FOR COGNITIVE PROBLEMS
HAMBURG, GERMANY—Although the estimated prevalence of cognitive dysfunction in multiple sclerosis (MS) is relatively high, at 45% to 65%, there remains a substantial proportion of cases in which MS-related cognitive problems never develop. Thus, clinicians often hesitate to discuss cognitive symptoms with MS patients for fear of upsetting the patients should these symptoms never appear.
However, a new study by Heesen et al suggests that clinicians broach the subject with MS patients. According to the study, information on cognitive problems does not increase the fears of MS patients, even those recently diagnosed, and is generally appreciated.
SCREENING FOR COGNITIVE DEFICITS
The authors gave a brochure on cognitive symptoms to 133 MS patients at two rehabilitation units and an outpatient clinic in Germany. The brochure, a German translation from patient information created by the European MS Rehabilitation Centers, defined cognition, described cognitive problems in MS as well as interventions such as neuropsychological rehabilitation, and offered coping tips.
The patients also received a questionnaire asking about MS duration and any problems with attention, memory, or thinking. In addition, the questionnaire inquired about patients’ level of familiarity with, interest in, and understanding of the information in the brochure and perceptions of the timing of the brochure’s distribution and value to MS patients in general.
Patients ranked their feelings about these issues on a scale of -5 to 5, with zero indicating a neutral perception and the two extremes reflecting a very negative or very positive view.
Of the 128 questionnaires included in the final analysis, 91 were from women and 37 were from men. These patients ranged in age from 34 to 48 and their median MS duration was eight years.
"Ninety-four patients reported that they had recognized some difficulties in concentration, memory, or thinking," related the authors. "Thirty-four reported these as main complaints."
RATING THE BROCHURE
Overall, many of the patients who read the brochure were new to its information, which suggested "that people who need the information are not currently receiving it," said the authors. "[N]early everyone found the information highly understandable." Indeed, the median ranking by patients for understandability was 4.6, with an interquartile range of just 4.2 to 4.8. The brochure also received strong overall rankings for relevance (3.05) and making the patient feel encouraged (2.2).
Not surprisingly, the brochure’s relevance was rated 3.9 by patients who reported cognitive deficits, versus 0.9 among those without cognitive problems. As indicated by a median ranking of 0.7 for familiarity, many of the patients with cognitive deficits were unfamiliar with the information in the brochure. "Furthermore, there was a trend for this group being more encouraged and getting more interested in the topic compared to patients without perceived cognitive deficit," the authors added.
In the subgroup of 20 patients with early MS (diagnosed less than 2.5 years prior), 10 reported cognitive deficits. These patients were much less likely to find the brochure encouraging, as shown by a median ranking of 0.5. They gave the degree of newness of the information a median ranking of 2.7, two points higher than that given by the overall study population, revealing a lack of familiarity among patients with the disease.
"All respondents recommended the information for all patients," said the authors. However, "patients with early MS without perceived cognitive deficits were not sure if they would have liked an earlier presentation. Nevertheless, they recommended the brochure for other patients even though they recommended it to a lower extent than the rest of the group."
The authors advised giving relevant information on cognitive deficits and other symptoms to all MS patients who complain of such difficulties.
"Our study offers further proof that carefully developed patient information is recommended by patients for other patients even when touching such sensitive areas as mental health and confronting patients with possible deficits of which they are not currently aware," the authors concluded.
NR
—Timothy Begany
Suggested Reading
Amato MP, Ponziani G, Siracusa G, Sorbi S. Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Arch Neurol. 2001;58:1602-1606.
Bobholz JA, Rao SM. Cognitive dysfunction in multiple sclerosis: a review of recent developments. Curr Opin Neurol. 2003;6:283-288.
Heesen C, Segal J, Reich C, et al. Patient information on cognitive symptoms in multiple sclerosis;acceptability in relation to disease duration. Acta Neurol Scand. 2006;114:268-272.
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