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Comorbid problems associated with multiple sclerosis in adults

INTRODUCTION

Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system (CNS) that is a leading cause of disability in young adults.

A range of symptomatic problems can occur in patients with MS. Cognitive dysfunction, depression, fatigue, and mood swings are increasingly common with disease progression. Spasticity, tremor, seizures, sphincter dysfunction, and sexual dysfunction may also complicate disease progression. The management of these comorbid problems associated with MS is reviewed here.

Other aspects of MS are discussed separately. (See "Epidemiology, risk factors, and clinical features of multiple sclerosis in adults" and "Diagnosis of multiple sclerosis in adults" and "Treatment of relapsing-remitting multiple sclerosis in adults" and "Treatment of progressive multiple sclerosis in adults".)

COGNITIVE DYSFUNCTION

Frank dementia is an uncommon feature of multiple sclerosis (MS) [1], occurring in less than 5 percent of patients. It is usually only encountered in severely affected individuals. However, 43 to 70 percent of patients have cognitive impairment on the basis of neuropsychological testing [2]. The prevalence of cortical syndromes such as aphasia, apraxia, and agnosia is low.

Cognitive impairment may be common even at the onset of MS [3,4]. The most frequent abnormalities are with abstract conceptualization, recent memory, attention, and speed of information processing [4,5]. Different disease courses may have different cognitive profiles. As an example, one study found that patients with relapsing-remitting MS generally had better cognitive performance than patients with progressive types of MS [6].
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