Introduction

Problems with cognition are common among people with multiple sclerosis (MS) – one study of 100 people with MS found that 43 percent experience cognitive challenges.² Read more about cognition in How Multiple Sclerosis Impacts Cognitive Function and the Signs You Should Look for.

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. There are proactive steps as recommended by the National MS Society you can take to manage MS-related cognition changes and the impact they have on your daily life. Cognition testing can be an early step to support your cognitive function.¹

Cognition testing is an assessment used to understand a person’s cognitive capabilities. Cognition tests for MS fall under the umbrella of neuropsychological testing and are designed to detect brain dysfunction, improve understanding of the changes happening in the brain, and assist in recommendations for treatment planning. Neuropsychological tests can be used for a diverse range of neurological conditions.³ 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.⁴

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 neuropsychological assessment or evaluation, conducted under the supervision of a neuropsychologist. You might also hear your doctor refer to cognition testing as testing batteries or batteries of tests – these are groupings of 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.¹

Here are some of the benefits of cognition testing for individuals with MS:

• Establish a baseline of cognitive function.
  A baseline allows your healthcare provider to understand how your cognition changes over time. The National MS Society recommends adults with MS undergo annual cognition testing to monitor disease activity, identify cognition changes, and evaluate treatment effectiveness.¹
• Determine potential interventions.
  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 healthcare provider evaluate and tailor your treatment plan to your needs.¹
• Narrow down the cause of cognitive challenges.
  A comprehensive evaluation can help determine if depression and anxiety, fatigue, other health problems, or medication side effects are impacting cognition.¹
• Meet requirements for government disability programs.
  A thorough evaluation from a particular type of provider may be necessary to qualify for government disability programs.¹

Having more information about your cognition helps you and your doctor choose interventions, exercises, and other strategies that can support cognitive function.¹ Download the Doctor Discussion Guide to start a conversation about cognition with your healthcare provider.

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.⁴

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.^1,5 Comprehensive neuropsychological tests often include physical assessments. Longer testing times and physical activities can cause some people to feel tired afterward.⁵ Ask your provider how long testing will last.

You may be given an iPad / tablet or 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 healthcare provider may ask you questions verbally.^1,6 Some testing batteries combine cognitive and physical assessments.⁵

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.

Symbol Digit Modalities Test (SDMT)

• The SDMT was introduced in 1982 and is one of the most widely used rapid cognition tests for adults with MS.⁷
• 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.⁷
• SDMT can be performed verbally or in writing.⁷
• This test is often used as a frontline assessment before someone with MS is referred to other forms of cognition testing or to other professionals who can support cognition.¹
• SDMT is helpful for assessing cognitive changes during relapses.¹

Processing Speed Test (PST)

• PST takes two minutes for a participant to complete. A few additional minutes are needed for explanation.^1,6
• This test is similar to the SDMT, but it is self-administered on a tablet / iPad in your healthcare provider’s office.¹
• In one single-center study, there was some evidence that the PST is slightly more sensitive than the SDMT to certain brain lesions.¹

Computerized Speed Cognitive Test (CSCT)¹

• CSCT takes five minutes to complete.
• CSCT is a verbal assessment rather than a written or tablet test.
• This test is particularly good for identifying information processing impairment.

Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ)⁸

• MSNQ takes five minutes to complete.
• MSNQ is a survey about cognitive function that can be filled out by a person with MS and someone they interact with regularly.
• The self-reported survey can help identify symptoms of depression.

Multiple Sclerosis Functional Composite (MSFC)

• MSFC includes one cognitive test, a timed walking test, and test of arm function.⁵
• This test can be performed by a trained professional and does not require a physician or neuropsychologist.⁵
• The National MS Society’s Clinical Assessment Taskforce developed the MSFC for use in clinical trials.⁹

Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)¹

• BICAMS takes 15 minutes to complete.
• This assessment includes the SDMT, and other tests to evaluate language ability and spatial recall.

Minimal Assessment of Cognitive Function in MS (MACFIMS)

• MACFIMS is a comprehensive evaluation that can last 90 minutes.¹ It includes the SDMT, as well as a battery of tests that evaluate language ability, spatial memory, and executive function.⁷
• MACFIMS is unique in its ability to also assess executive function.¹
• This exam is administered by a neuropsychologist or under the supervision of a neuropsychologist.¹⁰

Your doctor may recommend additional evaluations and follow-ups with other healthcare providers based on the results. Other neuropsychological tests can last up to 6 hours with multiple batteries of tests.⁵

Cognition testing is the first step. Based on the results, your doctor may recommend interventions such as physical exercise, brain exercises, diet, and disease-modifying therapies. Read more about interventions in Multiple Sclerosis and Cognition: Steps You Can Take Today that May Help With Brain Health.

Worried about talking to your loved ones about cognition? Check out tips for starting a conversation in Explaining Cognitive Symptoms at Home, at Work, and at School.

References

1. Kalb, R., Beier, M., Benedict, R. H., Charvet, L., Costello, K., Feinstein, A., ... Deluca, J. (2018). Recommendations for cognitive screening and management in multiple sclerosis care. Multiple Sclerosis Journal, 24(13), 1665-1680. doi:10.1177/1352458518803785

2. Rao, S. M., Leo, G. J., Bernardin, L., & Unverzagt, F. (1991). Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology, 41(5), 685–691. doi: 10.1212/WNL.41.5.685

3. Casaletto, K. B., & Heaton, R. K. (2017). Neuropsychological Assessment: Past and Future. Journal of the International Neuropsychological Society, 23(9-10), 778-790. doi:10.1017/s1355617717001060

4. Neuropsychological Evaluation FAQ. (n.d.). Retrieved June 21, 2019, from https://www.med.unc.edu/neurology/divisions/movement-disorders/npsycheval/

5. Rao, S. M. (2004). Cognitive Function in Patients with Multiple Sclerosis: Impairment and Treatment. International Journal of MS Care, 6(1), 9-22. doi:10.7224/1537-2073-6.1.9

6. Rudick, R. A., Miller, D., Bethoux, F., Rao, S. M., Lee, J., Stough, D., ... Alberts, J. (2014). The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool. Journal of Visualized Experiments, (88). doi:10.3791/51318

7. Benedict, R. H., Deluca, J., Phillips, G., Larocca, N., Hudson, L. D., & Rudick, R. (2017). Validity of the Symbol Digit Modalities Test as a cognition performance outcome measure for multiple sclerosis. Multiple Sclerosis Journal, 23(5), 721-733. doi:10.1177/1352458517690821

8. Konstantinopoulou, E., Ioannidis, P., Bakirtzis, C., Giantzi, V., Afrantou, T., Parissis, D., ... Grigoriadis, N. (2018). Estimating Everyday Neuropsychological Functioning in Multiple Sclerosis: Reliability and Validity of the Greek Multiple Sclerosis Neuropsychological Questionnaire. Multiple Sclerosis International, 2018, 1-6. doi:10.1155/2018/6301535

9. Cohen, J. A. (2001). Use of the Multiple Sclerosis Functional Composite as an Outcome Measure in a Phase 3 Clinical Trial. Archives of Neurology, 58(6), 961. doi:10.1001/archneur.58.6.961

10. Giedraitiene, N., Kaubrys, G., & Kizlaitiene, R. (2018). Cognition During and After Multiple Sclerosis Relapse as Assessed With the Brief International Cognitive Assessment for Multiple Sclerosis. Scientific Reports, 8(1). doi:10.1038/s41598-018-26449-7

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