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Objective and Background: Cognitive test performance by individuals with multiple sclerosis (MS) may be biased because of MS-related speech problems. The purpose of this study was to compare articulation and pause durations between individuals with MS and controls on cognitive tests requiring an oral response., Method: As part of a neuropsychological assessment, 41 patients with MS and 23 controls completed oral forms of 2 timed cognitive tests that are commonly used in MS. Acoustic analysis software segmented oral test responses into "articulation" and "pause" time durations., Results: Overall cognitive test performance by the patients with MS was significantly associated with average pause duration, but not average articulation duration. Articulation time did not contribute to or confound the outcome of either test., Conclusions: Articulation time did not contribute to differences in test performance between patients with MS and controls; rather, the time spent in silence between responses (pause time) largely accounted for group differences. Future research could use the methods described here to study speech characteristics during cognitive tests that require oral responses for patients with known speech impairments and more progressive forms of MS.

Objective: Patients with multiple sclerosis (MS) commonly use a variety of medications to slow disease progression, alleviate symptoms, and treat comorbid conditions. Polypharmacy has been linked to adverse outcomes in other patient groups, but has not been studied extensively in MS. We investigated the impact of polypharmacy on fatigue, objective neuropsychological performance, and subjective cognitive impairment in a sample of patients with MS., Methods: MS patients (n=85) completed a medication inventory, self-report questionnaires, and a battery of neurocognitive tests. MS patients with polypharmacy were compared to MS patients without polypharmacy, using multivariate analysis of covariance (MANCOVA)., Results: After controlling for disease characteristics, MS patients with polypharmacy (n=28) exhibited prospective memory deficits and reported significantly more fatigue and subjective cognitive problems than MS patients without polypharmacy., Conclusion: Clinicians and patients should carefully weigh the costs and benefits of prescribing multiple medications, as these may contribute to iatrogenic fatigue and cognitive problems in MS. Moreover, researchers should account for polypharmacy when conducting studies examining fatigue and cognition in MS., (Copyright © 2014 Elsevier Inc. All rights reserved.)