Measures of cognitive and emotional changes in multiple sclerosis and underlying models of brain dysfunction

  • Guido Gainotti
    Servizio di Neuropsicologia, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy. Fax: +39 06 3550 1945.
    Neuropsychology Service, Department of Neurological Sciences, Policlinico Gemelli Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
    Search for articles by this author


      In this short critical review, I will take first into account the cognitive defects usually observed in multiple sclerosis (MS) patients, the neuropsychological batteries constructed to measure these defects and the main objections that can be addressed to these batteries.
      I will then pass to consider the problem of the model of brain dysfunction corresponding to the pattern of neuropsychological impairment typical of MS patients, stressing the main differences between anatomical progression and across subjects consistency of the cognitive defects observed in Alzheimer's disease and MS patients.
      In the last part of my review, I will shortly consider the issues of the emotional changes observed in MS patients, of the interpretation of these emotional disorders and of the scales used to measure them.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Benedict R.H.B.
        • Fischer J.S.
        • Archibald C.
        • Arnett P.A.
        • Beatty W.W.
        • Bobholz J.
        • et al.
        Minimal neuropsychological assessment of MS patients: a consensus approach.
        Clin Neuropsychol. 2002; 16: 381-397
        • Rao S.M.
        • Leo G.J.
        • Bernardin L.
        • Unverzagt F.
        Cognitive dysfunction in multiple sclerosis: I. Frequency, patterns and predictions.
        Neurology. 1991; 41: 685-691
        • Smith A.
        Symbol digit modalities test: manual.
        Western Psychological Services, Los Angeles1982
        • Delis D.C.
        • Kramer J.H.
        • Kaplan E.
        • Ober B.A.
        California verbal learning test manual.
        in: Adult version. Second ed. Psychological Corporation, San Antonio, TX2000
        • Benedict R.H.B.
        Brief visuospatial memory test-revised: professional manual.
        Psychological Assessment Resources, Odessa, FL1997
        • Delis D.C.
        • Kaplan E.
        • Kramer J.H.
        California sorting test.
        Psychological Corporation, San Antonio, TX2001
        • Benton A.L.
        • Sivan A.B.
        • Hamsher K.
        • Varney N.R.
        • Spreen O.
        Contributions to neuropsychological assessment.
        2nd ed. Oxford University Press, New York1994
        • Benton A.L.
        • Hamsher K.
        Multilingual aphasia examination.
        AJA Associates, Iowa City1989
        • Rao S.M.
        Cognitive Function Study Group, National Multiple Sclerosis Society. A manual for the brief repeatable battery of neuropsychological tests in multiple sclerosis.
        National Multiple Sclerosis Society, New York1990
        • Beatty W.W.
        • Paul R.H.
        • Wilbanks S.L.
        • Hames K.A.
        • Blanco C.D.
        • Goodkin D.E.
        Identifying multiple sclerosis patients with mild or global cognitive impairment using the Screen Examination for Cognitive Impairment (SEFCI).
        Neurology. 1995; 45: 718-723
        • Buschke H.
        • Fuld P.A.
        Evaluating storage, retention and retrieval in disordered memory and learning.
        Neurology. 1974; 24: 1019-1025
        • Barbizet J.
        • Cany E.
        Clinical and psychometrical study of a patient with memory disturbances.
        Int J Neurol. 1968; 7: 44-54
        • Boringa J.B.
        • Lazeron R.H.C.
        • Reuling I.E.W.
        • Ader H.J.
        • Pfennings L.
        • Lindeboom J.
        • et al.
        The Brief Repeatable Battery of Neuropsychological Tests: normative values allow application in multiple sclerosis clinical practice.
        Mult Scler. 2001; 7: 263-267
        • Zachary R.A.
        Shipley Institute of living scale. Revised manual.
        Western Psychological Services, Los Angeles1982
        • Aupperle R.L.
        • Beatty W.W.
        • deNAP Shelton S.
        • Gontovsky S.T.
        Three screening batteries to detect cognitive impairment in multiple sclerosis.
        Mult Scler. 2002; 8: 382-389
        • Randolph C.
