Kognitive Störungen bei Multipler Sklerose – Erhebliche Auswirkungen auf Alltag und Lebensqualität

Kognitive Störungen bei Multipler Sklerose (MS) sind lange Zeit unterschätzt worden. Mittlerweile ist eine Prävalenz von 30–70 % gesichert. Weniger klar ist der Verlauf, wobei die Datenlage bislang zeigt, dass nur bei einem Teil der Betroffenen deutlich progrediente Störungen auftreten. Hauptbetroffen sind Informationsverarbeitungsgeschwindigkeit und Aufmerksamkeit. Morphologisches Korrelat scheint weniger die Läsionslast als die degenerative Komponente der Erkrankung zu sein, die aktuell am solidesten in der Gesamthirnatrophie abgebildet ist. Die Alltagsrelevanz für Berufstätigkeit und Lebensqualität ist erheblich. Sensitive Screeninginstrumente existieren, die Korrelation zu Alltagsfunktionen ist dabei wenig untersucht. Immunmodulatoren scheinen auch die Entwicklung kognitiver Störungen abzubremsen, wobei die Datenlage hier spärlich ist. Der Nutzen von Antidementiva ist nicht gut belegt. Einige Therapiestudien deuten einen Nutzen kognitiver Rehabilitation bei MS an; die vorhandenen Studien werden in dieser Übersicht vorgestellt. Wesentliche Fragen zur Wirksamkeit der Rehabilitation wie beispielsweise der Nutzen von Kompensationstechniken vs. Trainingstechniken und die Bedeutung für den Alltag sind ungeklärt. Informationen zu kognitiven Störungen werden, wenn patientengerecht aufgearbeitet, als hilfreich empfunden und können zur Enttabuisierung des Themas beitragen.

Cognitive symptoms in multiple sclerosis have long been not recognized. The prevalence is now estimated to range between 30–70 %. Few studies exist on the long–time evolution. It seems that only a smaller subgroup of patients develops substantial progressive decline. Major domains of affection are information processing and attention. The closest association to morphological parameters on MRI is with measures of brain atrophy. The relevance of cognitive disturbances for daily living and quality of life is high. Sensitive screening instruments nowadays exist but their correlation to daily activities has not been rigorously studied. Immune modulating agents seem to slow progressive decline but again the evidence is weak. Effects of cholinergic drugs or other drugs acting on cognitive processing have not been studied in larger series. There is some evidence on the effectiveness of neuropsychological rehabilitation but as reviewed in the paper data are not conclusive on the improvement of quality of life and daily functioning. Information on cognitive disturbances is considered helpful from the patient view depending on the framing of presentation.

Key words

Multiple sclerosis - cognition - rehabilitation - treatment

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