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NEUROPSYCHOLOGY - UCSF Multiple Sclerosis Center
Neuropsychology

It is estimated that between 45% and 65% of all people with MS experience problems with memory, attention, word-finding, problem-solving, or other cognitive functions as a symptom of the disease. These cognitive changes can vary considerably from one person to another, both in type and severity. There is very little relationship between the severity of physical symptoms and the severity of cognitive problems. One person may have severe physical symptoms but no problems with cognition. Another person may be very physically fit but have severe problems with thinking and remembering.

Cognitive difficulties can be particularly distressing for people because they are changes that nobody sees. Sometimes family,loved ones, or employers will believe that a person’s forgetfulness or lack of attention are willful ignoring, rather than a symptom of the MS. Many times the person with MS may not recognize that their problems with memory, attention, word-finding, and problem solving are MS-related, and he or she may worry that he or she is going crazy. Understanding the type and the source of cognitive problems is the first step for patients and their loved ones to begin coping with these symptoms effectively.

Although the types of problems seen in people with MS can vary considerably, some problems are seen more frequently than others. Some people may only have problems in one area, while others may have problems in many areas. Below is a list of the types of cognitive problems many people with MS experience

Cognitive Fatigue Studies show that people with MS, even if they have no other cognitive problems, can get fatigued from doing mentally challenging work over long periods of time, even if they aren’t exerting themselves physically. Once cognitively fatigued, people with MS are more likely to work slowly and make errors than people who don’t have MS. When someone is physically or cognitively fatigued, any other cognitive problems he or she has usually worsen.

Attention and Concentration Usually attention for simple tasks is good. Yet, as the difficulty of the task increases, problems with attention and concentration are more likely to occur. Problems often occur when people with MS are asked to concentrate on more than one thing, as is the case in office environments or households with children. Often, people with MS who have problems with attention find that they can only work on one thing at a time in quiet, distraction-free environments, whereas before they could talk on the phone, work on their computer, and listen to the radio, all at the same time.

Processing Speed Many people with MS experience an overall slowing in how fast they can process information. Some people describe this situation as my brain slows down or there’s a lag between my thoughts.

Memory Memory is a complex neuropsychological function. There are at least two separate systems for memory. Procedural memory is the memory for how to do things. This almost always remains intact in people with MS. Thus, you may forget to do something, but you will not forget how to do it. Semantic memory is the memory for events, words, or things. This memory can be affected in MS. Usually, people with MS have trouble remembering recent everyday events or everyday events since the diagnosis. It’s less common to have trouble remembering earlier life events or important historical information, like when you graduated from college or your child’s first birthday party. There are three parts to semantic memory. First, you must be able to perceive and attend to information. If you cannot attend to information, because of problems with attention or concentration, you will not have a chance to encode or learn it, which is the next step in memory. Finally, you have to be able to retrieve or recall it when you need it. People with MS related-memory problems can have problems in all these areas, or in only one or two. Sometimes, people will have problems learning and/or remembering what they see, but have no problems learning and/or remembering things they hear. Other times, people will have the opposite problem. Some people will have problems learning and/or remembering information regardless of how it is presented.

Language The types of language problems most commonly seen are those related to language fluency. These include increased word-finding difficulty (where either the person with MS can’t find the word they want to say, or where they say the wrong word accidentally) and problems with naming, the ability to accurately recall uncommon words or the names of acquaintances. People with MS can also have problems with dysphagia or dysarthria, which refer to problems coordinating the movements of the lips, mouth, tongue, and throat. People with these problems may have slurred speech or physical difficulty saying certain words or syllables, without any cognitive problems at all.

Problem Solving Sometimes people with MS have increased difficulty solving problems in new situations. When confronted with a problem, people with this difficulty will tend to try the same solution over and over, rather than generating new solutions, or they may have difficulty making decisions because it is hard to identify which of a number of choices is best

Visual Spatial Skills Sometimes, people with MS find themselves getting lost more frequently, losing items more frequently, or having trouble understanding visual-spatial information like maps, diagrams, and charts.

