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Abstract Details

Cognitive Concerns in Women With MS at Menopause: Patient-identified Care Gaps
Multiple Sclerosis
P11 - Poster Session 11 (11:45 AM-12:45 PM)
18-007
To qualitatively explore cognitive symptoms experienced by women with MS during perimenopause and identify clinical care gaps.
Cognitive concerns are common during perimenopause/early postmenopause in the general population, and in women with multiple sclerosis (MS). These concerns relate to other menopausal symptoms (hot flashes, poor sleep), but clinical guidance in addressing them is limited.
33 peri- and postmenopausal cis-women with MS enrolled in a myelin repair trial (ReWRAP; NCT04002934) participated in detailed interviews focused on cognitive changes. Thematic analysis was used to identify clinical care gaps.
Mean participant age was 53, mean MS duration was 11 years, median EDSS was 2.5; 30.3% had SDMT < 50. Overall, 87.9% endorsed cognitive changes during menopause, particularly in memory, word-finding, organization and cognitive fatigue. Three key care gaps were identified.
(1) Clarify symptom attribution uncertainty; 13/33 (40%) participants struggled to distinguish whether cognitive changes stemmed from MS, menopause, or both. This ambiguity created clinical uncertainty regarding which team should guide management and added burden navigating health systems. A collaborative, comprehensive care model was seen as essential.
(2) Contextualize the magnitude of lived cognitive changes. Since participants worried often unnecessarily that these changes represented MS progression and/or dementia, clinicians might contextualize these within the general perimenopausal population (acknowledging the insensitivity of cognitive batteries to MS- and menopause-related changes), starting before menopause, to alleviate additional worry. 
(3) Cognitive energy/effort management: 73% described a sensation of cognitive “overwhelm” and emotional distress in response to perceived cognitive challenges. They emphasized the potential impact of specific neuropsychological strategies to optimize cognitive energy and effort, guide work accommodations, and navigate interpersonal dynamics.
The care gaps identified by participants (integrated care; anticipatory, contextual education; targeted neuropsychological support) can be readily implemented in many MS care centers and could substantially alleviate the cognitive burden experienced by women with MS during perimenopause.
Authors/Disclosures
Min Ji Kim, BA
PRESENTER 		Ms. Kim has nothing to disclose.
Alyssa Nylander, MD, PhD (UCSF) Dr. Nylander has nothing to disclose.
Stephanie Hsu Stephanie Hsu has nothing to disclose.
Ayushi D. Balan (UCSF) Miss Balan has nothing to disclose.
Annika Anderson (UCLA David Geffen School of Medicine) Miss Anderson has nothing to disclose.
William Rowles Mr. Rowles has nothing to disclose.
Jennifer Reihm Ms. Reihm has nothing to disclose.
Riley Bove, MD, FAAN (University of California, San Francisco) Dr. Bove has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Bove has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen. Dr. Bove has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genzyme-Sanofi. Dr. Bove has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. Dr. Bove has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD-Serono. Dr. Bove has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cadenza. The institution of Dr. Bove has received research support from Biogen. The institution of Dr. Bove has received research support from Eli Lilly. The institution of Dr. Bove has received research support from Novartis. The institution of Dr. Bove has received research support from Roche Genentech.