President's Post May 2018
Prof Ralph Benedict
Professor of Neurology, Psychiatry and Psychology Jacobs Neurological Institute, SUNY Buffalo School of Medicine Buffalo General Hospital Buffalo, New York
Having just returned from the American Academy of Neurology meeting, I thought now might be an opportune time to comment on recent developments.
Cognition in MS was center stage on 26 April, in Session S44, MS Risk Factors, Susceptibility, Diagnosis, and Cognitive Impairment. Cognitive processing speed (CPS) as measured by Symbol Digit Modalities Test (SDMT) was included as an exploratory or tertiary outcome measure in the OPERA and EXPAND trials. Data reported by myself, and Stanley Cohan, showed that CPS benefited from ocrelizumab, and siponimod, respectively, and that the effects were clinically meaningful as per the MSOAC guidelines. There were three other cognition platforms, describing new evidence of word-finding deficits in MS, benchmarks for clinically meaningful deficits on the IPad based Processing Speed Test, and an fMRI marker of cognitive reserve.
A number of poster abstracts in the meeting also impressed me. Iris Penner et al carefully examined BICAMS data in 1600 MS patients and found that eliminating the verbal memory component had negligible impact on the BICAMS reliability and sensitivity. While the field continues to search for an ever-briefer assessment, Jim Sumowski reminds us that there is still a role for the more comprehensive exam – he (George et al) presented data showing that CPS and memory deficits are entirely separate factors thus challenging the assumption that CPS deficits underlie the memory deficit in MS. Finally, were I to give an award for the most novel presentation it may got to Lauren Krupp’s group (Clayton et al) for their case studies on cognitive training. They reported positive clinical responses to cognitive training combined with transcranial direct current stimulation (tDCS). There is much talk these days about combining cognitive training with other interventions, combined therapies if you will, including cognitive enhancer medication, exercise training, and now (tDCS). Who knows where this might lead!
Please stay tuned for my next message as we get closer to the exciting combined ECTRIMS/IMSCOGS meetings in Berlin.