Other Problems As with physical problems, the types and severity of cognitive problems vary considerably from one person to the next. Some people may experience emotional changes due to neurologic changes in the brain, such as suddenly bursting into tears or laughter without feeling particularly sad or happy. Some people also report brief periods of loss of awareness or feelings of disorientation.

What to do about Cognitive Changes

If you suspect you may be having cognitive changes, the first thing to do is to discuss your concerns with your care provider. If problems affect your ability to work or perform routine daily activities, a neuropsychological evaluation may help determine the extent of your problem. A neuropsychological evaluation consists of a series of tests of concentration, memory, problem solving, visual-spatial skills, and language. This assessment will evaluate both the specific types of cognitive problems the person is having and the person’s remaining strengths. Knowing what the person’s problems and strengths are can allow the neuropsychologist to make specific recommendations to help the person compensate for problems they are having. For example, a person who has memory problems which are caused by problems retrieving information may be helped by developing systems to improve organization and increase the use of reminders. On the other hand, if the memory problems are caused by problems with attention and concentration, strategies designed to reduce distractions and improve the person’s ability to focus will be more successful.

A neuropsychological evaluation may also help improve relations with family and friends. When people attribute their cognitive changes to going crazy and/or loved ones believe the memory lapses are willful, the result is often a pattern of self-doubt and misunderstanding that is extremely stressful and painful. Information from such an evaluation can often be the first step toward repairing self-esteem, improving relations with loved ones, and developing adaptive coping strategies.

In some cases, a neuropsychological evaluation may also help the person with MS determine whether he or she is able to continue working. Cognitive problems are a better predictor of inability to work than physical problems, and neuropsychological evaluations may be required or recommended if a person becomes disabled due to the MS and needs to apply for disability benefits

 
NEUROPSYCHOLOGY - UCSF Multiple Sclerosis Center
Neuropsychology

It is estimated that between 45% and 65% of all people with MS experience problems with memory, attention, word-finding, problem-solving, or other cognitive functions as a symptom of the disease. These cognitive changes can vary considerably from one person to another, both in type and severity. There is very little relationship between the severity of physical symptoms and the severity of cognitive problems. One person may have severe physical symptoms but no problems with cognition. Another person may be very physically fit but have severe problems with thinking and remembering.

Cognitive difficulties can be particularly distressing for people because they are changes that nobody sees. Sometimes family,loved ones, or employers will believe that a person’s forgetfulness or lack of attention are willful ignoring, rather than a symptom of the MS. Many times the person with MS may not recognize that their problems with memory, attention, word-finding, and problem solving are MS-related, and he or she may worry that he or she is going crazy. Understanding the type and the source of cognitive problems is the first step for patients and their loved ones to begin coping with these symptoms effectively.

Although the types of problems seen in people with MS can vary considerably, some problems are seen more frequently than others. Some people may only have problems in one area, while others may have problems in many areas. Below is a list of the types of cognitive problems many people with MS experience

Cognitive Fatigue Studies show that people with MS, even if they have no other cognitive problems, can get fatigued from doing mentally challenging work over long periods of time, even if they aren’t exerting themselves physically. Once cognitively fatigued, people with MS are more likely to work slowly and make errors than people who don’t have MS. When someone is physically or cognitively fatigued, any other cognitive problems he or she has usually worsen.

Attention and Concentration Usually attention for simple tasks is good. Yet, as the difficulty of the task increases, problems with attention and concentration are more likely to occur. Problems often occur when people with MS are asked to concentrate on more than one thing, as is the case in office environments or households with children. Often, people with MS who have problems with attention find that they can only work on one thing at a time in quiet, distraction-free environments, whereas before they could talk on the phone, work on their computer, and listen to the radio, all at the same time.

Processing Speed Many people with MS experience an overall slowing in how fast they can process information. Some people describe this situation as my brain slows down or there’s a lag between my thoughts.

