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Changes in Cognitive Processing Speed, Mood, and Fatigue in an Observational Study of Persons With Multiple Sclerosis Treated With Dalfampridine-ER

Triche, Elizabeth W. PhD; Ruiz, Jennifer A. DPT; Olson, Kayla M. MA; Lo, Albert C. MD, PhD

doi: 10.1097/WNF.0000000000000130
Original Articles

Objective Multiple sclerosis (MS) is a degenerative neurological condition that results in impairments in multiple domains including cognition, fatigue, and mood. Dalfampridine–extended release (D-ER) has been approved to improve walking in persons with MS. It is plausible that D-ER could improve cognition, fatigue, and mood through the same mechanisms. We aim to examine effects of D-ER on cognition, depression, mood, and fatigue and to describe how these associations differ among those with and without D-ER related improvements in walking speed.

Methods Patients with MS at the Mandell Center who were newly prescribed D-ER as part of their standard MS care were invited to participate in this observational pre-post study. Thirty-nine participants with MS were observed for 14 weeks; 31 remained on D-ER for 14 weeks or longer. Of these, 28 were then subdivided based on walk responder status. Cognition was assessed using the SDMT; depression was measured with the CESD. Self-reported cognition, mood, and fatigue were also measured using subscales of the Performance Scales (PS).

Results Among those on drug through 14 weeks, there was significant improvement in the SDMT (P < 0.001) and the PS Fatigue score (P = 0.04). Among those who discontinued drug before 14 weeks, PS Cognition and PS Mood scores significantly improved (P = 0.02). Timed walk responders had significant improvements in SDMT (P < 0.001) and PS Fatigue (P = 0.046) from baseline to week 14. Among timed walk nonresponders, none of the measures significantly changed.

Conclusions Dalfampridine–extended release may improve cognition and fatigue in persons with MS, especially among timed walk responders.

Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Hartford, CT.

Address correspondence and reprint requests to Elizabeth W. Triche, PhD, Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, A Saint Francis Care Provider, 490 Blue Hills Avenue, Hartford, CT 06112; E-mail:

Conflicts of Interest and Source of Funding: This investigator-initiated study was partially supported through an investigator-initiated grant (11-385) from Acorda Therapeutics, Inc., and by Mount Sinai Rehabilitation Hospital, Hartford, CT. Acorda Therapeutics, Inc., did not take part in designing or analyzing results of this study, nor did they provide medication for participants. A.C.L. has served on advisory boards for Acorda Therapeutics, Inc. No other authors have a disclosure or conflict of interest to report.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.