Problems with cognition can include difficulties with working memory (the information you hold in your mind at a given time) or episodic memory (remembering specific events from the past), as well as attention and the ability to think and reason.
Cognitive impairments can be a frustrating aspect of life with MS. Changes to your cognition can affect personal relationships, work, and the ability to perform daily tasks.
Proactive steps recommended by the National Multiple Sclerosis Society can help you manage MS-related cognitive deficits and their impact on your quality of life. Cognition testing can be an early step to support your cognitive function.
Cognition testing is used to understand a person’s cognitive capabilities. Cognition tests for MS fall under the umbrella of neuropsychological testing and are designed to:
Neuropsychological tests can be used for a diverse range of neurological conditions. A neuropsychological test is not the same as a mental health evaluation, although some tests may include a section aimed at assessing mood disorders such as depression.
Several types of tests have been developed to evaluate cognition in people with MS. You may receive short screening tests in the doctor’s office or a more formal assessment supervised by a neuropsychologist.
You might also hear your doctor refer to cognition testing as “testing batteries” or “batteries of tests” — this simply means taking several tests that assess different areas of cognitive function in people with MS.
Cognition testing can help you and your doctor understand the challenges you’re experiencing and identify opportunities to support you.
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Cognition testing has many benefits for individuals with MS, including informing your treatment plan and monitoring your condition over time. Here are some of the things cognition testing can do.
A baseline allows your health care provider to understand how your cognition changes over time. The National Multiple Sclerosis Society recommends adults with MS undergo annual cognition testing to monitor disease progression, identify cognition changes, and see how well treatments are working.
Cognition testing can help determine the areas of cognition where you have the most challenges. This allows your provider to recommend the best interventions to help strengthen your cognitive function. Additionally, understanding your cognition can help you and your health care provider evaluate and tailor your treatment plan to your needs.
A comprehensive evaluation can help determine if depression, anxiety, fatigue, other health problems, or medication side effects are impacting cognition.
Having more information about your cognition helps you and your doctor choose interventions, exercises, and other strategies that can support cognitive function.
As you consider cognition testing, it’s helpful to know what to expect. You cannot study for a cognition test. However, you can prepare by getting a good night’s sleep and avoiding alcohol 24 hours before the test.
The time it takes to complete a cognition test can vary. Some tests can be completed in a few minutes, while others can take several hours.
Comprehensive neuropsychological tests often include physical assessments. Longer testing times and physical activities can cause some people to feel tired afterward. Ask your provider how long testing will last.
You may be given an iPad, other tablet, or a paper form to take a test on your own — sometimes during a regular medical appointment or even while waiting to be seen. In other cases, your doctor may ask you questions verbally. Some testing batteries combine cognitive and physical assessments.
There are several types of cognition testing. Your doctor will help determine which tests are best for you. Below are examples of commonly used cognition tests.
The Symbol Digit Modalities Test (SDMT) was introduced in 1982 and is one of the most widely used rapid cognition tests for adults with MS. A person with MS is shown a key that pairs numbers with symbols and is then given 90 seconds to match the symbols and numbers. The entire test can be completed in five minutes or less. The SDMT can be performed verbally or in writing.
This test is often used as a front-line assessment before someone with MS is referred to other forms of cognition testing or to other professionals who can support cognition. Also, SDMT is helpful for assessing cognitive changes during MS relapses.
The Processing Speed Test (PST) — part of the Multiple Sclerosis Performance Test — takes two minutes to complete. A few additional minutes are needed for explanation. This test is similar to the SDMT, but it is self-administered on a tablet or iPad in your provider’s office. In one single-center study, there was some evidence that the PST is slightly more sensitive than the SDMT to certain brain lesions.
The Computerized Speed Cognitive Test (CSCT) takes five minutes to complete and is a verbal assessment rather than a written or tablet test. The CSCT is particularly good for identifying information-processing impairment.
The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) takes five minutes to complete. This is a self-reported survey about cognitive function that can be filled out by a person with MS and also by someone they interact with regularly. The MSNQ can help identify symptoms of depression and assess a person’s level of awareness about their own cognitive abilities.
The Multiple Sclerosis Functional Composite (MSFC) includes one cognitive test, a timed walking test, and a test of arm function. This test can be performed by a trained professional and does not require a physician or neuropsychologist. The National Multiple Sclerosis Society’s Clinical Assessment Task Force developed the MSFC for use in clinical trials.
The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) includes the SDMT and other tests to evaluate language ability and spatial recall. The BICAMS takes 15 minutes to complete.
The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is a comprehensive evaluation that can last 90 minutes. It includes the SDMT, as well as a battery of tests that evaluate language ability, working memory, spatial memory, and executive function. The MACFIMS is unique in its ability to also assess executive function. This exam is administered by or under the supervision of a neuropsychologist.
Cognition testing is the first step. Based on the results, your doctor may recommend further evaluations and follow-ups with other health care providers. Interventions such as physical exercise, cognitive rehabilitation, brain exercises, diet, and disease-modifying therapies may be prescribed to improve your cognitive performance.
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