Memory Memory is a complex neuropsychological function. There are at least two separate systems for memory. Procedural memory is the memory for how to do things. This almost always remains intact in people with MS. Thus, you may forget to do something, but you will not forget how to do it. Semantic memory is the memory for events, words, or things. This memory can be affected in MS. Usually, people with MS have trouble remembering recent everyday events or everyday events since the diagnosis. It’s less common to have trouble remembering earlier life events or important historical information, like when you graduated from college or your child’s first birthday party. There are three parts to semantic memory. First, you must be able to perceive and attend to information. If you cannot attend to information, because of problems with attention or concentration, you will not have a chance to encode or learn it, which is the next step in memory. Finally, you have to be able to retrieve or recall it when you need it. People with MS related-memory problems can have problems in all these areas, or in only one or two. Sometimes, people will have problems learning and/or remembering what they see, but have no problems learning and/or remembering things they hear. Other times, people will have the opposite problem. Some people will have problems learning and/or remembering information regardless of how it is presented.

Language The types of language problems most commonly seen are those related to language fluency. These include increased word-finding difficulty (where either the person with MS can’t find the word they want to say, or where they say the wrong word accidentally) and problems with naming, the ability to accurately recall uncommon words or the names of acquaintances. People with MS can also have problems with dysphagia or dysarthria, which refer to problems coordinating the movements of the lips, mouth, tongue, and throat. People with these problems may have slurred speech or physical difficulty saying certain words or syllables, without any cognitive problems at all.

Problem Solving Sometimes people with MS have increased difficulty solving problems in new situations. When confronted with a problem, people with this difficulty will tend to try the same solution over and over, rather than generating new solutions, or they may have difficulty making decisions because it is hard to identify which of a number of choices is best

Visual Spatial Skills Sometimes, people with MS find themselves getting lost more frequently, losing items more frequently, or having trouble understanding visual-spatial information like maps, diagrams, and charts.

Other Problems As with physical problems, the types and severity of cognitive problems vary considerably from one person to the next. Some people may experience emotional changes due to neurologic changes in the brain, such as suddenly bursting into tears or laughter without feeling particularly sad or happy. Some people also report brief periods of loss of awareness or feelings of disorientation.

What to do about Cognitive Changes

If you suspect you may be having cognitive changes, the first thing to do is to discuss your concerns with your care provider. If problems affect your ability to work or perform routine daily activities, a neuropsychological evaluation may help determine the extent of your problem. A neuropsychological evaluation consists of a series of tests of concentration, memory, problem solving, visual-spatial skills, and language. This assessment will evaluate both the specific types of cognitive problems the person is having and the person’s remaining strengths. Knowing what the person’s problems and strengths are can allow the neuropsychologist to make specific recommendations to help the person compensate for problems they are having. For example, a person who has memory problems which are caused by problems retrieving information may be helped by developing systems to improve organization and increase the use of reminders. On the other hand, if the memory problems are caused by problems with attention and concentration, strategies designed to reduce distractions and improve the person’s ability to focus will be more successful.

A neuropsychological evaluation may also help improve relations with family and friends. When people attribute their cognitive changes to going crazy and/or loved ones believe the memory lapses are willful, the result is often a pattern of self-doubt and misunderstanding that is extremely stressful and painful. Information from such an evaluation can often be the first step toward repairing self-esteem, improving relations with loved ones, and developing adaptive coping strategies.

In some cases, a neuropsychological evaluation may also help the person with MS determine whether he or she is able to continue working. Cognitive problems are a better predictor of inability to work than physical problems, and neuropsychological evaluations may be required or recommended if a person becomes disabled due to the MS and needs to apply for disability benefits

 
Teri Garr to speak at MS fundraiser - Worcester Telegram & Gazette News
Academy Award-nominated actress Teri Garr will speak this week at a fundraising event of the National Multiple Sclerosis Society, Central New England Chapter, in Worcester. MORE - Worcester Telegram & Gazette News

 
Hollis-Eden Pharmaceuticals Presents Additional Positive Data with Drug Candidate HE3286 - Forbes.com
In a separate presentation, the Company also showed data suggesting that a newly identified subclass of compounds may potentially provide benefit to patients with various other autoimmune diseases, including multiple sclerosis. Preliminary studies suggest these compounds provided benefit in the SJL female mouse model of EAE, a widely used animal model of multiple sclerosis. Moreover, these compounds are highly potent at reducing inflammation in mouse models of LPS induced shock, regulating both NF-kappaB activation and levels of pro-inflammatory cytokines such as TNF-alpha.

