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NEUROPSYCH & CLINICAL NEURO > Week 5: Multiple Sclerosis > Flashcards

Week 5: Multiple Sclerosis Flashcards

1
Q

What type of disease is MS?

A

An autoimmune disease

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2
Q

What does an autoimmune disease do?

A

Attacks healthy cells in the body

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3
Q

What are the two processes/features of MS?

A

Demyelination and astrogliosis with some axonal destruction

Inflammatory and neurodegenerative

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4
Q

What is astrogliosis?

A

Abnormal astrocyte levels due to the destruction of nearby neurons
- these support cells in the BBB, provide nutrients to cells etc

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5
Q

Does everyone experience MS the same?

A

No, very diverse experiences. How a person experiences MS depends on which part of the brain contains the affected neurons.

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6
Q

What is the role of an oligodendrocyte?

A

To produce myelin

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7
Q

What are the two types of white blood cells that help immune function?

A

B cells and T cells

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8
Q

What are B cells? and what do they do?

A

They are produced in bone marrow

- produce antibodies that ambush foreign antigens in the bloodstream

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9
Q

What are T cells? and what do they do?

A

They develop in the thymus gland (near the lungs)
- Directly attack foreign substances by attaching to them to send out cytokines. These cytokines direct other cells (B cells) to attack

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10
Q

What happens with T cells in the immune system of individuals with MS?

A

T cells start attacking healthy cells in the brain (neurons) and does so by attacking their myelin sheaths

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11
Q

MS lesions occur when….

How impactful are they on the individual

A

There is a lot of inflammation in the brain

  • May have an impact on everyday functioning or they may go unnoticed
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12
Q

MRI success at looking at MS lessions?

A

Sometimes they cannot detect small fine grain changes

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13
Q

Why might lessions not impact MS individuals in everyday life?

A

We can find ways to adapt even if our brain is lesioned - this is because of brain plasticity

  • However there may come a time where we can no longer compensate (or tap into other cognitive resources)
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14
Q

What are the main areas of the body affected by MS?

A

CNS: cog impairment, depression, unstable mood
Visual: optic neuritis, diplopia
Speech: dysarthria
Throat: dysphagia
Musculoskeletal: weakness, spasms, ataxia
Sensation: pain
Bowel: incontinence, diarrhea, constipation
Urinary: incontinence, frequency or retention

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15
Q

Why do so many individuals with MS live away from the equator?

A

Because they typically have temperature intolerance. They move to cooler climates to cope with this symptom

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16
Q

What is the typical age of MS onset?

A

Usually late 20s/early 30s

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17
Q

Are there any gender differences in MS?

A

2x as likely in females

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18
Q

Roughly how many people in Australia have MS?

A

About 24,000 people and rising

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19
Q

There is a common misdiagnosis with MS. What are people initially diagnosed with?

A

Depression

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20
Q

Which state in Australia has the highest MS prevalence?

A

Tasmania followed closely by Canberra

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21
Q

What are the different types of MS?

A 
First demyelinating event 
Progressive-relapsing 
Secondary progressive 
Primary progressive 
Relapsing-remitting 
Benign
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22
Q

What is a first demyelinating event?

A

The first diagnosis before formal diagnosis

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23
Q

What is the progressive-relapsing type of MS?

A

Steady decline since onset with superimposed attacks

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24
Q

What is the secondary progressive type of MS?

A

Initial relapsing-remitting MS that begins to have declines without periods of remission.

Typically more women

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25
Q

What is the primary progressive type of MS?

A

Steady increase in disability without attacks

Very unique - only 5%

Typically more men

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26
Q

What is the relapsing-remitting type of MS?

A

Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission (continual relapse and remission)

This is usually the first diagnosis a person will receive

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27
Q

What does corticosteroid medication do?

A

Gives the neurons a chance to recover by reducing inflammation

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28
Q

What is benign MS?

A

Someone is diagnosed but then they never have another attack

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29
Q

If someone presents with more than 2 clinical attacks and evidence of more than 2 lesions, do you need any more information to diagnose them with MS?

A

No

30
Q

What is a clinical attack?

A

A flare-up in the brain

31
Q

If someone has had more than 2 attacks and evidence of one lesion, what else do they need to be diagnosed with MS?

A

An additional attack implicating another CNS site or an MRI

32
Q

If someone has had one clinical attack and has evidence of more than 2 lessions?

A

Need an additional attack or CSF testing to be diagnosed with MS

33
Q

What is CSF testing looking for with MS?

A

Looking for specific oligoclonal bands

34
Q

If someone has had only one attack and only one lesion in the brain, what else do we need to be able to diagnose them with MS?

A

Need an additional attack OR one that implicates a different CNS site OR CSF testing

35
Q

What is the EDSS? and what are the benefits of using it? what are its limitations?

A

Expanded Disability Severity Scales

Helps a neurologist keep track of the progression of MS symptoms overtime

It is not always appropriate however, as it focuses more on physical rather than cognitive

36
Q

Is MS genetic?

A

It is likely that you can be genetically predisposed to MS

- but environmental agent that triggers immune-mediated response

37
Q

MS is likely due to an interaction between several factors. What are they?

