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Case Reports and Review of the Literature

Gary M. Franklin, MD, MPH; Lorene M. Nelson, MS; Christopher M. Filley, MD; Robert K. Heaton, PhD

Arch Neurol. 1989;46(2):162-167.

Abstract
• Neuropsychological and neuroradiologic evidence of cerebral lesions is described for 12 patients with multiple sclerosis in whom cognitive disability was far greater than any other neurologic disability. Cognitive dysfunction resulted in significant functional impairment at work or home in three fourths (9 of 12) of the patients described here, despite mild physical disability (mean Kurtzke Expanded Disability Status Scale score, 3.2). A unique feature of the neurologic examination in these patients was the presence of prominent frontal release signs (gait apraxia and placing response) in the lower extremities. Two new scales, a Cognitive Function Scale and a Frontal Release Scale, were adapted for the investigation of these patients. The extensive literature relating to cognitive dysfunction in multiple sclerosis is reviewed and discussed with regard to its clinical relevance.

Author Affiliations
From the Rocky Mountain Multiple Sclerosis Center (Dr Franklin and Ms Nelson) and the Departments of Neurology (Drs Franklin and Filley), Preventive Medicine and Biometrics (Dr Franklin), and Psychiatry (Drs Filley and Heaton), University of Colorado School of Medicine, Denver. Dr Franklin is now at the Department of Environmental Health, University of Washington School of Public Health and Community Medicine, Seattle. Dr Heaton is now at the Department of Psychiatry, University of California, San Diego.

Footnotes
Accepted for publication Oct 10, 1988.

Reprint requests to the Department of Environmental Health, SC-34, University of Washington School of Public Health and Community Medicine, Seattle, WA 98195 (Dr Franklin).

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