Clean intermittent self-catheterization in persons with multiple sclerosis: the influence of cognitive dysfunction

Background Bladder problems are very common in persons with multiple sclerosis (PwMS). Objective The aim of this study was to investigate the ability of PwMS to learn clean intermittent self-catheterization (CISC). Methods The physical disability of 23 PwMS was evaluated with the Expanded Disability Status Scale (EDSS), and cognitive status was evaluated with the Brief Repeatable Battery of Neuropsychological Tests (BRB-N). CISC was taught by the same continence advisor who was blinded to the cognitive test results. The ability to learn CISC was evaluated immediately after sessions and 3 months later. Twenty-three consecutive PwMS participated in the study. Results In all, 87% (20/23) of the PwMS successfully finished CISC training. The number of lessons needed to acquire CISC skills differed significantly depending on the EDSS (Spearman r = 0.682, P = 0.0003), but the total cognitive decline subscore did not influence the ability to learn CISC. Only 13% (3/23) of the PwMS failed to learn CISC. The ability to learn CISC depended on the number of lessons needed to acquire CISC (r = -0.499, P = 0.0313) and the EDSS score (r = -0.433, P = 0.0390) but not on the course of the disease (r = 0.125, P = 0.5696) or on cognitive decline (r = -0.311, P = 0.1480). After 3 months of follow-up, 30% (6/20) of the PwMS had ceased performing CISC. A follow-up indicated no statistically significant correlations among any of the subscores of the cognitive test battery, the EDSS score, the course of the disease, and the time required to learn CISC and effective bladder management. Conclusions Our study thus confirmed that most (87%) PwMS were able to learn CISC in spite of cognitive dysfunction and therefore to improve their quality of life. Multiple Sclerosis 2009; 15: 379-384. http://msj.sagepub.com