Original Research

Multidisciplinary Management of a Patient With Multiple Sclerosis:Part 3. Psychologists’ Perspective

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Multiple sclerosis is a complex, progressive disease requiring a multidisciplinary approach to patient care; however, with the hub-and-spoke network in place, practitioners at any facility can take advantage of the care provided by the Multiple Sclerosis Centers of Excellence.


 

References

Multiple sclerosis (MS) poses a host of cognitive and psychosocial challenges that may contribute to functioning and quality of life (QOL). Although each patient’s experience with MS is different, some challenges are more common than are others, including cognitive changes, depression, and maintaining positive health behaviors. William’s case study illustrates some of these challenges as well as the resources and strategies of the psychologists at the MS
Centers of Excellence (MSCoE) to help patients with MS adapt and thrive.

Cognition

Difficulties with cognitive functioning are common in patients with MS. About half of patients with MS will develop cognitive impairments in one or more areas during their lifetime. 1 Although cognitive difficulties tend to worsen over the course of the disease, they can appear at any point in the illness, differ greatly from patient to patient, and are only modestly correlated with physical symptoms. 1 Impairments are most common in the areas of information processing speed and memory, as well as in complex attention and mental flexibility. These impairments can impact activities of daily living, sustained employment, driving, and social relationships.

Early in the disease, William, who admitted to difficulties with cognition and the impact of cognitive impairment on his life, benefited from neuropsychological testing. Typically, an MSCoE will use a battery of tests tailored to patients with MS. For patients, the results of these tests can be used to clarify areas of relative strength and weakness and inform team decisions related to treatment and future life activities, such as whether the patient will need accommodations at work. Test results may also be used to guide how the MS treatment team interacts with the patient.

An initial clinic screening from neurology indicated William had below average cognitive processing speed, and he agreed to neurocognitive testing. The psycholopsychologist asked William about his functioning at home. William noted poor attention and memory made it difficult to advocate for himself. He recounted an episode of taking his car to be repaired and only later realizing that he had been charged twice for the same part. He also disclosed that he had gotten lost while driving through familiar places. On several occasions while cooking, he had become distracted and started another task only to find he had burned his food.

Cognitive rehabilitation has shown considerable promise in helping patients work through difficulties with memory, attention, and problem solving by developing compensatory strategies. 2 Skill training is available in individual and group formats. There is also promising but very preliminary evidence that some psychosocial interventions might improve memory performance for patients with MS. 3

William’s neuropsychological testing confirmed impairments in information processing speed, attention, and memory, and William was diagnosed with cognitive disorder not otherwise specified. His cognitive impairment correlated with his magnetic resonance imaging (MRI) findings, which included lesions on the corpus callosum and in multiple subcortical areas.

During a feedback session, William was encouraged to use compensatory strategies, including memory aids, visual cueing, and self-pacing. He was given a referral to speech and language pathology to develop and practice these strategies. The psychologist also reminded William’s health care team to speak slowly and repeat important information to him, write down important instructions, and cue him when asking questions in the clinic. William was provided with a kitchen timer and instructed to set it whenever he began cooking, so that even if he got distracted, the alarm would remind him to return to his cooking. William was asked whether he would like to participate in the MSCoE cognitive compensatory training program. 4 The program, offered through a research protocol, involved a series of classes that taught strategies to manage cognitive symptoms and improve patients’ ability to function independently. William agreed to participate and reported feeling hopeful that his situation could improve.

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