Cognitive Effects

Cognitive dysfunction is the most common neuro-behavioral syndrome that develops as a consequence of white matter disease. The deficits are generalized rather than focal and, as in the case of multiple sclerosis, severe enough to be classified as a dementia. The range of possible neuropsychological symptoms in these cases includes the following: sus tained, divided, and selective attention deficits; executive dysfunction; confusion; memory retrieval deficits; visuospatial impairment; personality change; depression; somnolence; lassitude; and fatigue. Occasionally, young patients are given DSM psychiatric diagnoses as the primary cause of the clinical presentation, and there are cases that initially present with psychiatric symptoms before cognitive impairment is identified. Affected patients with gliomatosis cerebri and multiple sclerosis, for example, experience apathy and fatigue before signs of cognitive deficits and functional decline. Apathy is typically associated with medial frontal lesions, and fatigue accompanies frontal lobe demyelina-tion. Early emotional symptoms are indicators of a more localized illness that precedes progression to a generalized disorder.

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