What the clinicians see.

A National MS Society task force has been looking at the cognitive deficits in MS. According to Nancy Holland, EdD, RN, vice president of Clinical Programs at the Society, cognitive problems appear to be present in more than half of people with MS.

"Learning, memory, speed of information processing, and cognitive flexibility are among those functions most commonly impaired," Dr. Holland said. "Deficits in these areas can affect the ability to work and may also have an impact on relationships, everyday activities such as driving or cooking, and adherence to medication and treatment regimens," she added.

Health-care providers should consider periodic screening or assessment for cognitive problems, because their patients may not always be aware of them or may not discuss cognitive issues with their doctor or nurse.

Compensation makes a difference

"People can use a learned, practice approach and create routines for their cognitive tasks," Dr. Holland said. "External aids and substitution strategies are very useful. The compensatory approach also involves learning to use intact cognitive abilities to circumvent or bolster problem areas.

"Memory strategies include using lists, or specific memory aids, such as clustering. Visualization can substitute visual memory for impaired verbal memory. Other strategies include using recording devices and making a habit of scheduling.

Creating a structured environment can be key," Dr. Holland concluded. "Conducting conversations and serious activities in quiet places will minimize distraction."

Do drugs help?

The Society's medical advisors note that worsening cognitive impairment, as indicated by testing, is a sign of active disease and should be viewed as justification for starting or changing disease-modifying therapy. Sleep problems, fatigue, and depression may also be evaluated for contributions to cognitive symptoms.

A recent trial with Aricept[R] suggested it provided some benefits for people with MS. Small studies of amantadine produced mixed results; some showed no beneficial effects while others did.

In a small, controlled trial funded in part by the National MS Society, Dr. Dennis Bourdette and colleagues at the Oregon Health & Science University showed a significant difference between a group taking ginkgo biloba and those receiving placebo in just one area: performance on the Stroop Test, which measures learning and memory. The finding suggests that further study of this extract from leaves of the ginkgo tree is warranted but can't be taken as evidence of efficacy. Detailed information on ginkgo biloba and MS, including important cautions and information on side effects, can be found on www.ms-cam.org.

Jo Stratmoen is a science writer who often reports on MS.