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MS Cognition – Processing Speed First — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS Cognition – Processing Speed FirstSCE Neurology

A 60-year-old man with known MS develops progressive cognitive impairment. Formal testing shows deficits in processing speed (SDMT z-score −3.0), executive function, and working memory. He asks what specific cognitive domain is most commonly affected first in MS. What is the answer?

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Correct answer: D — Processing speed — measured by the Symbol Digit Modalities Test (SDMT) — is typically the first and most commonly affected cognitive domain in MS

Processing speed is the most commonly and earliest affected cognitive domain in MS. The SDMT (Symbol Digit Modalities Test) is the recommended screening tool because it is brief (90 seconds), highly sensitive, reproducible, and correlates with everyday functioning. A ≥4-point decline in SDMT from baseline is considered clinically meaningful. NICE NG100 recommends annual cognitive screening for MS patients. A: Episodic memory is the hallmark of AD, not MS. C: Language is relatively preserved in MS. D: Visuospatial can be affected but processing speed is earliest. E: Orientation is preserved until very late.

Reference: NICE NG100 MS; Benedict et al. MS Cognition; SDMT Validation