Abstract
Objectives The Royal Melbourne Hospital newly hosts a dedicated cognition clinic for patients with multiple sclerosis (MS) and other neuroimmunological disorders. An audit of the cognitive unit was conducted following the first eighteen months of service operation to describe the approach and practice of cognitive diagnosis and to characterize the first cohort of patients to receive care.
Methods Medical records of all patients referred to the unit were reviewed for patient diagnosis, basis of cognitive referral, psychometric profile, and management outcomes. Cognitive dysfunction was determined using the Brief International Cognitive Assessment for MS (BICAMS) with scores less than 1.5SD below the mean considered impaired.
Results The clinic serviced patients across cognitive, neurological, psychological and functional referral points. Of 127 patients seen, 104 had MS. 37%, 11% and 2% of MS patients were impaired on at least 1, 2 or 3 subtests of BICAMS, respectively. Recommendations for patient management frequently included referral for clinical psychology (38%), further neuropsychological management (13%) or psychiatric opinion (7%), as well as other interventional strategies for fatigue and pain.
Conclusion Consistent with the MS scientific literature, cognitive impairment was heterogenous in the cohort. The rate of diagnosed cognitive impairment, however, diverges from published prevalence estimates. This unique sample of patients referred to the Royal Melbourne Hospital Multiple Sclerosis Centre Cognitive Unit provides a new window to the MS patient, outside parameters set for recruited research samples. The high service demand from both patients and clinicians alike demonstrates the need for specialist MS and neuroimmunological cognitive opinion.
