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Neuropsychology > Lecure 12: Motor 2: MS: Chapter 23 > Flashcards

Lecure 12: Motor 2: MS: Chapter 23 Flashcards

1
Q

What is MS (Multiple sclerosis)?

A

Chronic disorder of the central nervous system in which there is multifocal inflammation and demyelination.

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2
Q

What is the typical age of onset of MS?

A

20-40 years

It’s the most common neurlogical disorder in young adults

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3
Q

What is the prevalence of MS in western vs. non-western countries? Is there a gender difference?

A

Western: 100-200 per 100.000
Non-western: 2-10 per 100.000

Gender: 2x more common in women

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4
Q

What is the heritability of MS?

A

20-30% (twin studies)

10-15 times higher risk if a parent has MS

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5
Q

What are 3 factors contributing to the complex etiology of MS?

A
  1. Genetics
  2. Inflammation
  3. Lifestyle
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6
Q

What are 3 lifestyle factors that increase risk of MS?

A
  1. Vitamin D deficiency
  2. Smoking
  3. Obesity in childhood and adolescence
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7
Q

Explain the risk factor of inflammation for developing MS

A

Increased risks with a serious viral infection, such as epstein-barr virus

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8
Q

What are 3 aspects of neuropathology in MS?

A
  1. Demyelination
  2. Inflammation
  3. Neurodegeneration
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9
Q

What is demyelination in MS?

A

Loss of myelin sheath around neurons

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10
Q

Why does inflammation happen in MS?

A

Demyelination triggers autoimmune response

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11
Q

What is neurodegeneration in MS?

A

Loss of grey and white matter

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12
Q

With which symptom does MS typically start?

A

Impairment of sensory perception in the limbs or temporary problems with vision

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13
Q

What is the expanded disability status scale (EDSS)?

A

Scale that maps the severity and extent of an individual’s clinical symptoms. It measures functional decrease in 8 different functional systems of the nervous system

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14
Q

What are the 4 subtypes of MS describing the disease course?

A
  1. Relapse remitting (85%)
  2. Secondary progressive (30%)
  3. Primary progressive (12%)
  4. Progressive relapsing (less common)
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15
Q

What is the relapse-remitting disease course?

A

Loss of function, followed by recovery (flat line with bumps)

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16
Q

What is the secondary progressive disease course?

A

Relapse remitting course, followed by period without relapse, but gradual decline (flat line with bumps, after that slope with bumps)

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17
Q

What is the primary progressive disease course?

A

No relapses, but gradual decline (straight line/slope)

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18
Q

What is the progressive relapsing disease course?

A

Relapse and gradual decline (straight line/slope with bump(s))

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19
Q

What are 4 aspects of the clinical presentation of MS?

A
  1. Visual impairment (double vision, involuntary eye movements)
  2. Sensory impairment (tingling)
  3. Motor impairment, bladder control issues, sexual dysfunction
  4. (Mild) cognitive impairment, fatigue
20
Q

What is the main subtype of MS?

A

Relapse-remitting (85%)

21
Q

What is an exacerbation? How often does it occur in relapse-remitting patients?

A

A period of relapse in MS, where an inflammatory reaction in the myelin sheath increases symptoms

1 or 2 times per year

22
Q

What is benign MS?

A

Disease progressing with few complaints, sometimes for decades

23
Q

How does MS affect life expectancy? How do these people often die?

A

Life expectancy is not severely affected by MS: there is a reduction of a few years

They often die from another disease. If someone dies from MS, it’s from a severe respiratory infection or urinary tract infection

24
Q

When is a positive diagnosis of MS made? (3)

A
  1. At least 2 periods with clinical symptoms
  2. Symptoms can be accounted for by various white matter lesions
  3. Complaints must not be attributable to another cause
25
Q

What does it mean when a person has an attack with dissemination in space and time? How can you assess this (2)?

A

Space: evidence of lesions in at least 2 locations

Time: evidence of new lesions in follow-up assessments, worsening over time

Assessment by MRI or cerebrospinal fluid markers

26
Q

What are 3 types of drugs used in treatment of MS?

A
  1. Anti-inflammatory drugs: reduce relapses
  2. Drugs slowing down neurodegeneration
  3. Drugs for managing symptoms like fatigue, sleeping problems and sensorimotor complaints
27
Q

What is an important gender difference between men and women in MS?

A

Women are 2x more likely to get MS, but the course of disease is more severe in men

28
Q

What is a possible explanation of fatigue in MS?

A

Immunesystem response impacts your energy level

29
Q

What percentage of people with MS experience anxiety/depression?

A

20-30%

30
Q

How does MS influence quality of life? (3)

A
  1. Unable to work
  2. Progression impacts acutely and prospectively
  3. Carers are impacted to
31
Q

What are the 2 most common psychological symptoms in MS?

A

Fatigue and reduced quality of life

32
Q

What are the 2 most common cognitive dysfunctions in MS?

A

Slow information processing and executive dysfuntion

33
Q

When are cognitive impairments most pronounced?

A

Further on in the disease course

34
Q

What is the current view on the etiology of MS?

A

Autoimmune disease that is caused by exogenous trigger factors in people with a specific genetic predisposition

35
Q

What is the role of vitamin D in MS?

A

A deficiency is a risk factor for developing MS
It plays a role in the immunesystem

36
Q

What is striking about the cerebrospinal fluid (CSF) in MS?

A

The cerebrospinal fluid differs from healthy people. There are increased numbers of white blood cells

37
Q

What percentage of people with MS suffer from cognitive impairment?

A

43-70%

38
Q

What could be an explanation of decreased intelligence scores in MS?

A

Decline in speed of processing, motor/visual limitations

39
Q

Which characteristics are most prominent if a MS patient gets dementia?

A

Frontal-subcortical characteristics

40
Q

What is the most commonly used test for processing speed? Why is it so popular?

A

The multimodal PASAT test

Popular, because it’s not too specific and measures multiple domains (working memory, speed and attention)

41
Q

What is the most common memory problem in MS? What is often intact?

A

Problem: retrieving, working memory, more time needed to learn new info

Intact: recognition

42
Q

What is the relation between the extent of cognitive dysfunction and the severity of the neurological impairments?

A

There is only a moderate correlation

43
Q

What is a good predictor of cognitive functioning in MS? (3)

A
  1. Extent of cerebral cortical atrophy, not white matter lesions
  2. Width of third ventricle
  3. Atrophy of subcortical structures (thalamus
44
Q

How is the cognitive impairment in the different subtypes?

A

Relapseremitting: less severe cognitive impairment

Progressive courses: more cognitive impairment

45
Q

How are the cognitive impairments during an exacerbation period?

A

They go up, but go down if the exacerbation has ended

46
Q

What is the relationship between depression and cognitive functioning in MS?

A

Depression has a detrimental effect on cognitive functioning, especially on executive tasks

47
Q

What do people with MS experience as the most limiting symptom?

A

Fatigue

Neuropsychology (16 decks)

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