![]() Given the known pathophysiological changes that are frequently evident on Visual Evoked Potential (VEP) and Auditory Evoked Potential (AEP) investigations, it is likely that discrete changes to WM processing occur. Indeed, WM is thought to rely upon discrete subcomponents activated depending upon the type of information (auditory, visual) and requirement for maintenance and integration. However, despite this general understanding of WM impairment in MS, there is little understanding how WM impairments differentially manifest within individual pwMS (WM phenotypes), particularly early within the disease. This in turn impacts higher cognitive processes associated with goal-directed behaviour. Changes to working memory (WM) are common, affecting the proficiency with which pwMS maintain and manipulate different types of information in an “active” and accessible format. Cognitive impairment is reported in up to 70% of people with MS (pwMS) irrespective of disease subtype. Multiple sclerosis (MS) is a chronic disease of the central nervous system, characterised by an interplay between neurodegenerative and inflammatory processes. Although this may be unsurprising, given that the SDMT is a measure of cognitive processing speed in MS, this does highlight the limitation of the SDMT as a general screening tool for cognitive impairment in early MS. The SDMT did not achieve diagnostic accuracy greater than chance. The test of visual–spatial WM provided the best diagnostic accuracy for detecting WM impairment and progression. The most common WM phenotypes were (1) visual–spatial sketchpad + episodic buffer + phonological loop + central executive, (2) visual–spatial sketchpad + central executive. The most subcomponents impaired were visual,–spatial and auditory WM. Some 61.9% of RRMS patients were impaired on at least one WM subcomponent. Factors affecting WM (age/gender/intelligence/mood) and MS factors (disease duration/disability) were also evaluated. RRMS patients were followed-up for two years. ![]() A total of 88 participants (63 early relapsing–remitting MS: RRMS, 25 healthy controls) completed five WM tests (visual–spatial, auditory, episodic, executive) as well as the symbol digit modalities test as a measure of processing speed. We aimed to determine the most frequent WM phenotypes in early MS, how they progress and which WM test(s) provide the best measure of WM impairment. As such, unique WM impairment phenotypes occur. However, WM is comprised of different activated subcomponents depending upon the type of information (auditory, visual) and integration requirements. Predominantly, WM impairments are considered in a binary manner, with patients considered either impaired or not based on a single test. Working memory (WM) impairments are common and debilitating symptoms of multiple sclerosis (MS), often emerging early in the disease.
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