Neuropsychological assessment in multiple sclerosis

OBJECTIVE: Over the past 20 years great advances have been made in understanding the neuropsychological changes in multiple sclerosis. In this paper we review the nature of mental deterioration in multiple sclerosis and the procedures used for its evaluation. DEVELOPMENT: First we give a short summary of present knowledge of the involvement of different functions and the instruments most generally used to evaluate it. We then consider the different approaches to neuropsychological assessment, the use of broad guidelines as opposed to screening techniques, bearing in mind their advantages and disadvantages in the clinical field and in investigation. Similarly we mention the current trends in the evaluation and treatment of multiple sclerosis. CONCLUSIONS: The general profile of neuropsychological alterations in multiple sclerosis is characterized by the presence of changes in secondary memory and speed of thought, although the nature of this defect is still not clear. Changes are also seen in other neuropsychological functions, although less frequently and more controversially. Our knowledge of the prevalence of these changes comes from the use of guidelines for thorough examination. However, the current tendency is to seek instruments for evaluation which combine diagnostic efficiency, clinical usefulness and brevity. In this respect, although progress is being made, there are still questions to be answered.