A
  • Immunological
  • Environmental - geography, vitamin d (white collar disease)
  • Personal - gender, age
  • Infectious factors - epstein-barr (glandularfever involved in modulating the onset of MS, triggers immune response and once it is on it is hard to switch off)
  • Smoking
  • Genetics - ethnicity (vikings disease), having a sibling or a 1st degree relative
38
Q

How many people with MS experience cognitive impairments?

A

58%

39
Q

What is considered the invisible symptom of MS?

A

Cognitive impairments associated with the disease

40
Q

Cognitive impairments in MS are….

A

Heterogenous - no uniform pattern as can occur in different areas of the brain

41
Q

Which cognitive areas are most affected in MS?

A 
Processing speed
Complex attention: divided & sustained attention
New learning and memory 
Prospective memory 
Working memory 
Executive functions 
Social cognition
42
Q

Which cognitive areas are least affected in MS?

A 
General knowledge 
Intelligence 
Basic attention 
Language (other than word finding) 
Recognition memory 
Implicit memory
43
Q

Why is processing speed declines a hallmark of MS?

A

Occurs because of myelin loss

  • slowed nerve conduction
  • signals find it harder to get through
44
Q

What do processing speed challenges relate to?

A

Working memory challenges

45
Q

What is the most reported symptom of MS? explain

A

Long term memory problems
But these are because of learning difficulties (encoding) rather than retrieval - slow processing - can’t keep up with what you’re experiencing

46
Q

Visuospatial abilities in someone with MS?

A

May have visual disturbances due to optic nerve
- the optic nerve has a lot of myelin on it

Can result in difficulties with organizing visual information, seeing the relationship between objects and proprioception

47
Q

How many of those with MS will have issues with visuospatial abilities?

A

1/4

48
Q

…………. is less common than memory and processing speed but is still seen in MS

A

executive ability declines

49
Q

What Executive functions are impaired?

A 
Organisation 
Sequencing and planning 
Problem solving 
Sticky thinking - can't shift from one task to another 
Can't maintain focus with distractors

All because of slowed processing speed

50
Q

Grey matter atrophy is related to….

A

the extent of cognitive deficits

51
Q

Screening for cognitive decline early in the disease course plays a crucial role in what

A

clinical decision making, good for them to be involved while they still can be

52
Q

When those with MS have cognitive impairments it is predictive of what?

A

Disability progression and cortical thinning

53
Q

What are some of the social cognitions that may be impaired through MS?

A

Pseudobular affect: uncontrollable laughing and crying at inappropriate times

Emotion recognition: Impaired on fear and anger - typically negative emotions are difficult

Theory of mind: ability to see anothers perspective

Emotional liability: like pseudobular affect

Inappropriate behaviour

54
Q

How many of those with MS have severe cognitive impairment?

A

10%

55
Q

How is MS dementia different to normal dementia?

A

Basic language is intact
Orientation to place/person rarely affected
MS memory is more due to retrieval or acquisition in AD it is due to storage retention

56
Q

What is plasma exchange?

A

The liquid portion of the persons blood is removed and separated from cells - then mixed with a protein and injected back in

57
Q

What are immunosuppressants?

A

They suppress the immune system

58
Q

What are immunomodulators?

A

They change the action of the immune system

59
Q

How do maintenance therapies of MS work?

A

They are continuously administered and are only active in suppressing relapse when theyre being taken

  • immunosupressants and immunomodulators
60
Q

What are immune constitution therapies?

A

Treatment is administered for short periods of time but effectiveness lasts

  • deplete immune system allowing it to repair itself
  • closest thing to a cure
61
Q

Stem cell treatments for MS?

A

It is not well understood how effective it is
- works for some people but it is very expensive and intensive

There is also a death rate involved

62
Q

What is the process of stem cell treatment?

A

Cells moved from bone marrow to blood stream using chemo

Collect blood and separate stem cells

Cells are frozen

Chemo used to fully wipe bone marrow and immune system

Cells returned to body via drip

Body then recovers over a period of 3-6 months

63
Q

There are no treatments for those with progressive MS - they need to rely on other things to manage their symptoms such as….

A

Physical therapy

Muscle relaxants

Medications to reduce depression, fatigue, pain, bladder and bowel problems

64
Q

How to improve memory difficulties in MS?

A 
use memory techniques: 
Repetition and rehearsal 
Increased exposure 
Write information down 
Visualise information 
Space learning overtime
65
Q

How to improve processing speed in MS?

A

Take your time to interpret and learn

Have information repeated to you

66
Q

How to manage fatigue?

A

Take regular breaks
Do important tasks when you are most alert
CBT - change perceptions of management

67
Q

Can improved sleep quality improve cognition?

A

May improve own perspective of function instead of actual function

68
Q

Can exercise improve cognition?

A

Improves verbal memory

Lowers inhibition errors

69
Q

What are MS relapses typically associated with?

A

New lesions forming in the brain or spinal cord

70
Q

Pseudorelapses?

A

Body reacting to things like infections, exercise or heat that flare up symptoms - will go away when the trigger is removed

71
Q

Treatments for MS relapse should be given…..

A

as soon as possible in order to be effective

72
Q

Concept of self in MS?

A

Changes in how they describe themselves - change multiple time as the disease progresses

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