        Repeatable battery for the assessment of neuropsychological status.
        Psychological Corporation, San Antonio, TX1998
        • Folstein M.S.
        • Folstein S.E.
        • McHugh P.R.
        ‘Mini Mental State’: a practical method of grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-196
        • Solari A.
        • Mancuso L.
        • Motta A.
        • Mendozzi L.
        • Serrati C.
        Comparison of two brief neuropsychological batteries in people with multiple sclerosis.
        Mult Scler. 2002; 8: 169-176
        • Higginson C.I.
        • Arnett P.A.
        • Voss W.D.
        The ecological validità of clinical tests of memory and attention in multiple sclerosis.
        Arch Clin Neuropsychol. 2000; 15: 185-204
        • Wilson B.A.
        • Cockburn J.
        • Baddeley A.
        The rivermead behavioural memory test.
        Thames Valley Test Co, Reading, UK1985
        • Robertson I.H.
        • Ward T.
        • Rigdgewayet V.
        • Nimmo-Smith I.
        The test of everyday attention.
        Thames Valley Test Co, Suffolk, UK1994
        • Braak H.
        • Braak E.
        Staging of Alzheimer's disease related neurofibrillary tangles.
        Neurobiol Aging. 1995; 16: 271-284
        • Jennekens-Schinkel A.
        • Sanders E.A.C.M.
        Decline of cognition in multiple sclerosis: dissociable deficits.
        J Neurol Neurosurg Psychiatry. 1986; 49: 1354-1360
        • Jennekens-Schinkel A.
        • Laboyrie P.M.
        • Lanser J.B.K.
        • Van der Velde E.A.
        Cognition in patients with multiple sclerosis. After four years.
        J Neurol Sci. 1990; 99: 229-247
        • Rey A.
        Memorisation d'une serie de 15 mots en 5 répétitions.
        in: Rey A. L'examen clinique en psychologie. Presses Universitaires de France, Paris1958: 139-193
        • Nelson H.E.
        A modified card sorting sensitive to frontal lobe defects.
        Cortex. 1976; 12: 313-324
        • Raven J.C.
        Progressive matrices: set A, AB, B: board and book form.
        Lewis, London1949
        • Rao S.M.
        Multiple sclerosis.
        in: Cummings J.L. Subcortical dementia. Oxford University Press, New York1990: 164-180
        • Albert M.L.
        • Feldman R.G.
        • Willis A.L.
        The ‘subcortical dementia’ of progressive supranuclear palsy.
        J Neurol Neurosurg Psychiatry. 1974; 37: 121-130
        • Benedict R.H.
        • Bakshi R.
        • Simon J.
        • Priore R.
        • Miller C.
        • Munschauser F.
        Frontal cortex atrophy predicts cognitive impairment in multiple sclerosis.
        J Neuropsychiatry Clin Neurosci. 2002; 14: 44-51
        • Arnett P.A.
        Neuropsychological presentation and treatment of demyelinating disorders.
        in: Halligan P.W. Kischka U. Marshall J.C. Handbook of clinical neuropsychology. Oxford University Press, Oxford, UK2003: 368-386
        • Brassington J.T.
        • Marsh N.V.
        Neuropsychological aspects of multiple sclerosis.
        Neuropsychol Rev. 1998; 8: 43-77
        • Huber S.J.
        • Paulson G.W.
        • Shuttleworth E.C.
        • Chakeres D.
        • Clapp L.E.
        • Pakalnis A.
        • et al.
        Magnetic resonance imaging correlates of dementia in multiple sclerosis.
        Arch Neurol. 1987; 44: 732-736
        • Rao S.M.
        • Leo G.J.
        • Haughton V.M.
        • St Aubin-Faubert P.
        • Bernardin L.
        Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis.
        Neurology. 1989; 39: 161-166
        • Edwards S.G.M.
        • Liu C.
        • Blumhardt L.D.
        Cognitive correlates of supratentorial atrophy on MRI in multiple sclerosis.
        Acta Neurol Scand. 2001; 104: 214-223
        • Beatty W.W.
