Cognitive impairment is present in about 40 per cent of multiple sclerosis patients from community samples(33) and contributes significantly to the overall disability. The pattern of impairment is characterized by the following.
• Visual and auditory attention deficits, as well as slowing of information processing, are very common and may be present in the early stages of the disease/34)
• Memory disturbances are seen, with greater impairment of recall over recognition.
• Executive function deficits are present, with poor working memory, conceptual reasoning, and abstract reasoning.
• Language skills and visuospatial functions tend to be preserved.
Cognitive impairment is more severe in those with progressive disease and significant neurological disability, although severe impairment amounting to dementia has been reported in patients in the absence of significant neurological disturbance. (35> Cognitive impairment is also correlated with brain lesion load as measured by MRI(36) and with the presence of brain atrophy, although these correlations are not close.
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