Should You See a Neuropsychologist for MS?
Cognitive changes are a common symptom of multiple sclerosis (MS). In fact, according to the National Multiple Sclerosis Society, over 50% of people living with MS will experience some form of cognitive difficulty. That may include problems with memory, focus and attention, organizational skills, problem-solving skills, expressive language (such as finding words), or ability to perceive the environment visually.
Cognitive problems are considered some of the most disabling symptoms of MS. Even so, they’re not always given the attention they deserve. But addressing them early can help improve your quality of life over the long term.
Once cognitive problems are identified, your medical team can determine whether there are interventions that can help. This can include medications, cognitive rehabilitation, and adjustments or accommodations to your environment to help you adapt to MS-related cognitive issues.
Evaluating any cognitive problems caused by multiple sclerosis is where a neuropsychologist comes in.
What Is a Neuropsychologist?
A neuropsychologist is a type of clinical psychologist who focuses on brain behavior relationships and is especially trained to diagnose and assess cognitive function.
A neuropsychologist is “a clinical psychologist who went on to do extra training in neuropsychology and looking at how different medical conditions can impact someone's memory, attention, and cognition,” explains Meghan Beier, Ph.D., a board-certified neuropsychologist and assistant professor of physical medicine and rehabilitation at Johns Hopkins Medicine.
These specialists focus on conducting tests to evaluate cognitive abilities and interpreting the results to create a plan that will help the person adapt to these changes and preserve cognitive function.
A neuropsychologist’s training is extensive. “There's a lot of technical skill required,” says Kevin Alschuler, Ph.D., psychology director and director of rehabilitation research at the UW Medicine Multiple Sclerosis Center in Seattle. “You have to know all the tests, you have to know all the ins and outs, and you have to know how to interpret them.”
Who Should See a Neuropsychologist for MS?
It’s typical for people with multiple sclerosis to see a neurologist. These specialists focus on managing the medical side of your care, from diagnosis to treatment recommendations. A neurologist often acts as the head of your MS care team and can make referrals to other specialists as needed to help you best manage your condition.
Your neurologist may refer you to a neuropsychologist for evaluation if you’re experiencing cognitive symptoms of MS. It’s important that you discuss any cognitive issues you’ve experienced with your neurologist, including concerns about how you’re functioning at work or home.
“The concerns that bring MS patients to a neuropsychologist tend to be with how a patient is thinking on a day-to-day basis, around things like their speed of thinking, or their ability to multitask, their memory, and so forth,” Alschuler says.
Neuropsychological Testing for MS
In a sense, everyone with MS should undergo cognitive testing. Initially, your neurologist may conduct a short screening test that they repeat with you at follow-up appointments. The neurologist may refer you to a neuropsychologist if there are concerns raised by the screen (or if there is a decline in your screening score over time).
“If there are any challenges with work, or if people in your family are noticing changes in your cognition, or if there is a change on that screening, you should be seen by a neuropsychologist,” adds Beier.
Both testing and keeping your doctor updated on any changes in your thinking are important, as cognitive changes in MS typically happen slowly over time, says Alschuler.
What to Expect During a Visit with a Neuropsychologist
Depending on where you go, an evaluation by a neuropsychologist may take a few hours or be a full day and will include a version of the following steps.
Step 1: Intake
“What the neuropsychologist does is they'll sit the patient down first for an interview to learn more about the patient and about the cognitive concerns that they have,” Alschuler says.
The neuropsychologist may ask questions about your history, Beier adds, including:
- Your education
- Any learning disabilities you may have
- Any other medical conditions you’ve been diagnosed with
- Your family cognitive health history, particularly if there’s a history of MS, dementia, or other conditions that affect cognition
- Any psychological factors that could be affecting cognition
- Fatigue and other physical symptoms that coincide with the cognitive problems
“We're trying to get a really comprehensive view of what could be contributing to somebody's cognitive challenges,” explains Beier. “It may not just be MS—it may be a number of factors.”
Step 2: Testing
After the intake is done, “they'll have the patient complete a number of tests of cognitive functioning,” says Alschuler. These are standardized tests—they’re given the same way to anyone who takes them, so results can be compared—typically via pencil and paper, but sometimes on the computer.
The specific types of neuropsychological testing for MS that you receive will vary depending on why you’ve been brought in, but may include an evaluation of the following:
- Memory/learning abilities
- Cognitive efficiency
- Sensory and motor abilities
- Visuospatial abilities
“Most assessments of cognitive functioning focus on understanding to what extent the patient is able to use their thinking skills at the speed we would expect, juggle or manage information in the way we'd expect, and learn new information and remember that information,” Alschuler explains.
However, since there are other areas of cognition that MS can affect, the neuropsychological evaluation typically is quite comprehensive and covers other areas of cognition that may or may not be affected by MS (such as visuospatial functioning and perception).
Step 3: Results and Next Steps
Once the evaluation is complete, the neuropsychologist will review and score the test results and explain what they mean.
“Because we've given [these tests] to as many people as we have, we're able to understand where the average patient would be expected to perform, depending on things like their age, sex, and education level,” Alschuler says.
Along with the scoring, the neuropsychologist will weigh the information that was gathered during the intake to determine the person’s cognitive strengths and weaknesses and get a better understanding for how their brain is functioning.
“Some providers will write up the report and talk over all the results in a follow-up appointment,” Beier adds.
Depending on the results, there are a variety of things that may happen next:
- Your neuropsychologist could refer you to a specialist who does cognitive rehabilitation, which provides strategies to help improve or work around areas of weakness.
- The neuropsychologist is likely to pass along the results to the rest of your treatment team so they can help you decide if any changes to your treatment (medications or other types of treatment) are needed.
- You may be able to use the results to help you obtain accommodations at work or school (as per the Americans with Disabilities Act) or just make more informal adjustments at home or school or work to accommodate for cognitive changes.
- The information from the report can be used to determine whether there are factors outside of true cognitive impairment that might be causing what seems like cognitive decline (such as psychiatric distress, fatigue, and distractibility associated with other physical symptoms).
How to Find a Neuropsychologist
“Everyone with MS should at least know of a neuropsychologist that they can reach out to,” explains Beier, “then when you're experiencing challenges, you can see them earlier, faster, and get intervention.”
Unfortunately, these specialists can be hard to come by. There are only about 1,400 clinical neuropsychologists in the United States.
Most neuropsychologists are a part of specialized MS clinics. If you’re not getting care through an MS clinic or receiving a referral from your neurologist, it can be challenging to find a neuropsychologist. However, many of them will see patients who aren’t already part of that clinic if they have a referral.
“If somebody lives in an area where neuropsychology is really hard to get into, or there just isn't one, you can also see either a speech pathologist or an occupational therapist,” adds Beier. “They don't have as extensive training, but they can do cognitive assessment, and they can help intervene with cognitive challenges.” You may also look for a neuropsychologist who does neuropsychological evaluations virtually.
Don’t Give Up Hope
Experiencing cognitive changes can be concerning, but seeking care from a neuropsychologist can help you stay on top of it.
“There is something that can be done for cognitive challenges—and the earlier they're addressed, the better,” Beier says. However, even if cognitive changes are already an issue for you, a neuropsychological evaluation for MS can help you address them and make treatment and environmental changes that can have a significant impact on your quality of life.
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