"What was striking about these findings in the CIA animal model," said Dr. Halina Offner, Professor of Neurology at Oregon Health Science University, who conducted the work, "is that HE3286 not only limited the severity of disease, but based on histology it also appeared to help repair the tissue damage in the joints of the mice. This is a remarkable and extremely intriguing observation." MORE: HE3286 - Forbes.com

 
Australia Debates Lifting Ban on Cloning Embryos for Research - Bloomberg.com
Nov. 30 (Bloomberg) -- Scientists will be allowed to create human embryo clones for medical research if the Australian government passes news laws, being debated today, to lift a four-year ban.

The Australian lower house is debating a proposal to legalize the creation of human embryos through so-called somatic cell nuclear transfer to aid research into diseases including Parkinson's and multiple sclerosis. The debate is expected to take four days, double the time the House of Representatives discussed the annual budget and Telstra Corp.'s privatization.

If approved, scientists could create embryos with the DNA of a person from stem cells using the same therapeutic cloning technology that produced Dolly the sheep and 10 other animals. Stem cells extracted from such an embryo would be genetically identical to the person donating the DNA, as would tissue such as neurons grown from its stem cells. The research is controversial because it could, in theory, lead to human clones.

``We have to allow people to look to science for answers to cure debilitating and fatal diseases,'' Labor lawmaker Simon Crean told parliament today. ``We have to bring an open mind and honest heart to the debate.''MORE - Bloomberg.com

 
Myelin to Blame for Many Neuropsychiatric Disorders... UCLA Department of Neurology
What makes the human brain unique? Of the many explanations that can be offered, one that doesn't come readily to mind is — myelin.

Conventional wisdom holds that myelin, the sheet of fat that coats a neuron's axon — a long fiber that conducts the neuron's electrical impulses — is akin to the wrapping around an electrical wire, protecting and fostering efficient signaling. But the research of UCLA neurology professor George Bartzokis, M.D., has already shown that myelin problems are implicated in diseases that afflict both young and old — from schizophrenia to Alzheimer's.

Now, in a report published in the journal Biological Psychiatry and available online, Bartzokis argues that the miles of myelin coating in our brain are the key "evolutionary change that defines our uniqueness as a species" and, further, may also be the cause of "our unique vulnerability to highly prevalent neuropsychiatric disorders." The paper argues that viewing the brain as a myelin-dependent "Internet" may be key to developing new and novel treatments against disease and aid in assessing the efficacy of currently available treatments, including the use of nicotine (delivered by a patch, not smoking), which may enhance the growth and maintenance of myelin.

Myelin, argues Bartzokis, who directs the UCLA Memory Disorders and Alzheimer's Disease Clinic, is "a recent invention of evolution. Vertebrates have it; invertebrates don't. And humans have more than any other species."

Bartzokis studied the reported effects of cholinergic treatments, using drugs that are known to improve a neuron's synaptic signaling in people who suffer diseases like Alzheimer's. Furthermore, he notes, some clinical and epidemiological data suggest that such treatments may modify or even delay these diseases.

Looking at such effects from a myelin-centric point of view, Bartzokis argues that cholinergic treatments may have nonsynaptic effects as well, perhaps by enhancing myelination and myelin repair — and the better the myelin, the more efficient the neuron signaling and our "Internet's" function. Specifically, such cholinergic treatments may enhance oligodendrocytes, a type of glia cell in the brain that produces myelin during the brain 's development and constantly maintains and repairs it as we age.

While more work needs to be done to fully understand the role of nonsynaptic cholinergic effects on brain development, said Bartzokis, his hypotheses can easily be tested through in vivo imaging of the brain to study the breakdown and growth of myelin. That will make it possible to directly test in humans the practical utility of the myelin-centered model of the human brain.

Ultimately, it could foster the development of novel treatments, as well as aid in assessing the efficacy of currently available treatments. These include the use of cholinergic treatments that include acetylcholinesterase inhibitors (used to treat Alzheimer's) and nicotine patches.

