Mark Gudesblatt, MD

Mark Gudesblatt, MD,
South Shore Neurologic Associates, PC,
Patchogue, New York

Factors affecting self-reported cognitive impairment (CI) among patients with multiple sclerosis (PwMS) differed from the factors that influence a clinician’s perception of cognitive impairment in this patient population, according to findings presented at the 2022 Consortium of Multiple Sclerosis Centers meeting.

“Neurologists’ self-reported accuracy in assessing the presence of CI is reported to be inaccurate,” stated Mark Gudesblatt, MD, and colleagues. “The accuracy of self-reported CI in [PwMS] might be suboptimal as well, and the literature has reported mixed results. Some research has suggested that there are external factors that affect perceived functioning. For instance, depression and fatigue may contribute to the perception of cognitive deficits. Importantly, studies have not explored how PwMS regard their cognitive functioning compared with the perceptions of their clinicians.”

Dr. Gudesblatt and colleagues aimed to determine the factors that impact self-reported cognitive deficits among PwMS and whether assessment of cognitive deficits varied between patients and their clinicians. Participants completed a computerized, multi-domain cognitive screening exam and reported perceptions of fatigue using the Modified Fatigue Impact Scale, depression using the Beck Depression Inventory-II, and quality of life using a Likert scale. Clinicians evaluated physical disability with the Expanded Disability Status Scale, and perceived cognitive deficits among clinicians and patients were self-reported using a Likert scale.


Identifying Cognitive Impairment ‘Should Not Be Left to Perception Alone’

The study included 202 PwMS (aged 20-88; 71% female). Patient-reported fatigue (P<0.001) and cognitive (P<0.05) scores significantly predicted patient-perceived cognitive deficits, but not depression or physical disability. Multiple factors significantly predicted clinician-perceived cognitive deficits, including cognitive scores (P<0.001), depression (P<0.001), physical disability (P<0.05), age (P<0.05), and self-reported quality of life (P<0.05). Of note, according to Dr. Gudesblatt and team, fatigue did not significantly predict cognitive deficits observed by clinicians.

The researchers also noted that the study results “provide further insight” into the factors that affect self-reports about the extent of CI among PwMS, as well as how those factors are different from those that clinicians report in perceptions of CI among this patient population.

“In PwMS, CI affects real-world ability, and identifying the presence of, or a change in, CI in PwMS should not be left to perception alone,” the researchers wrote. “Future studies should explore whether patients or clinicians accurately perceive a patient’s CI.”