Symptoms in MS

The vicious cycle of MS symptoms. #MSBlog #MSResearch

“This study shows that MS-related cognitive impairment is more related to clinical disability and disease duration than depression and anxiety. This may be the case when you look at a group of MSers, but in my experience in individual MSers fatigue, depression and anxiety go with poor cognitive functioning. Mental fatigue is a manifestation of cognitive impairment and the brains compensatory mechanisms. MSers use a lot more mental energy to complete the same cognitive task as normal people; this is how the brain compensates when it is damaged. When you ask MSers to describe their mental fatigue it is way and above the levels of fatigue normal people feel when completing complex and prolonged mental tasks, for example a school or university examination paper. I don’t think we appreciate how severe this fatigue can be.”

“If MSers have depression this results in low motivation and exacerbates fatigue. Similarly, anxiety consumes unnecessary mental energy with rumination about negative things. Both anxiety and depression affect sleep, for example early morning waking or an increased sleep latency (the time it takes to get to sleep), which exacerbates daytime fatigue. All these symptoms create a vicious cycle, which is why we need to take detailed histories and manage MSers holistically.”

Epub: Karadayi et al. The relationship of cognitive impairment with neurological and psychiatric variables in multiple sclerosis patients. Int J Psychiatry Clin Pract. 2013 Sep 19.

Objective: Cognitive impairment (CI) in MS can develop any time. CI is associated with degree of neuronal loss but disease duration, fatigue, comorbid affective disorder and drug dose may also affect cognition. 

Aim: To assess which cognitive domain was disturbed primarily in mild MSers and to see if CI was related with clinical and psychiatric features. 

Method: Neurological and psychiatric evaluation of 31 MSers and 31 age-sex-education matched healthy controls were done with SCID-I. Depression, anxiety, functionality, fatigue, disability scoring was done with Hamilton Depression-Anxiety scales, Global Assessment of Functionality, Fatigue Severity and Expanded Disability Status Scales. Cognitive functions were assessed by Mini Mental, Serial Digit Learning, Verbal and Nonverbal Cancellation, Stroop and Rey Auditory Verbal Learning tests. 

Results: Retrieval from long term memory and psychomotor speed were significantly worse in MS group. CI was correlated with disease duration, number of attacks and physical disability but not correlated with depression and anxiety severity. Disease duration predicted disturbances in recall and psychomotor speed, whereas fatigue and disability predicted depression. 

Conclusion: Psychomotor speed and memory were primarily impaired in MSers and CI was closely associated with clinical aspects of MS rather than depression and anxiety.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

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