        A strategy for studying memory disorders in multiple sclerosis.
        in: Squire R.L. Butters N. Neuropsychology of memory. NY Guilford Press, New York1992: 285-298
        • Wishart H.
        • Sharpe D.
        Neuropsychological aspects of multiple sclerosis: a quantitative review.
        JCEN. 1997; 19: 810-824
        • Vleugels L.
        • Lafosse C.
        • van Nunen A.
        • Nachtergaele S.
        • Ketelaer P.
        • Charlier M.
        • et al.
        Visuoperceptual impairment in multiple sclerosis patients diagnosed with neuropsychological tasks.
        Mult Scler. 2000; 6: 241-254
        • Brown L.N.
        • Metz L.M.
        • Sainsbury R.S.
        Sensory temporal thresholds and interhemispheric transfer time in multiple sclerosis: a preliminary study of a new outcome measure.
        JCEN. 2003; 25: 783-792
        • Demaree H.A.
        • DeLuca J.
        • Gaudino E.A.
        • Diamond B.J.
        Speed of information processing as a key deficit in multiple sclerosis: implications for rehabilitation.
        J Neurol Neurosurg Psychiatry. 1999; 67: 661-663
        • DeLuca J.
        • Chelune G.
        • Tulsky D.S.
        • Lengenfelder J.
        • Cavalloti N.D.
        Is speed of processing or working memory the primary information processing deficit in multiple sclerosis?.
        JCEN. 2004; 26: 550-562
        • Peyser J.M.
        • Poser C.M.
        Neuropsychological correlates of multiple sclerosis.
        in: Folskov S.B. Boll T.J. Handbook of clinical neuropsychology. vol. 2. Wiley, New York1986: 364-397
        • Joffe R.T.
        • Lippert G.P.
        • Gray T.A.
        • Sawa G.
        • Horvath Z.
        Mood disorder and multiple sclerosis.
        Arch Neurol. 1987; 44: 376-378
        • Beck A.T.
        • Ward C.H.
        • Medelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Zung K.W.
        A self-rating depression scale.
        Arch Gen Psychiatry. 1965; 12: 63-70
        • Nyenhuis D.L.
        • Rao S.M.
        • Zajecka J.M.
        • Luchetta T.
        • Bernardin L.
        • Garron D.C.
        Mood disturbance versus other symptoms of depression in multiple sclerosis.
        J Int Neuropsychol Soc. 1995; 1: 291-296
        • Arnett P.A.
        • Higginson C.I.
        • Randolph J.J.
        Depression in multiple sclerosis: relationship to planning ability.
        J Int Neuropsychol Soc. 2001; 7: 665-674
        • Gainotti G.
        • Azzoni A.
        • Razzano C.
        • Lanzillotta M.
        • Marra C.
        • Gasparini F.
        The Post-Stroke Depression Rating Scale: a test specifically devised to investigate affective disorders of stroke patients.
        JCEN. 1997; 19: 340-356
        • Patten S.B.
        • Metz L.M.
        • Reimer M.A.
        Biopsychosocial correlates of lifetime major depression in multiple sclerosis: the role of uncertainty, coping and hope.
        Mult Scler. 2000; 6: 115-120
        • Lynch S.G.
        • Kroeccke D.
        • Denney D.R.
        The relationship between disability depression in multiple sclerosis: the role of uncertainty, coping and hope.
        Mult Scler. 2001; 7: 411-416
        • Rabins P.V.
        • Brooks B.R.
        • O'Donnel P.
        • Pearlson G.D.
        • Moberg P.
        • Jubelt B.
        Structural brain correlates of emotional disorder in multiple sclerosis.
        Brain. 1986; 109: 585-597
        • Honer W.G.
        • Hurwitz T.
        • Li D.K.B.
        • Palmer M.
        • Paty D.W.
        Temporal lobe involvement in multiple sclerosis patients with psychiatric disorders.
        Arch Neurol. 1987; 44: 187-190
        • Sadovnick A.D.
        • Remick R.A.
        • Allen M.D.
        • Swartz E.
        • Yee I.M.L.
        • Eisen K.
        • et al.
        Depression and multiple sclerosis.
        Neurology. 1996; 46: 628-632