Cognitive and Language Deficits in Multiple Sclerosis: Comparison of Relapsing Remitting and Secondary Progressive Subtypes

Katerina Ntoskou1, Lambros Messinis2, *, Grigorios Nasios3, Maria Martzoukou3, Giorgos Makris4, Elias Panagiotopoulos1, Panagiotis Papathanasopoulos5
1 Rehabilitation unit for Patients with Spinal Cord Injury, “Demetrios and Vera Sfikas”, Department of Medicine, University of Patras, 26504 Patras, Greece
2 Neuropsychology Section, Department of Neurology, University of Patras Medical School, 26504 Patras, Greece
3 Higher Educational Institute of Epirus, Department of Speech and Language Therapy, Ioannina, Greece
4 Higher Educational Institute of Peloponnese, Department of Speech and Language Therapy, Patras, Greece
5 University of Patras Medical School, Patras, Greece

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© 2018 Ntoskou et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Neuropsychology Section, Department of Neurology, University of Patras Medical School, 26504 Patras, Greece; Tel: +302613603348; E-mail:



The objective of this study was to investigate the pattern and severity of cognitive and language impairment in Greek patients with Relapsing-remitting (RRMS) and Secondary Progressive Multiple Sclerosis (SPMS), relative to control participants.


A prospective study was conducted in 27 patients with multiple sclerosis (PwMS), (N= 15) with RRMS, (N= 12) with SPMS, and (N= 12) healthy controls. All participants were assessed with a flexible comprehensive neuropsychological – language battery of tests that have been standardized in Greece and validated in Greek MS patients. They were also assessed on measures of disability (Expanded Disability Status Scale; EDSS), fatigue (Fatigue Severity Scale; FSS) and depression (Beck Depression Inventory - fast screen; BDI-FS).


Our results revealed that groups were well matched on baseline demographic and clinical characteristics. The two clinical groups (RRMS; SPMS) did not differ on overall global cognitive impairment but differed in the initial encoding of verbal material, mental processing speed, response inhibition and set-shifting. RRMS patients differed from controls in the initial encoding of verbal material, learning curve, delayed recall of verbal information, processing speed, and response inhibition. SPMS patients differed in all utilized measures compared to controls. Moreover, we noted increased impairment frequency on individualized measures in the progressive SPMS group.


We conclude that MS patients, irrespective of clinical subtype, have cognitive deficits compared to healthy participants, which become increasingly worse when they convert from RRMS to SPMS.On the contrary,the pattern of impairment remains relatively stable.

Keywords: Multiple sclerosis, Impairment, Cognition, Language, Relapsing remitting MS, Secondary progressive MS.