Although up to half of patients with Multiple Sclerosis (MS) in the U.S. have cognitive impairment and about one in three meet the criteria for clinically significant depression, a new study suggests that few are formally screened for these conditions. An analysis of 300 charts pulled from two MS clinics in the Southeastern U.S. revealed that just 52% of patients were screened for cognitive impairment and 63% were screened for depression and only about a quarter of patients diagnosed with these conditions were referred for higher-level care. Validated tools were only used in 2% and 4% of these cognitive impairment and depression screenings, respectively. Survey data from neurologists at 13 MS centers across the nation identified several barriers to the use of validated screening tools. While the neurologists who participated in the survey mentioned lack of integration into electronic medical records, lack of compensation/reimbursement from insurance companies, lack of qualified staff, and other reasons for failing to use validated screening tools, being short on time was a major theme to emerge. Disparities in screening were also noted, with younger patients having higher rates of depression, but being screened less frequently. Additionally, Whites were more likely than people of other racial/ethnic groups to receive cognitive screening, but Blacks were the most likely to be diagnosed with cognitive impairment. Use of formal screening tools in clinical practice may help better identify patients with these conditions and get them appropriate support and treatment.
The study, supported by a research grant from Genentech, was presented on February 2nd at the third annual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2018 in San Diego, CA under the title “Screening for Cognitive Impairment and Depression in MS Patients: Current Practices, Perceptions, and Barriers in Selected United States MS Clinics.”
Results indicate that screening, when it does happen, is often informal. Neurologists are familiar with the signs of cognitive decline and depression and may assume they don’t need to rely on validated measures to diagnose these conditions. Also, time is in short supply since their schedules tend to be packed with patient appointments. Spending more time than anticipated with a given patient might mean playing catch-up the rest of the day.
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