Cognitive impairments in patients with primary progressive multiple sclerosis: challenges and a clinical case

This article is dedicated to the study of cognitive impairments in patients with primary progressive multiple sclerosis (PPMS), a form of multiple sclerosis characterized by a progressive course from onset. Cognitive dysfunction is observed in 50—75 % of patients with PPMS, a rate significantly higher than in other types of MS, and it has profound clinical significance, affecting quality of life, social functioning, and professional activity. The study analyzes key cognitive domains affected in PPMS, including information processing speed, short-term and visual memory, executive functions, visuospatial abilities, and verbal fluency. Notably, impaired information processing speed, assessed by the Symbol Digit Modalities Test (SDMT), is the most sensitive marker of cognitive dysfunction in MS. Visual memory is affected more frequently (54—56 %) than verbal memory (29—34 %), while executive functions, such as planning and decision-making, are impaired in 15—28 % of cases. A clinical case of a 47-year-old male patient diagnosed with PPMS at age 38 is presented to illustrate these impairments. The patient exhibited progressive neurological and cognitive deficits, including short-term memory decline, word-finding difficulties, slowed thinking, and impaired planning. Neuropsychological assessments (SDMT, BVMT-R, HVLT-R, Addenbrooke’s Cognitive Examination) confirmed significant cognitive dysfunction, particularly in information processing speed, visual memory, and verbal fluency. Electrophysiological testing of event-related potentials (P300) revealed a delayed peak and reduced amplitude, indicating severe cognitive impairment. The article highlights the link between PPMS progression and cognitive deficit severity, driven by predominant neurodegenerative processes. It emphasizes the need for regular cognitive assessments using standardized neuropsychological tests and electrophysiological methods to enable early detection and comprehensive management, including cognitive rehabilitation, pharmacological therapy, and psychosocial support. The findings underscore the importance of individualized approaches to improve diagnostic accuracy, optimize therapeutic strategies, and enhance patients’ quality of life. These results can inform clinical guidelines for monitoring and managing cognitive impairments in PPMS and guide future research into its neurodegenerative aspects.