2) This program is supported by an educational grant from Bristol Myers Squibb & is intended for #healthcare #providers. Accreditation statement & faculty disclosures at https://t.co/QO3HNwSqFh. Check out prior programs, still available for 🆓CE/#CME, at https://t.co/F9LsuVjqdM.
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
4) Did you know?? The answer is B. Sadly, #cognitive decline is among the first symptoms for many persons with #MS, who are often diagnosed between ages 20 and 40 years–a time when persons are expected to be at their peak cognitive performance. pic.twitter.com/3qB3NZFwQH
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
6) #MS-related cognitive impairment was classically labeled as a “subcortical #dementia” characterized by diffuse white matter pathology, and in which the predominant #cognitive feature is profound slowing. pic.twitter.com/xAzxwbpMbc
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
8) #DMTs have quieted #inflammatory activity & reduce the number and size of white matter lesions. However, a pattern of subtle but progressive #graymatter atrophy has emerged. MS is now seen as both an inflammatory and a neurodegenerative disease. See https://t.co/pj3w2fMVFL
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
9b) This was detailed in a 2018 consensus statement led by @MSHSNeurology’s @jimsumowski in @GreenJournal, which discussed priorities for characterizing cognitive function: 🔓https://t.co/ibjwJRNuuT.
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
10b) … Raising the concern that #neurodegenerative aspects of MS may occur even with good prevention of new inflammatory lesions. See https://t.co/t8HGpE2Z05.
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
12) What makes the #SDMT the most sensitive #cognitive screening measure in #MS?
A. It is a measure of pure processing speed
B. It has high specificity
C. It measures multiple cognitive processes
D. It is not influenced by practice effects— MultipleSclerosis_CME (@ms_cme) October 12, 2022
14) The #SDMT is highly sensitive but non-specific because it isn’t capturing a unitary underlying function, but rather reflects the performance of several cognitive functions. See https://t.co/dqBCFmwRAo
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
16) Put simply, a poor score on the #SDMT tells us that #cognitive dysfunction has likely occurred, but it doesn’t characterize the nature of the deficit. Two people may have the same SDMT score, but for very different reasons (e.g., memory versus language dysfunction).
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
18) In conjunction with objective cognitive assessment, patients are a reliable and valid source of information about their own cognition, especially in early #MS. #PatientReportedOutcomes
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
20) Subtle but impactful #cognitive changes may be reported by a patient but missed by objective testing, which is often cross-sectional and lacks the necessary premorbid comparison to appreciate small changes.
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
21b) … @jimsumowski shows that patients starting to the right of the curve would still be characterized as “cognitively intact.” From 🔓https://t.co/ibjwJRNuuT pic.twitter.com/6g1LGMHtAx
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
23) Our objective #cognitive tests are also imperfect. Traditional cognitive assessments often have modest ecological validity, meaning test performance may not always relate to real-world function.
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
25) Another example of the value of listening to patients: word-finding is one of the most frequently reported cognitive complaints in #MS. However, it remains underexplored, likely because our traditional measures do not pick up this deficit. See 🔓 https://t.co/qSmJWGNZrB
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
27) Other factors such as #fatigue, #mood disturbance, and #sleep problems likely contribute to #cognitive symptoms in #MS. Look for modifiable factors! pic.twitter.com/c6FFM0a3Fw
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
28b) Other lifestyle factors that can help #MS #cognition: #smoking_cessation 🚭, #stress management, and optimal treatment of #mood. See 🔓https://t.co/EVrN7vmHoQ. pic.twitter.com/dNLMUrDJmQ
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
30) And finally: Listen 👂 to your patients; they are experts on their own cognitive experience. I’m @SarahLevyPhD, thanks for joining us in this #tweetorial. You can now claim your 0.5hr 🆓CE/#CME at https://t.co/sZzeqlipFA. Follow us for more programs!!
— MultipleSclerosis_CME (@ms_cme) October 12, 2022
