B - 2 Life-Changing Treatment, Lifelong Challenges: a Case Study on the Neuropsychological Impact of Remission of Multiple Sclerosis Following Clinical-Trial Treatment

Abstract Objective The impact of neurodegenerative diseases on cognitive functioning is well documented; however less is known about the lasting impacts following remission of diseases with previously limited treatability. The present case uses neuropsychological assessment in furthering the understanding of the brain-behavior relationship in a case of multiple sclerosis (MS) in remission subsequent to clinical-trial treatment complicated by a history of medical comorbidities, childhood trauma, underlying psychiatric conditions, and preexisting learning disabilities. Method The patient is a 45-year-old right-handed male with nine years of education, diagnosed with MS (in remission) complicated by cerebrovascular disease, myocardial infarction, cerebral vascular accident, past substance-abuse, and multisource childhood trauma., He was referred for neuropsychological evaluation by his primary-care physician pursuant to learning, attention, and emotional concerns impacted by his medical history. Results Neuropsychological testing reflects global cognitive deficits evidenced by difficulties with intellectual functioning, motor abilities, complex sequencing, executive functioning, problem-solving, phonemic fluency, and variable attention, which affects learning and recall tasks. A self-report of psychological functioning revealed emotional difficulties associated with anxiety, depression, health concerns, hypersensitivity, emotional discord, a history of self-harm, cognitive inefficiency, and difficulty managing anger and past and present stressors. Findings were most consistent with cognitive decline associated with medical conditions, learning difficulties, and attention deficit disorder. Conclusions This neuropsychological case study provides an example of the long-term consequences of neurodegenerative diseases across multiple areas of neuropsychological functioning and quality of life, even when ground-breaking and innovative medical interventions result in remission. It further emphasizes the complex interactions between neurological disease and biopsychosocial factors.