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psychoneuro 2007; 33(12): 508-515
DOI: 10.1055/s-2008-1038304
Schwerpunkt

© Georg Thieme Verlag Stuttgart · New York

Kognitive Störungen und Fatigue bei Patienten mit Multipler Sklerose - Über den Einsatz subjektiver und objektiver Screeningverfahren

Cognitive deficits and fatigue in patients with MS - Application of subjective and objective screening instrumentsIris-Katharina Penner1 , Pasquale Calabrese1,2
  • 1Abteilung für Kognitive Psychologie und Methodologie, Schwerpunktbereich Kognitive Neurowissenschaften, Universität Basel, Schweiz(Ordinarius: Prof. Dr. K. Opwis)
  • 2Abteilung für Neuropsychologie und Verhaltensneurologie, Neurologische Universitätsklinik (Knappschaftskrankenhaus) Bochum (Direktor: Prof. Dr. U. Schlegel)
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Publication History

Publication Date:
18 January 2008 (online)

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Die Multiple Sklerose gilt als eine der häufigsten neurologischen Erkrankungen des frühen und mittleren Erwachsenenalters. Die Ursachen der Erkrankung sind bislang ungeklärt. Als gesichert gilt, dass es sich sowohl um eine neuroinflammatorische als auch neurodegenerative Erkrankung des zentralen Nervensystems handelt, bei der es zu multiplen, zeitlich und örtlich disseminierten Demyelinisierungen unterschiedlichster Lokalisation kommt. Diese bedingen auf klinischer Ebene, neben vielfältigen physischen Symptomen, kognitive Teilleistungsstörungen und psychosoziale Beeinträchtigungen wie eine Depression und Zustände abnormer Ermüdbarkeit (Fatigue). Da der Krankheitsausbruch für die meisten Patienten in eine Lebensphase der beruflichen und sozialen Etablierung und Neuorientierung fällt, stellen v.a. die neurokognitiven Probleme und die Fatigue für einen Großteil der Betroffenen unüberwindbare Hürden dar. Es ist daher von besonderer Relevanz, diese Symptome bereits frühzeitig im Krankheitsgeschehen zu erfassen. Um eine zuverlässige kosten- und zeitökonomische Diagnostik in der klinischen Routine sicherzustellen, wurden subjektive und objektive Screeningverfahren entwickelt, über deren Einsatz bei Multipler Sklerose im Folgenden berichtet wird.

Multiple sclerosis belongs to one of the common neurological diseases of early and middle adulthood. Though the etiology of the disease is still unknown, most findings indicate a combined inflammatory as well as neurodegenerative component with multiple demyelinations at different brain sites being distributed in time and space. These lesions may lead to a variety of symptoms, such as cognitive deficits, depression and fatigue. Since the disease affects individuals during their psychosocial and vocational settlement the symptoms may strongly interfere with daily activities, thus influencing quality of life. Assessment of these symptoms already in early stages of the disease is therefore of high relevance. To provide reliable cost and time economic diagnosis in clinical routine, subjective as well as objective screening methods have been developed. The present article will review on the application of these tools in MS.

