Do you think cognitive impairment is a more important outcome in MS trials compared to physical disability (mobility, bladder, etc.)?
At present most clinical trials of disease-modifying therapies focus on the impact of therapy on physical disability and largely ignore the impact of MS on cognition. This survey is being done to see what is more important to MS’ers.
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Thank you.
I think that cognitive impairment is largely ignored in MS studies and research but I don't think it's helpful to try to promote the importance of one set of symptoms over another. If it were possible to choose only cognitive or physical symptoms, I don't know which I would choose and, as it is not possible, it is a futile exercise.
I agree with the above comment. It's impossible to choose between the two….
As a follow-up to the comments above: 1. The purpose of the poll is to simply get a feel for what is important and to generate discussion around the question asked.2. Interestingly, early on in MS, at the CIS stage, cognition may be the most sensitive readout of damage we have. Unfortunately it is not been incorporated into clinical trials at present. 3. Physical disability is the current gold standard, but only really occurs after substantial damage has occurred already.I believe a paradigm shift is needed to make trialists to start focusing on early MS and cognition.
Thank you for the information in your points 2 and 3. It is still impossible to say which type of impairment is more important. Even Stephen Hawking might be happy to give up some cognition if he could walk amd talk again
My vote can only be based on my own personal circumstances, and in my case my physical disabilities cause me more problems than my cognitive ones.However, I can see how valuable the hidden, less dramatic symptoms are, in early stage MS’ers for the research into unlocking the MS puzzle.
Re: "I don't know which I would choose and, as it is not possible, it is a futile exercise."I am not sure. The good thing is that it is making people think about the issue and debate it.
It's not like it's an either or situation. Both are grim. Both substantially impact on the quality of life. I did some work at an OAP home and there was a woman of 90 doubled up in bed with arthritis, but very with it. Another woman in her 70s came bounding down the ward, but had dementia. The ward sister asked which one I would choose to be when I got old!Unfortunately, academics use terms like debate, but this isn't an academic issue. I'd like treatments which deal with both – am I asking too much?
Re: "I'd like treatments which deal with both – am I asking too much?" No not at all; it just depends on what stage of the disease we study. Early on in the disease cognitive endpoints are more meaningful as most MS'ers don't develop disability at this stage. In addition, the EDSS which is used as the primary outcome in most trials does not assess the impact of MS on cognition. This is why we are having this debate.