Multiple Sclerosis: A Neuropsychological Perspective

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Transcript Multiple Sclerosis: A Neuropsychological Perspective

Multiple Sclerosis:
A Neuropsychological
Perspective
National Multiple Sclerosis Society:
Eastern North Carolina Chapter
Antonio E. Puente, Ph.D.
University of North Carolina Wilmington
11.18.10
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Outline
• Traditional Perspectives of Cognitive &
Emotional Changes in MS
• Cognitive Changes
• Emotional Changes
• System Changes
• Summary & An Alternative Perspective
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Defining MS:
The National Multiple Sclerosis Society:
• MS is a chronic, often disabling disease that attacks
the central nervous system.
• Symptoms vary from mild, (numbness in the limbs)
to severe (paralysis, loss of vision).
• The progress, severity, and specific symptoms are
unpredictable and vary from one person to another.
• New treatments and advances in research are giving
new hope to people affected by the disease.
SOURCE: nationalmssociety.org
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Neuropsychology & MS:
Sampling the Traditional Sources
• Medline
– Neuropsychology is not listed as a search term
– If searched, 0 citations
• Multiple Sclerosis Foundation
– Neuropsychology cannot be found using search
• National MS Society: Research News
– Website
• 75 citations, 0 involving neuropsychology
• Searching for neuropsychology, 0 references
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MS Symptoms
WebMD
Common and Uncommon Symptoms of MS
• The most common early symptoms of MS include:
• Tingling
• Numbness
• Loss of balance
• Weakness in one or more limbs
• Blurred or double vision
Less common symptoms of MS may include:
• Slurred speech
• Sudden onset of paralysis
• Lack of coordination
• Cognitive difficulties
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MS Symptoms
Mayo Clinic
• Numbness or weakness in one or more limbs, which typically occurs
on one side of your body at a time or the bottom half of your body
• Partial or complete loss of vision, usually in one eye at a time, often
with pain during eye movement (optic neuritis)
• Double vision or blurring of vision
• Tingling or pain in parts of your body
• Electric-shock sensations that occur with certain head movements
• Tremor, lack of coordination or unsteady gait
• Fatigue
• Dizziness
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MS Symptoms:
Looking for Cognitive Changes
MS Society
5-10% may experience:
• Memory (acquiring, retaining, and retrieving new information)
• Attention and concentration (particularly divided attention)
• Information processing (dealing with information gathered by the five senses)
• Executive functions (planning and prioritizing)
• Visuospatial functions (visual perception and constructional abilities)
• Verbal fluency (word-finding)
Likely to remain intact:
• General intellect
• Long-term (remote) memory
• Conversational skill
• Reading comprehension
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MS Symptoms:
Looking for Emotional Changes
MS Society
• Major depressive episodes as well as less severe
depressive symptoms
• Grieving for losses related to the disease
• Stress and reactions to stressful situations
• Generalized distress and anxiety
• Emotional lability or mood swings
• Pseudobulbar Affect - uncontrollable laughing and/or
crying
• Inappropriate behavior such as sexual aggressiveness
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Neuropsychological Evaluation
• Components
– Record Review
– Interviews (including collateral)
– Testing
• Time (5-10 hours)
• Costs (typical medical co-pay)
• Outcomes
– Understanding of deficits and abilities
– Treatment recommendations
– Possible trajectory
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Measuring Cognitive Changes
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Orientation
Attention
Fluency
Visuo-Motor
Communication
Reasoning/Problem Solving
Memory
Intellectual
Effort
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Typical Neuropsychological
Findings
• Findings Affected by Length & Type of MS
• Probable Mediating Factors
– Cognitive Loading
– Fatigue
• Major Reliable Changes;
– Attention
– Processing Speed
– Verbal Memory
– Problem Solving (Executive Dysfunction)
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– “Automaticity”
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Cognitive Deficits and
Everyday Functional Activities
• Using neuropsychological testing, Kalmar, et al. (2008)
reported:
That individuals with and without cognitive
impairment differ in functional status, and the
aspects of cognition are predictive of the
functional status of the individuals with MS.
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Measuring Emotional Changes in MS
• Measures
– MMPI
– Beck
– History (collateral information)
• Major Reliable Symptoms
– Depression (15-50%)
– Mania/Disregulation/Inappropriate
Behavior/Disinhibition
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Co-Morbidity of Depression &
Cognitive Alterations
– Prevalence
• Estimates from 0 to 96%. Most often report by
individuals with Mild Cognitive Impairment.
– Significance
• Prodromal
– Depression could represent early dementia.
• Risk Factor
– Persons experiencing depression have approximately double
the risk of developing dementia as those without a prior
history of depression.
– Depression could exacerbate their dementia.
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System Alterations in MS
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Family
Friends
Vocational
Financial
Legal
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Treating MS
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Interdisciplinary Approach
Support Groups
Traditional Psychological Approaches
Neuropsychological Approaches
Lifestyle Modifications
Caregiver Focus & Assistance
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Summary & An
Alternative Perspective
• Traditional Perspectives Minimize Cognitive &
Emotional Changes
• Significant Percentage Experience Both
• Cognitive Changes are Subtle & Difficult to
Measure and Understand
• Emotional Changes May Be Primary Problems
• How Do I Know Why?
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Contact Information
Antonio E. Puente, Ph.D.
University:
Department of Psychology
University of North Carolina Wilmington
Wilmington, NC 28403
910.962.3812
[email protected]
Practice:
1508 Military Cutoff Road, Suite #303
Wilmington, North Carolina 28403
910.509.9371
[email protected]
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