Pharmacology Treatment of Cognitive Dysfunction in Multiple Sclerosis
There are two categories of treatment for cognition in MS:
• Prophylactic treatment - to prevent occurrence and slow progression of cognitive deterioration.
• Symptomatic treatment - to alleviate immediate effects of cognitive dysfunction.
Prophylactic treatment -Currently there no medicines that can be used to treatment cognitive impairment in people with MS. However, in a number of the trials, neuropsychological outcomes have been used as additional markers and there is some evidence to suggest that neuropsychological functioning works the same way other disease functioning works, in that some of these medications delay the develop of further cognitive difficulty.
Symptomatic treatment - People have tried a number of pharmacological agents for symptomatic treatment. FDA has not identified any of these as being effective in treating cognitive dysfunction in MS so any use of these drugs is off-label. It's important to note that people without a disease can show improvements in attention, so we don't know how specific it is to the cognitive problems of MS. Also we also have to balance this with some difficulties with abuse of psycho stimulants. One class of drugs receiving a lot of attention is called aseatal cholinesterase inhibitors. Several are approved for treatment of memory loss in Alzheimer's disease. It is possible to improve cognitive function by treating some of the comorbid conditions. An FDA approved drug for treating fatigue is modafenol also called provigil. Some cognitive problems can be related to fatigue, and this drug could be effective in treating fatigue, and might have the added benefit of improving cognition. And we know that depression and insomnia can clearly affect cognitive problems, so the usual methods of treating depression and insomnia with pharmaceutical agents could be effective in helping a cognitive disturbance.
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