Cognitive impairment in multiple sclerosis

master's thesis

• Title (croatian): Kognitivno oštećenje u multiploj sklerozi
• Author: Meytar Zohari
• Mentor: Tereza Gabelić (mentor)
• Committee member: Tereza Gabelić (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Ivana Zadro (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Multiple sclerosis (MS) is a neuroinflammatory, potentially disabling demyelinating disease of the central nervous system (CNS), with neurodegeneration being the most prominent in progressive phenotypes. The disease results in motor, sensory and cognitive symptoms, all of which can occur independently of one another. Patients with multiple neurological signs or CNS lesions that are separated in time are diagnosed with relapsing-remitting (RR) or primary progressive multiple sclerosis (PPMS). A progressive course refers to worsening of the neurological disability, independent of relapses. Cognitive impairment (CI) is a common but still challenging expression of MS and a frequent cause of socioeconomic decline and disability for MS patients. There is still no data regarding the direct relationship between cognitive impairment and the clinical course of the disease. Thus, cognitive deficits which occur during the early stages of the disease are the ones that need to be specially identified and addressed, to prevent worsening of CI, implicating a poor prognosis in MS. The Symbol Digit Modalities Test (SDMT) test is a valuable screening tool for CI and can be the starting point when assessing CI in MS patients when other comprehensive screening tools are not available. The neuropsychological assessment should also discriminate between CI and other causes of perceived deficits, including quality of life (QoL), depression, and anxiety. A healthy diet, no addiction lifestyle, regular physical exercise and the proper control of co-morbidities can positively affect cognition in patients with MS. Recent data also indicate that proper disease-modifying therapy (DMT) implemented early in the course of RRMS can stabilize or even improve cognition. Since there is no standardized protocol for identification and assessment of CI, further studies are needed in order to elaborate a "golden standard” for screening and diagnosing of cognitive deficits in MS, and for the development of evidence-based effective preventive methods and treatment approaches.

Abstract (croatian)

Multipla skleroza (MS) je upalna, potencijalno onesposobljavajuća demijelinizirajuća bolest središnjeg živčanog sustava (CNS), a neurodegeneracija je najistaknutija u progresivnim fenotipovima bolesti. Bolest rezultira motoričkim i kognitivnim simptomima, koji se svi mogu pojaviti neovisno jedni o drugima. Bolesnicima s višestrukim neurološkim znakovima ili lezijama CNS-a koje su vremenski odvojene dijagnosticira se relapsno-remitirajuća (RR) ili primarno progresivna multipla skleroza (PPMS). Progresivni tijek bolesti odnosi se na pogoršanje neuroloških simptoma i onesposobljenosti, neovisno o relapsima. Kognitivno oštećenje (KO) čest je, ali i dalje izazovan simptom MS-a i čest uzrok lošijeg socioekonomskog statusa i invaliditeta MS bolesnika. Još uvijek nema podataka o izravnoj vezi između kognitivnih oštećenja i kliničkog tijeka bolesti. Kognitivni deficit, pogotovo u ranoj fazi bolesti, je onaj koji treba identificirati i liječiti kako bi se spriječilo pogoršanje KO-a, koje implicira lošiju prognozu u MS-u. SDMT test je dragocjen alat za provjeru KO-a i može biti početna točka za procjenu KO-a u bolesnika s MS-om kada drugi sveobuhvatni alati nisu dostupni. Neuropsihološka procjena također bi trebala razlikovati kognitivna oštećenja i druge moguće uzroke uključujući kvalitetu života, depresiju i anksioznost. Zdrava prehrana, životni stil bez ovisnosti, redovita tjelovježba te pravilna kontrola komorbiditeta mogu pozitivno utjecati na kogniciju u bolesnika s MS-om. Nedavni podaci također ukazuju da pravovremena terapija za modificiranje tijeka bolesti koja se uvodi rano tijekom RRMS-a može stabilizirati ili čak poboljšati kogniciju. Budući da ne postoji standardizirani protokol za identifikaciju i procjenu KO, potrebna su daljnja istraživanja kako bi se razvio "zlatni standard" za probir i dijagnosticiranje kognitivnog deficita u MS-u te razvile učinkovite preventivne metode i pristupi liječenju utemeljenom na dokazima.

• Keywords: multiple sclerosis; cognitive impairment; SDMT; neuropsychological assessment; treatment of cognitive impairment
• Keywords (croatian): multipla skleroza; kognitivno oštećenje; SDMT; neuropsihološka procjena; terapija kognitivnog oštećenja
• Language: english
• URN:NBN: urn:nbn:hr:105:991354
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-12-22 11:16:42