Multiple sclerosis (MS) is a chronic, autoimmune disease of the central nervous system that affects the myelin or white matter of the brain and spinal cord, leading to the appearance of sclerotic plaques that impede the normal functioning of these nerve fibers. It is present in young adults, with the average age of onset being 29-33 years, but the age range is very broad, approximately from 10 to 59 years, and it occurs more frequently (more than double) in women than in men.
To diagnose MS, several procedures are needed, which include the following examinations: a) Clinical history, b) Neurological examination, c) Auditory and visual evoked potential tests, d) Nuclear magnetic resonance imaging, and e) Lumbar puncture
Acute MS symptoms can be controlled with short-term administration of corticosteroids such as prednisone or methylprednisolone. A relatively recent treatment, interferon beta in injections, reduces the frequency of relapses. Other promising treatments, still under investigation, consist of other interferons, oral myelin, and copolymer 1, which will help prevent the body from attacking its own myelin.
However, in addition to medical treatment, neuropsychological work is fundamental. Therefore, below, we will highlight the role of the neuropsychologist in patients with multiple sclerosis.
When there is no confirmed neuropsychological diagnosis of MS, it is advisable to perform a screening examination, and if signs of cognitive impairment are observed, proceed to a more exhaustive evaluation. The most widely used screening instrument in MS, recognized by professionals with training in neurorehabilitation, has been the BRB-N (Brief Repeatable Battery of Neuropsychological Test in Multiple Sclerosis), which is composed of the following 5 tests:
– SRT (Selective Reminding Test): which measures verbal learning ability and long-term retention; distinguishes between short-term and long-term memory, and between learning and retrieval difficulty.
– SPART (10/36 Spatial Recall Test): measures visuospatial learning ability and long-term retention.
– SDMT (Symbol Digit Modalities Test): measures sustained attention and concentration ability, as well as visomotor speed; responses are given verbally instead of in writing to reduce the influence of motor alterations.
– PASAT (Paced Auditory Serial Addition Test): which measures information processing speed, working memory, and sustained attention.
– WLG (Word List Generation): evaluates phonemic verbal fluency.
To this battery, it would be advisable to add tests to measure intellectual quotient (IQ), emotional state, and the incidence of fatigue, as these can be very helpful and significant data.
When it is detected that a patient with multiple sclerosis pathologically prolongs the denial phase of the disease, it makes the neuropsychologist a “fundamental piece” in the multidisciplinary team (Vivancos Mora, 2015). This denial phase “the patient has to go through, but there are reasonable deadlines and others that are not, and if this happens, action must be taken” (Vivancos Mora, 2015). At that moment, action must be taken (by the neuropsychologist) together with the neurologist and the nurse, insisting that this initial stage be overcome “with closeness, with truthful information, and by exposing the affected person to the real perspective of a diagnosis that is not wanted to be accepted” (Vivancos Mora, 2015).
There are a series of rehabilitation techniques that can help manage cognitive difficulties and improve the quality of life for people with MS, included in ISEP’s Master’s in Neurorehabilitation. Evidence shows that these techniques improve cognitive functions of attention and memory. Daily support from family and friends is necessary to implement them properly:
– Self-generation: this is an effective method to improve the ability to learn and recall new information. It is based on the idea that the process of recalling and understanding information improves when a person generates their own correct answers to a problem rather than when someone provides them directly. Therefore, both the patient and family and friends should work in this direction.
– Spaced learning: consists of repeating the activity or content to be learned with a time difference between each learning session. This method appears to be more positive for the patient’s memory than consecutive learning sessions without a break.
– Retrieval practice: this method advocates the idea that testing (e.g., through an exam) the memory of previously learned knowledge improves subsequent recall of this information, more so than re-studying the material.
Regarding the rehabilitation of executive functions, numerous online programs are being created, among which stand out: the free Cognifit program, which offers a series of applications and games through which patients can exercise different functions to improve their mental skills. Through this program, a wide variety of cognitive abilities that may be impaired in MS can be evaluated and trained, such as memory, attention, processing speed, distance estimation, or eye-hand coordination, with users also having the flexibility to decide which areas they want to train.
The Neuron-UP program, which is a web platform that expands and improves therapists’ tools to care for patients with cognitive impairment. It includes more than 6,000 rehabilitation and stimulation exercises; exercises, games, simulators, and worksheets, which allow us to work on both higher cognitive functions and daily living activities, as well as doing so specifically with each of the subprocesses within all cognitive functions; orientation (processing speed, sustained attention, selective attention…), language, memory (semantic, episodic, procedural), praxias, gnosias (visual, auditory, tactile, olfactory, gustatory, body schema), visuospatial skills (spatial relationship, cognitive flexibility, planning, reasoning, decision-making, etc.).
Finally, the neuropsychologist is also responsible for working on awareness of limitations in MS patients, as well as modifying maladaptive behaviors and conducting family intervention to ensure the collaboration of family group members with the patient’s rehabilitation process. The neurorehabilitation course will help you, as a psychotherapy and health professional, to intervene with people with MS and offer them the possibility of comprehensive care, beyond purely medical treatment.