Week Five - Multiple Sclerosis

Question 1

What is MS?

Answer 1

An auto-immune disorder with both inflammatory and neurodegenerative pathologies

• affects the neurons and is heterogenous

Question 2

What are the 2 major processes that affect MS?

Answer 2

demyelination - occurs due to inflammation

axonal disruption

Question 3

What are the 2 white blood cells that help immune functioning?

Answer 3

B cells

T cells

Question 4

Where do B cells develop and what do they do?

Answer 4

Develop in bone marrow and produce antibodies that ambush foreign antigens in the bloodstream.

Question 5

Where do T cells develop and what do they do?

Answer 5

Develop in the thymus gland and direct attacks on foreign substances (eg bacteria, viruses)

Question 6

What do T cells produce?

Answer 6

Substances called cytokines that direct responses and activities in other immune cells

Question 7

What is MRI success at looking at MS lesions?

Answer 7

Cannot always detect small fine grain changes

Question 8

When do MS lesions occur?

Answer 8

When there is a lot of inflammation in the brain

Question 9

Main symptoms of MS

Answer 9

Central (unvisible) eg fatigue - most common, impairments
Visual
Speech (dysarthria), Throat (dysphagia)
Musculoskeletal
Sensation
Bowel
Urinary

Question 10

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

Answer 10

Because they typically have temperature intolerance - move to colder climates

Question 11

Onset age of MS?

Answer 11

Late 20s, early 30s

Question 12

Gender differences in MS?

Answer 12

x2 more females

Question 13

Common misdiagnosis of MS?

Answer 13

Depression

Question 14

What are the 4 different types of MS?

Answer 14

Progressive-relapsing
Secondary progressive
Primary progressive
Relapsing-remitting

Question 15

What is PROGRESSIVE-RELAPSING MS associated with?

Answer 15

A steady decline since onset with superimposed attacks

Question 16

What is SECONDARY PROGRESSIVE MS associated with?

Answer 16

Initial relapsing-remitting MS that suddenly begins to have decline without period of remission

Question 17

What is PRIMARY PROGRESSIVE MS associated with?

Answer 17

Steady increase in disability without attacks

Question 18

What is RELAPSING-REMITTING MS associated with?

Answer 18

Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission.

Question 19

What do we need to diagnose MS?

Answer 19

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)

Question 20

Why is the EDSS scale not always appropriate?

Answer 20

Too much focus on physical functioning and not enough of cognitive and invisible symptoms

Question 21

What causes MS/risk factors?

Answer 21

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)

Question 22

Cognitive impairments occur largerly independent of what?

Answer 22

Disease duration

Question 23

Most people report what type of cognitive impairments?

Answer 23

Mild to moderate

Question 24

Do cognitive impairments occur in a uniform pattern?

Answer 24

No, they are heterogenous across people

Question 25

Cognitive areas most affected by MS?

Answer 25

``` processing speed complex attention learning and memory of new things prospective memory working memory EF social cognition ```

Question 26

What is the hallmark feature of cognitive impairments in people with MS? why?

Answer 26

Processing speed because it is directly related to myelin loss and irreversible damage to neurons

Question 27

What aspects of attention are most affected?

Answer 27

The most complex ones - working memory - divided attention - sustained attention (directly related to fatigue

Question 28

What is one of the most reported symptoms in MS?

Answer 28

Long-term memory - but more related to learning than retrieval

Question 29

What aspects of memory are most affected?

Answer 29

long term | prospective

Question 30

What are memory deficits in MS undermined by?

Answer 30

Slow processing speed, susceptibility to interferences, executive difficulties, and visual difficulties

Question 31

Why do people with MS have visuospatial difficulties?

Answer 31

Visual disturbances due to optic nerve (optic neuritis)

Question 32

Difficulties in visuospatial abilities can result in what? (3)

Answer 32

Difficulties: Organising visual information Seeing relationships between objects Proprioception

Question 33

What characteristics are related to having more cognitive difficulties?

Answer 33

``` disease course gender - males temperature cannabis users smoking ``` grey matter atrophy!

Question 34

What are some social cognition effects of MS? (5)

Answer 34

Pseudobular affect: uncontrollable laughing/crying out of context Emotion recognition Theory of mind: ability to see another's perspective Emotional lability Inappropriate behaviour

Question 35

How is MS Dementia different to other dementia?

Answer 35

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

Question 36

What are some drugs used for MS relapses?

Answer 36

Corticosteroids | Plasma exchange

Question 37

What are the three types of drugs that modify progression of MS?

Answer 37

- immunosuppressants - immunomodulators - immune constitution therapies

Question 38

How do immunosuppressants and immunomodulators work?

Answer 38

By being continuously administered and only active in suppressing relapse when they are being taken

Question 39

How do immune constitution therapies work?

Answer 39

By being administered short periods of time but effectiveness lasts as it allows immune system to repair itself (closest thing to a cure)

Question 40

What is the process of stem cell treatment/therapy?

Answer 40

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

Question 41

Are there treatments for those with progressive MS?

Answer 41

No They need to focus on: physical therapy muscle relaxants and medications to reduce cog an phys difficulties

Question 42

Strategies to improve memory in MS?

Answer 42

Techniques to increase chances of encoding/restoring - repetition/rehearsal - increased exposure - writing down - self-learning

Question 43

Strategies to improve processing speed in MS?

Answer 43

Take time to repeat and learn | Have information repeated

Question 44

Strategies to improve EF in MS?

Answer 44

Plan ahead Ask for help Break things down List alternatives

Question 45

Can improved sleep quality help cognition in MS patients?

Answer 45

May only improve their own perception of cognitive function

Question 46

Can high intensity training improve cognition in MS patients?

Answer 46

Can improve verbal memory and lowers inhibition errors

Question 47

Concept of self in MS?

Answer 47

There are changes in how people describe themselves (over the disease progression)