"Through these rather benign interventions," Bartzokis said, "such effects on the brain's vulnerable oligodendrocyte populations may offer exciting opportunities for the prevention of both developmental and degenerative brain disorders. They deserve much closer scrutiny."MORE: UCLA Department of Neurology

 
Antibodies Against Myelin Protein Prominent in Primary Progressive MS
NEW YORK (Reuters Health) Nov 27 - IgG antibodies to the myelin oligodendrocyte glycoprotein (MOG) appear to participate in the more severe type of multiple sclerosis (MS), investigators in Germany report in the PNAS Early Edition, published online on November 27.

Of the self-antigens previously evaluated in MS patients, none has a proven biological activity, senior author Dr. Bernhard Hemmer, from Heinrich Heine University in Dusseldorf, and his associates note.

MOG is present at the outermost surface of the myelin sheath, and anti-MOG antibodies have been implicated in the pathogenesis of MS, making it a "promising target" for further investigation of its role in MS. Up until now, researchers have evaluated fragments or linear constructs of MOG.

To construct a more natural model of MOG, Dr. Hemmer's team transduced human glial cells with full-length human MOG cDNA.

Dr. Hemmer and his associates conclude: "The occurrence of antibodies with demyelinating properties further supports the pathogenic role of the humoral immune system in MS and calls for the development of B cell directed therapies not only for relapsing remitting MS, but also for primary progressive MS.MORE

 
Results of study on prevalence of MS in Lewistown to be presented - Canton Daily Ledger
LEWISTOWN -- Results of a study on the prevalence of multiple sclerosis (MS) in Lewistown and four other small Illinois communities will be announced in a series of presentations at those five towns

Responding to citizen concerns about a perceived high number of MS cases in small Illinois communities, Health Systems Research of the University of Illinois College of Medicine at Rockford applied for a grant to study the prevalence of the disease in DePue, Lewistown, Morrison, Paw Paw and Savanna.

The grant was awarded in October 2002 from the Agency for Toxic Diseases and Disease Registry, a division of the Centers for Disease Control and Prevention. The project was funded as one of five areas of the nation to study MS and ALS (Lou Gehrig's Disease).

The study, which sought to determine local rates and compare them to national levels, has now been completed and the results will be announced at the meetings scheduled in the five small towns in Illinois.

Health Systems Research sought to find all individuals with MS and ALS who lived in the zip code areas of those communities from 1998 to 2002. Self-identifying individuals then completed information on their medical, residential and occupational history and gave permission for their medical records to be reviewed to verify the diagnosis, a press release said.

For more information contact Joel Cowen, principal investigator, at 1-800-854-4461 or joelc@uic.edu.

 
Axonal protection in multiple sclerosis--a particular need during remyelination?
The current issue of Brain contains four papers that illuminate different aspects of inflammatory demyelinating disease, especially multiple sclerosis (Black et al., 2006; Coman et al., 2006; Howell et al., 2006; Patrikios et al., 2006). One paper focuses on axonal protection, while the others describe aspects of spontaneous remyelination in the disease. Promoting remyelination is a major therapeutic goal in multiple sclerosis, but some observations from the current papers raise the possibility that remyelination may transiently render axons vulnerable to degeneration before long-term protection is achieved, as discussed below.

In recent years the identification of strategies to protect axons from degeneration in multiple sclerosis has emerged as a major research priority. FULL ARTICLE

 
Multiple Sclerosis Gift Guide - 10 Great Gift Ideas for People with MS: "f you're looking for something practical or functional for that special someone living with MS, use this multiple sclerosis gift guide as your winter holiday helper.

MS Gift Guide #1: Voice Recognition Software
If the person on your list has problems with manual coordination then she might benefit from voice recognition software for her computer. The software creates documents based on the voice and intonations of the user, rather than by typing and mouse operation. This could open a world that has been closed because of physical limitations.

MS Gift Guide #2: Pool Membership
If your loved one is interested in starting a new exercise routine, swimming is highly recommended for people with MS."
Many communities have pools that are open to the public and surprisingly affordable. Most pools offer a monthly membership or a punch pass. Swimming is low-impact, and water creates buoyancy, which allows freedom from many of the usual mobility constraints. Additionally, water keeps a person cool while they are exercising to prevent overheating and fatigue.
MS Gift Guide #3: Personalized Cane

Many people with MS either choose to or must use a cane for mobility. Some people see the cane as an accessory, which can represent who they are or as an accent for an outfit. Canes are available in many colors, and some are even adorned with flames or rhinestones. Find one that reflects the personality of your loved one. Either choose an unusual one from a cane vendor or add unique touches to a plain one with paints and crafting supplies.

