Research by Dr Claire Gall

All of our attendees carry out a piece of research in an area of MS clinical practice or treatment that interests them.

This snapshot, which won the MS Academy MasterClass 5 Project Award 2019, gives you a quick idea of what they found and why. If you want to learn more, just click through to the full research report, or follow the links within the snapshot.

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Aim

This study’s aims were twofold: to assess the clinical relevance of cognitive impairment in people with multiple sclerosis (MS) receiving the disease-modifying treatment (DMT) natalizumab; and to understand the usefulness of the Montreal Cognitive Assessment (MoCA) qualitative cognitive test in assessing patients.

Headlines

  • Cognitive impairment in patients with MS using DMTs, aside from the general impact on their treatment decisions and ability to attend follow-up and monitoring appointments, is especially significant regarding
  • The MoCA tool, chosen by the MS nurses within the researcher’s MS service was already in use in the Parkinson’s service under the same neurology department.
  • MoCA, which has existing evidential use in MS, has some specific advantages over other cognitive screening tools, including:
    • better at examining executive function
    • more sensitive than other tests currently used in the UK
    • easy to administer,
    • palatable to patients
    • provides a good level of qualitative information

Key findings

  • Using MoCA amongst the MS service’s highly active relapsing remitting MS patients receiving natalizumab suggests a high prevalence of cognitive impairment, in some cases quite severe.
  • Of 83 patients recently or currently receiving natalizumab treatment as found via the LTHTR MS database, 72 had been screened using MoCA.
    • MoCA scores are out of 30 with ‘normal’ being 26 and over.
    • Scores ranged from 15 upwards with an average score of 25.7.
    • Age range was 18-69, with an average age of 47.
    • 30 patients ( 41.7%) scored 25 or less, putting them below the cut off for cognitive impairment. Their average age was 43 (range 18-69).
  • Below cut off letter fluency seemed to be frequent.
  • Patients with low scores were often observed to have frequent DNA (‘did not attend’ letters on file.

Core recommendations

  • MoCA may be a useful tool for cognitive screening in patients with MS including those undergoing therapies associated with PML risk.
  • MoCA results may indicate:
    • a need for more detailed consent and follow-up or monitoring
    • some of the qualitative aspects of cognitive dysfunction so that practical strategies can be put in place.

 

More information