Impairment of affect and cognition in patients with multiple sclerosis

Depression, fatigue and cognitive impairment are common symptoms of patients with multiple sclerosis (MS), which frequently occur early in the disease course and exert a strong impact on quality of life. While the pathogenesis of depression and fatigue is still unknown, cognitive impairment correlates well with cerebral atrophy. Clinical experience and a few studies demonstrate the effectiveness of antidepressants in MS patients with depression and of amantacline and modafinil in MS patients with fatigue. The immunomodulatory therapy with interferon-beta (IFN-beta) slows the progression of cerebral atrophy and cognitive impairment. In addition one study indicates, that ocetylcholinesterase inhibitors may be effective. According to their importance in everyday life depression, fatigue and cognitive deficits should be considered more adequately in research and therapeutic approaches.