MS Gift Guide #4: Books or Subscriptions

Help the one you love stay ahead of current MS news. There is a large collection of MS books now available about the disease and how people live with it. You also can purchase a subscription to a lifestyle magazine for people living with MS, such as InsideMS.

MS Gift Guide #5: Recumbent Bike

If your loved one is interested in starting an exercise routine, and would prefer to workout at home, a recumbent bike may be a great way to encourage activity. A recumbent bike allows the user to be seated, which accommodates balance issues. Many recumbent bikes now have advanced computer monitors that allow tracking of heart rate, calories, time and miles. Some even have television screens.

MS Gift Guide #6: Independent Floorvac

Finding strategies to avoid fatigue are often key to living well with MS. Daily activities, such as house cleaning, can be exhausting. Make the list of chores shorter for someone you know with MS by getting them an automated vacuuming and floor cleaning device. Intelligent floorvacs navigate independently and clean as they go.

MS Gift Guide #7: Page Turner

MS may affect a person’s manual control, but the person may have perfect vision. If someone you know matches this description, and loves to read, a page turner may be extremely beneficial. Page turners range from a simple plastic device, which helps move the pages if it is difficult to grab a hold of a single page, to a fully automated electronic device, which turns the pages for you with the click of a switch.
MS Gift Guide #8: Grocery Delivery Service

Activities such as grocery shopping can be challenging for someone with MS.

Many grocery stores now offer delivery service for a small fee. Through the Internet, a person can shop virtually and select a delivery day and time. A gift certificate for a weekly or monthly delivery may allow your loved one to use their limited energy supply to take on a new project or challenge.
MS Gift Guide #9: Honorary Donation

If you’re looking for a thoughtful gift that is not a material object, then consider making an honorary donation to your loved one’s local chapter of the National Multiple Sclerosis Society. You can earmark the donation for a program that is meaningful to the beneficiary.

MS Gift Guide #10: Your Time

MS can be a lonely disease, so a gift of your time can be priceless. Many people with MS are limited to activities that are close to home, so taking your loved one on a field trip or a mingler could be a holiday highlight. Even something as simple as a weekly commitment to a board game can be very meaningful.

 
"Glatiramer acetate therapy for multiple sclerosis: a review."
[Expert Opin Drug Metab Toxicol. 2006 Dec;2(6):Wayne State University School of Medicine, Department of Neurology...]
The past decade has witnessed a revolution in the treatment of multiple sclerosis (MS), the most common demyelinating disorder of the human CNS. After being considered as an untreatable disease for more than a century, six disease-modifying treatments have been approved between 1993 and 2006. Glatiramer acetate (GA) is a worldwide drug approved for the treatment of relapsing-remitting MS in 1996. The drug is a synthetic copolymer of four amino acids based on the composition of myelin basic protein, one of several putative autoantigens implicated in the pathogenesis of MS. Three separate double-blind, placebo-controlled trials have established its efficacy in relapsing-remitting MS. Observations from an ongoing study, the longest prospective study in MS therapeutics so far, suggest that the effect of GA in reducing the relapse rate and neurological disability is maintained over a 10-year period. Independent investigators have identified several putative immunological mechanisms of action of GA, with the unique observation of the generation of GA-reactive T-helper 2 (anti-inflammatory) polarised lymphocytes within days to weeks of initiating therapy and sustaining an anti-inflammatory milieu for years in the peripheral immune system and, presumably, in the CNS. Emerging data from immunological and imaging studies quantifying axonal injury in the brain point towards neuroprotective abilities of GA. Combined with its remarkable safety and tolerability, long-term efficacy and neuroprotective effect, GA presents it self as a first-line choice in relapsing-remitting MS, and holds immense promise in developing its potential as a combination therapy in MS, as well as extending its indications to other neurodegenerative diseases.

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