Kognitive Stoerungen bei Multipler Sklerose und anderen autoimmunen Erkrankungen des zentralen Nervensystems [Cognitive dysfunction in multiple sclerosis and other autoimmune disorders in central nervous system]

Cognitive dysfunction is a frequent symptom in people with multiple sclerosis, affecting up to 70 % of patients, in particular with progressive disease. The pathophysiology of cognitive impairment is not fully understood, multiple magnetic resonance imaging studies suggest associations of structural brain damage (especially of the cortical and deep grey matter [thalamus]) with cognitive dysfunction. In recent years MS is increasingly viewed as network disorder where lesions in or microstructural damage to strategic white matter tracts may cause a „multiple disconnection syndrome“ leading to impaired cognition. A brief assessment of cognitive function, for example by the BICAMS or SDMT, should be incorporated in patient management in daily clinical care. However, these brief test batteries cannot fully replace an extensive neuropsychological assessment that may be necessary in some circumstances, for example impending loss of employment. Pharmacotherapeutic options of cognitive impairment in MS are scant, and the impact of immunomodulatory therapy on cognition has not been systematically investigated. Current therapeutic approaches comprise cognitive rehabilitation programs as well as individual coping strategies. Internet-based cognitive rehabilitation could be a feasible and supplementary therapeutic tool in the future. Data on cognition in important MS differential diagnoses such as neuromyelitis optica spectrum disorders are sparse