SPMS Patients Have More Cognitive Decline Than Those with RRMS, Study Reports

SPMS Patients Have More Cognitive Decline Than Those with RRMS, Study Reports

People with secondary progressive multiple sclerosis (SPMS) have more cognitive decline than those with relapsing-remitting MS (RRMS), according to a Greek study.

The finding confirmed a long-held assumption that the more progressive form of the disease — SPMS — also involves more cognition problems. Some previous research has confirmed that hypothesis, but other studies have contradicted it.

The Greek team’s article, “Cognitive and Language Deficits in Multiple Sclerosis: Comparison of Relapsing Remitting and Secondary Progressive Subtypes, appeared in The Open Neurology Journal.

Neurocognitive impairment affects between 40 and 65 percent of MS patients. The impairment occurs regardless of the stage of the disease, how long a person has had it, and the severity of their physical disability. And it worsens over time.

Researchers have done a number of studies on whether cognition is worse in different forms of the disease than others, but the findings have been contradictory.

A team at the University of Patras hoped to shed more light on the subject. They evaluated the cognitive and linguistic functioning of 27 patients — 15 with RRMS and 12 with SPMS. They also assessed 12 healthy volunteers as controls.

All participants took a battery of neuropsychological and language tests.

Both categories of MS patients showed worse cognition than healthy volunteers — a finding that confirmed the results of previous studies.

A key finding was that the SPMS patients had cognition problems in all areas they were tested for. Meanwhile, RRMS patients had impairments in three categories — initial verbal word encoding, word consolidation, and delayed recall of verbal information.

Interestingly, researchers found no differences in verbal fluency between RRMS patients and healthy people, suggesting that this function is affected only at later stages of the disease.

The results of the various tests also revealed that SPMS patients’ impairments were more severe. This was particularly true with verbal encoding and processing new items. In addition, SMPS patients had poorer mental processing speed.

Another difference was that SPMS patients also had significantly worse performance in tests of executive function, which deal with behavior, than RRMS patients.

The researchers said the findings “confirm the assumption that MS patients, irrespective of the clinical subtype, have more severe deficits than healthy participants, which become increasingly worse as the severity of the disease proceeds and RRMS patients convert to SPMS.”

“Thus, the hypothesis that the progressive type of disease shows a relatively greater reduction in cognitive function, compared to the RRMS type, was confirmed,” the team wrote.

The two groups showed similar patterns of global cognitive function, however, the researchers wrote. Global cognition involves learning, thinking critically, and interacting with others effectively.

“Although they do not differ on overall global cognitive function, they differ on important cognitive abilities such as learning new information, speed of mental processing, ability to inhibit overlearned responses and mental flexibility,” the team wrote. “These cognitive deficits have a significant impact on everyday functioning abilities and quality of life.”



  1. Tracy Smith says:

    There just doesn’t seem to be as much research on SPMS. I wish there were more trials offered for our group and new medicines targeted specifically for SPMS. After I was taken off Betaseron due to my body building up an immunity to it, my neurologist has not tried any new medicine.I have not been getting any treatment for at least 10 years.

  2. Me says:

    This study is just comparing earlier stage MS patients to later. The results aren’t remotely surprising. SPMS means that your accumulated brain/nerve damage has passed the point where your nervous system can form connections to bypass the affected areas (neural plasticity), leading to disability. This usually happens after you have MS for a while.

    RRMS & SPMS were invented labels to help drug companies show an effect in trials and to get designation as an orphan disease. You can count relapses in short trials but it would take years to show an effect on progression. They call it SPMS but there’s no magic switch that’s been turned on; it’s the same disease.

    Effective drugs will slow down the inflammatory processes leading to this end. The earlier and more effectively you treat MS, the less damage occurs.

    As far as treatments for preventing further progression, Cladribine should especially be good since it is able to safely get into the brain and lymphatic system to kill the lymphocytes as well as being very effective at stopping acute attacks through the blood-brain barrier (relapses).

    Our understanding of MS biology is evolving and improving. It would be nice if our news websites covered newer thinking, or at least present that there are different theories.

  3. Gretchen Korman says:

    No shit! My long-term memory helped spark that witty retort!
    How one lives on with such cognitive decline is my $64K question! I am ill-equipped to manage with that in store👹

  4. williams says:

    There are several questions I have about the article. What are the ages of the SPMS patients versus the RRMS patients? Where are the lesions located?

    • Liz Colpoys says:

      I’d like to know those details, too. Certainly cognitive decline, especially memory loss, accompanies aging, and I think secondary progressive MS does, too. That said, the results of this study shouldn’t be surprising.

  5. Kaylene says:

    My neurologist wants me to take a chemo drug Aubagio for my MS. I wonder if any others have had experiences using this drug. While I need medication, I’m a bit worried about the side effects & long term use.

  6. Brian says:

    I’ve had PPMS for 10 years now. I used to monitor it’s progression the degree of my physical limitations month to month. I have always been somewhat optimistic that I will be able to overcome the these suttle changes in my life. They’ll find an answer to this Ive always thought. Progression has been slow but constant over the years. I’m now at a stage where optimism is losing ground to the reality of how disabled I have become. At 63, I’m half the man I used to be. I’m becoming more dependant on others. Life is now an endurance and I’m thinking more often of how to end it.

    • Louis LaBarber, PhD says:

      Clinical depression is often associated with MS. I hope you are seeking treatment for depression concurrently with your MS. There are effective treatments available which can impact your coping abilities.

    • Janet says:

      With you on that one Brian & I have been on antidepressants for almost 20 years, when it gets this hard just to survive I just want to sleep forever.

    • Nancy says:

      Hey Brian, I feel the same way you do. I was always optimistic before. MS has slowly robbed me of the life I thought I’d have. Now the constant pain, the debilitating fatigue, the cog fog, the decreasing ability to function combined with aging make it hard to keep my spirits up. I also think at times of how I want to end it. I don’t know – in some weird way I find it comforting to hear from another person that they feel this way too. I’m sorry you are feeling like this & hope you are oddly comforted to hear from me. I sincerely hope your life improves & you have less moments of darkness & more good times than bad.

  7. Lambros says:

    Lambros Says
    Please try cognitive rehabilitation a neurobehavioural intervention with positive results in recent neuropsychological and neuroimaging findings in order to delay cognitive decline

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