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What Do We Really Know About Cognitive Dysfunction, Affective Disorders, and Stress in Multiple Sclerosis? A Practitioner's Guide

Mellen Center for MS Treatment and Research (U-10), Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195-5244

Frederick W. Foley

MS Center at St. Agnes Hospital, White Plains, New York, and Department of Psychology, Yeshiva University, Bronx, New York

James E. Aikens

Department of Psychiatry, University of Chicago, Chicago, Illinois

G. Dean Ericson

MS Center at Shepherd Spinal Center, and Health and Rehabilitation Psychologists of Atlanta, Georgia

Stephen M. Rao

Department of Neurology, Medical College of Wisconsin, Mihvaukee, Wisconsin

Steve Shindell

Private Practice, Atlanta, Georgia

Multiple sclerosis (MS) patients often present with difficult neuropsychological and emotional problems. This article describes work undertaken by the psychology specialty panel in conjunction with a June 1993 Consortium of Multiple Sclerosis Centers (CMSC),sponsored conference entitled "What Do We Really Know About MS?" We summarize our critical review of one hundred seven controlled studies of cognitive dysfunction, affective disorders, and stress in MS, emphasizing what we know, what we believe we know, and what we do not know but need to know. We also present results of a survey of seventy-six MS practitioners (neurologists and mental health practitioners) covering beliefs about these topics and clinical practices, and we highlight discrepancies between our empirical knowledge and current clinical practices. Based on our literature review and practitioner survey, we identify critical gaps in our knowledge, highlighting the need for research on treatments for MS-related cognitive dysfunction, assessment of affective disturbance in MS, and effects of stress on disease activity.

Key Words: Cognitive dysfunction • Affective disorders • Stress • Multiple sclerosis.

Neurorehabilitation and Neural Repair, Vol. 8, No. 3, 151-164 (1994)
DOI: 10.1177/136140969400800309


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