Answers About Dementia In MS
Itís very evident that MS can have effects on personality: mood swings, irritability, depression, etc. These can fluctuate and have remissions and exacerbations, just as physical symptoms do. So itís not generally a predictor. Cognitive impairment early on in MS is felt to bode poorly for the long term.
There is evidence of some problems in recent memory and new learning in MS. There is more forgetfulness and some delay in retrieving old information and difficulty in consolidating new information. In most cases, these cognitive problems are not severe enough to seriously impair social and vocational functioning, but they can be.
MS can cause
emotional, psychological, and cognitive problems as a direct effect of
the inflammation and demyelination on normal nervous system functioning.
It is certainly true that corticosteroids can have profound effects on
mood, usually resulting in depression, and can even cause psychosis or
It's also conceivable that agitation or depression can be a direct or indirect effect of having MS.
It is not uncommon for dementia to supervene in MS without additional accumulation of changes on the MRI scan. Having dementia in MS, as opposed to any other kind of symptom (tremor, vision impairment, etc) often implies a more widespread demyelination process. The progression of MS in someone with dementia is generally associated with the progression of other symptoms and deficits.
It is also clear that neuropsychological deficits are common in MS, and up to 5% of patients may develop serious dementia. These are usually correlated with fairly widespread demyelination, usually in the frontal lobes of the brain. Very often, the dementia is part and parcel of general disease progression, with physical disability associated with vision, coordination, walking, and sensory problems. Sometimes, the severity of the dementia exceeds the non-cognitive deficits. This dementia can be extremely disabling. If there is a component of an "attention-deficit-disorder" to the dementia, with problems in concentration and attention, there is sometimes benefit from stimulants such as methylphenidate or stimulating antidepressants such as venlafaxine. There have not been formal studies of the anticholinesterase inhibitors used to improve Alzheimer's disease, such as donepezil; there are some theoretical reasons to believe these might have some activating benefit in this situation, but more research is needed.
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