Læknablaðið : fylgirit - 01.05.2002, Blaðsíða 19

ABSTRACTS / 33RD SNC & 2ND SCNN
ABSTRACTS AND LECTURES
L01 - Multiple sclerosis and its treatment: Lessons from history,
literature, and science
McDonald I
Queen Square, London, United Kingdom
Abstract not received.
L02 - The prognosis after an optic neuritis
Fredriksen J
Dept. of Neurology, University Hospital Glostrup, Denmark
Abstract not received.
L03 - Prognostic Possibilities in Multiple Sclerosis (MS)
Fredrikson S
Division of Neurology, Neurotec, Karolinska Institutet, Huddinge University
Hospital, Stockholm, Sweden
One major challenge to all clinical neurologists is to predict the
course of multiple sclerosis (MS) in the individual patient. The
course of MS in the individual patient has by many neurologists
been considered as unpredictable. There are, however, several
reasons why studies of prognostic “markers” and the natural course
of MS are important, for example (1) to identify patients who are at
risk of developing severe disability and to select patients possibly
suitable for treatment attempts; (2) to establish what is the normal
evolution of the disease as a comparison to what is found in patients
using long term disease-modifying treatments; (3) to delineate the
clinical heterogeneity of patients with MS into more homogenous
categories which may increase our understanding of possible
pathogenetic mechanisms operating in various clinical phenotypes;
and (4) to improve our prognostic ability and thus improve medical
advice in clinical practice. Studies of the natural course of the disease
have been performed over many years and different patterns have
appeared. This presentation will review some clinical characteristics
possibly reflecting both the inflammatory and degenerative aspects
of MS, as well as findings on magnetic resonance imaging (MRf) of
the brain, that may improve our prognostic possibilities in MS.
L04 - Cognitive aspects in MS
Hámalainen P
Masku Neurological Rehabilitation Centre, Masku, Finland
Cognitive problems are commonly reported by MS patients. Both
temporary and more permanent cognitive deficits are known to be
related to MS. Temporary deficits are possible as a consequence of
relapses, depression or fatigue. Permanent changes are thought to be
associated with both subcortical and cortical changes in the Central
Nervous System. Different kinds of neuropathological alterations
are supposed to affect cognition in approximately 50% of patients.
The most vulnerable cognitive areas are reported to be memory,
complex attention and information processing as well as executive
functions, whereas, for example, language problems are supposed
to be more infrequent. It is also known that dementia typical for
diseases with more widespread cortical pathology is relatively rare
in MS. However, in MS, no single profile of cognitive impairments
can be observed. Instead, cognitive problems are heterogeneous
and highly individual. Therefore, cognitive problems associated
with MS cannot be adequately described by the term subcortical
dementia. In clinical practise, the profile of cognitive impairments
can be determined only by an individual assessment.
As other MS symptoms, also cognitive deficits are difficult to
predict. Cognitive problems can be among the first symptoms of the
disease. No clear relationship between cognitive impairments and
disease duration, course of disease or physical disability as
measured with the EDSS exists. Instead, the correlation between
the range of cognitive deficits and lesion burden measured with
MRI techniques is at least moderate. Positive correlations have
been reported also between cognitive impairments and metabolic
changes observed in PET studies and electrical changes observed in
event related potential studies. The natural history of cognitive
impairments is not well understood - longitudinal studies are few in
number and the results are partly contradictory. However, our
three year follow-up study demonstrated that determined cognitive
decline frequently predicts further deterioration. In line with these
findings are also the results of a recent ten year follow-up study.
Even miid cognitive impairments affect patients’ everyday life.
Cognitive deficits have been observed to have an effect on personal
competence and self-esteem as well as on employment and ability
to take care of social relations. Cognitive problems have also been
shown to affect rehabilitation outcome. Therefore, methods to
alleviate the effects of cognitive impairments are needed. Experi-
ments with medications and rehabilitation have shown both posi-
tive and negative results. Disease modifying drugs have shown
promise in slowing down both the occurrence and further progress
of cognitive decline. However, these effects have been demonstra-
ted only in certain patient samples. Also well-planned rehabilita-
tion programs have been shown to be effective in decreasing certain
types of cognitive impairments or in alleviating the effects of cogni-
tive problems in patients’ everyday life. In the present presentation,
the frequency, characteristics, heterogeneity, natural history and
treatment methods of cognitive impairments in MS are discussed.
Key features of cognitive decline in MS
• about 50% of MS patients have cognitive problems
• many aspects of cognition are vulnerable
• no single pattern of cognitive deficits can be identified
• defined cognitive decline predicts further deterioration
• cognitive deficits can be the first symptom of MS
• severely physically handicapped MS patient can be cognitively
normal
• cognitive problems call for individual diagnostics and rehabili-
tation
A model for alleviating the effects of cognitive problems in MS
• information about cognitive deficits in MS
• neuropsychological assessment
• evaluation of the characteristics of cognitive decline
• feedback of cognitive strengths and weaknesses
• ways to use individual strengths effectively
• possible compensatory strategies
• sharing experiences with other patients with cognitive problems
• supporting the nearest ones
Læknablaðið/Fylgirit 43 2002/88 19