Week Five - Multiple Sclerosis Flashcards
What is MS?
An auto-immune disorder with both inflammatory and neurodegenerative pathologies
- affects the neurons and is heterogenous
What are the 2 major processes that affect MS?
demyelination - occurs due to inflammation
axonal disruption
What are the 2 white blood cells that help immune functioning?
B cells
T cells
Where do B cells develop and what do they do?
Develop in bone marrow and produce antibodies that ambush foreign antigens in the bloodstream.
Where do T cells develop and what do they do?
Develop in the thymus gland and direct attacks on foreign substances (eg bacteria, viruses)
What do T cells produce?
Substances called cytokines that direct responses and activities in other immune cells
What is MRI success at looking at MS lesions?
Cannot always detect small fine grain changes
When do MS lesions occur?
When there is a lot of inflammation in the brain
Main symptoms of MS
Central (unvisible) eg fatigue - most common, impairments Visual Speech (dysarthria), Throat (dysphagia) Musculoskeletal Sensation Bowel Urinary
Why do so many individuals with MS live away from the equator?
Because they typically have temperature intolerance - move to colder climates
Onset age of MS?
Late 20s, early 30s
Gender differences in MS?
x2 more females
Common misdiagnosis of MS?
Depression
What are the 4 different types of MS?
Progressive-relapsing
Secondary progressive
Primary progressive
Relapsing-remitting
What is PROGRESSIVE-RELAPSING MS associated with?
A steady decline since onset with superimposed attacks
What is SECONDARY PROGRESSIVE MS associated with?
Initial relapsing-remitting MS that suddenly begins to have decline without period of remission
What is PRIMARY PROGRESSIVE MS associated with?
Steady increase in disability without attacks
What is RELAPSING-REMITTING MS associated with?
Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission.
What do we need to diagnose MS?
At least 2 occurrences of flare ups in the brain (space) and evidence that there are 2 distinct lesions in the brain from MRI (time)
Why is the EDSS scale not always appropriate?
Too much focus on physical functioning and not enough of cognitive and invisible symptoms
What causes MS/risk factors?
Interaction of
- immunological and environmental factors (vitamin D deficiency - white collar workers)
- personal factors (age, gender)
- infectious factors (epstein-barr)
- smoking
- genetics (ethnic background - vikings disease, siblings/relative)
Cognitive impairments occur largerly independent of what?
Disease duration
Most people report what type of cognitive impairments?
Mild to moderate
Do cognitive impairments occur in a uniform pattern?
No, they are heterogenous across people
Cognitive areas most affected by MS?
processing speed complex attention learning and memory of new things prospective memory working memory EF social cognition
What is the hallmark feature of cognitive impairments in people with MS? why?
Processing speed because it is directly related to myelin loss and irreversible damage to neurons
What aspects of attention are most affected?
The most complex ones
- working memory
- divided attention
- sustained attention (directly related to fatigue
What is one of the most reported symptoms in MS?
Long-term memory - but more related to learning than retrieval
What aspects of memory are most affected?
long term
prospective
What are memory deficits in MS undermined by?
Slow processing speed, susceptibility to interferences, executive difficulties, and visual difficulties
Why do people with MS have visuospatial difficulties?
Visual disturbances due to optic nerve (optic neuritis)
Difficulties in visuospatial abilities can result in what? (3)
Difficulties:
Organising visual information
Seeing relationships between objects
Proprioception
What characteristics are related to having more cognitive difficulties?
disease course gender - males temperature cannabis users smoking
grey matter atrophy!
What are some social cognition effects of MS? (5)
Pseudobular affect: uncontrollable laughing/crying out of context
Emotion recognition
Theory of mind: ability to see another’s perspective
Emotional lability
Inappropriate behaviour
How is MS Dementia different to other dementia?
Basic language is intact
Complex attention is less impaired early in the disease course
Memory problems are due to retrieval and initial acquisition
Orientation to place/person rarely affected
What are some drugs used for MS relapses?
Corticosteroids
Plasma exchange
What are the three types of drugs that modify progression of MS?
- immunosuppressants
- immunomodulators
- immune constitution therapies
How do immunosuppressants and immunomodulators work?
By being continuously administered and only active in suppressing relapse when they are being taken
How do immune constitution therapies work?
By being administered short periods of time but effectiveness lasts as it allows immune system to repair itself (closest thing to a cure)
What is the process of stem cell treatment/therapy?
Cells moved from bone marrow to blood stream
machine collects and separates out stem cells
Then frozen
Chemo to fully wipe out bone marrow/immune system
new cells returned via a drip
recovery
Are there treatments for those with progressive MS?
No
They need to focus on:
physical therapy
muscle relaxants and medications to reduce cog an phys difficulties
Strategies to improve memory in MS?
Techniques to increase chances of encoding/restoring
- repetition/rehearsal
- increased exposure
- writing down
- self-learning
Strategies to improve processing speed in MS?
Take time to repeat and learn
Have information repeated
Strategies to improve EF in MS?
Plan ahead
Ask for help
Break things down
List alternatives
Can improved sleep quality help cognition in MS patients?
May only improve their own perception of cognitive function
Can high intensity training improve cognition in MS patients?
Can improve verbal memory and lowers inhibition errors
Concept of self in MS?
There are changes in how people describe themselves (over the disease progression)
