The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians

Christos Bakirtzis1, Panagiotis Ioannidis1, Lambros Messinis2, *, Grigorios Nasios3, Elina Konstantinopoulou4, Panagiotis Papathanasopoulos5, Nikolaos Grigoriadis1
1 The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
2 Department of Neurology, Neuropsychology Section, University of Patras Medical School, Patras, Greece
3 Department of Speech and Language Therapy, Higher Educational Institute of Epirus, Ioannina, Greece
4 Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
5 University of Patras Medical School, Patras, Greece

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Creative Commons License
© 2018 Bakirtzis 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 Department of Neurology, Neuropsychology Section, University of Patras Medical School, Patras, Greece; Tel: ++302613603348; E-mail:


About half of patients with multiple sclerosis exhibit cognitive impairment which negatively affects their quality of life. The assessment of cognitive function in routine clinical practice is still undervalued, although various tools have been proposed for this reason. In this article, we describe the potential benefits of implementing cognitive assessment tools in routine follow -ups of MS patients. Early detection of changes in cognitive performance may provide evidence of disease activity, could unmask depression or medication side-effects and provide suitable candidates for cognitive rehabilitation. Since apathy and cognitive deficiencies are common presenting symptoms in Progressive Multifocal Leukoencephalopathy, we discuss the utility of frequent monitoring of mental status in multiple sclerosis patients at increased risk. In addition, we propose a relevant algorithm aiming to incorporate a systematic evaluation of cognitive function in every day clinical practice in multiple sclerosis.

Keywords: Multiple sclerosis, Cognition, Clinical practice, Monitoring, Depression, Fatigue.