ABSTRACT
The functional consequences of MS-related cognitive impairment can be striking. Compared to cognitively intact patients with comparable physical disability, cognitively impaired MS patients are significantly less likely to be employed and to engage in social activities, and they are significantly more likely to need assis tance with daily activities such as personal care and household management.!3,12,13] Clinical experience suggests that cognitively impaired MS patients have difficulty performing complex mul tiple-step activities, including complex treatment regimens, and they are more prone to accidents at home and while driving. Thus, MS-related cognitive impairment is common, functionally disabling, and directly related to cerebral MS lesions. However, traditional MS clinical outcome measures are insensitive to MS-related cognitive deficits.!14]
The purpose of this chapter is to review natural history studies and clinical trials of disease-modifying and symptomatic medications in which neuropsychological outcomes have been explicitly assessed, and to make recommen dations about the assessment of neuropsychologi cal outcomes in future MS clinical trials. It extends concepts that have been previously advanced,!15^ emphasizing work conducted in the last 3 years.