Key words

Neurocognition - fatigue - multiple sclerosis - screening instruments

Literatur

  • 1 Amato MP. et al. . Cognitive impairment in early-onset multiple sclerosis: Pattern, predictors, and impact on everyday life in a 4-year follow-up.  Arch Neurol. 1995;  52 168-172
    CrossrefPubMedGoogle Scholar
  • 2 Amato MP, Zipoli V.. Clinical management of cognitive impairment in multiple sclerosis: a review of current evidence.  Int MS J. 2003;  10 72-83
    PubMedGoogle Scholar
  • 3 American Psychiatric Association. .Diagnostic and statistical manual of mental disorders (DSMIV). Washington, DC 1994
    Google Scholar
  • 4 Armstrong C. et al. . Serial position and temporal cue effects in multiple sclerosis: two subtypes of defective memory mechanisms.  Neuropsychologia. 1996;  34 853-862
    CrossrefPubMedGoogle Scholar
  • 5 Arnett PA. et al. . Executive functions in multiple sclerosis: an analysis of temporal ordering, semantic encoding, and planning abilities.  Neuropsychology. 1997;  11 535-544
    CrossrefPubMedGoogle Scholar
  • 6 Attarian HP. et al. . The relationship of sleep disturbances and fatigue in multiple sclerosis.  Arch Neurol. 2004;  61 525-528
    CrossrefPubMedGoogle Scholar
  • 7 Bakshi R. et al. . Fatigue in multiple sclerosis and its relationship to depression and neurologic disability.  Mult Scler. 2000;  6 181-185
    PubMedGoogle Scholar
  • 8 Barak Y, Achiron A.. Cognitive fatigue in multiple sclerosis: findings from a two-wave screening project.  J Neurol Sci. 2006;  245
    PubMedGoogle Scholar
  • 9 Beatty WW. et al. . Demographic, clinical, and cognitive characteristics of MS patients who continue to work.  Neurorehabil Neural repair. 1995;  9 167-173
    PubMedGoogle Scholar
  • 10 Beatty WW, Monson N.. Picture and motor sequencing in MS.  J Clin Exp Neuropsychol. 1994;  16 165-172
    PubMedGoogle Scholar
  • 11 Benedict RHB. et al. . Reliable screening for neuropsychological impairment in multiple sclerosis.  Mult Scler. 2004;  10 675-678
    CrossrefPubMedGoogle Scholar
  • 12 Benedict RHB. et al. . Screening for multiple sclerosis cognitive impairment using a self-administered 15-item questionnaire.  Mult Scler. 2003;  9 95-101
    CrossrefPubMedGoogle Scholar
  • 13 Bergamaschi R. et al. . Clinical aspects of fatigue in multiple sclerosis.  Funct Neurol. 1997;  12 247-251
    PubMedGoogle Scholar
  • 14 Bertolone K. et al. . Cytokine correlates of fatigue in multiple sclerosis.  Neurology. 1993;  43 356
    PubMedGoogle Scholar
  • 15 Bobholz JA, Rao SM.. Cognitive dysfunction in multiple sclerosis: a review of recent developments.  Curr Opin Neurol. 2003;  16 283-288
    CrossrefPubMedGoogle Scholar
  • 16 Calabrese P. et al. . Das Multiple Sklerose Inventarium Cognition (MUSIC).  Psychoneuro. 2004;  30 384-388
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Cella DF. et al. . Validation of the functional assessment of multiple sclerosis quality of life instrument.  Neurology. 1996;  47 129-139
    CrossrefPubMedGoogle Scholar
  • 18 Chalder T. et al. . Development of a fatigue scale.  J Psychosom Res. 1993;  37 147-153
    CrossrefPubMedGoogle Scholar
  • 19 Clark CM. et al. . Sleep disturbance, depression, and lesion site in patients with multiple sclerosis.  Arch Neurol. 1992;  49 641-643
    PubMedGoogle Scholar
  • 20 Colosimo C. et al. . Fatigue in MS is associated with specific clinical features.  Acta Neurol Scand. 1995;  92 353-355
    PubMedGoogle Scholar
  • 21 Comi G. et al. . Physiopathology and treatment of fatigue in multiple sclerosis.  J Neurol. 2001;  248 174-179
    PubMedGoogle Scholar
  • 22 Dickinson CJ.. Chronic fatigue syndrome - aetiological aspects.  Eur J Clin Invest. 1997;  27 257-267
    CrossrefPubMedGoogle Scholar
  • 23 Djaldetti R. et al. . Fatigue in multiple sclerosis compared with chronic fatigue syndrome: A quantitative assessment.  Neurology.. 1996;  46 632-635
    PubMedGoogle Scholar
  • 24 Edgley K. et al. . A survey of multiple sclerosis: II Determinants of employment status.  Can J Rehabil. 1991;  4 127-132
    PubMedGoogle Scholar
  • 25 Feinstein A.. The neuropsychiatry of multiple sclerosis.  Can J Psychiatry.. 2004;  49 157-163
    PubMedGoogle Scholar
  • 26 Feinstein A.. The clinical neuropsychiatry of multiple sclerosis.  CNS Spectr. 2005;  10
    PubMedGoogle Scholar
  • 27 Filippi M. et al. . Functional magnetic resonance imaging correlates of fatigue in multiple sclerosis.  Neuroimage. 2002;  15 559-567
    CrossrefPubMedGoogle Scholar
  • 28 Fisk JD. et al. . The impact of fatigue on patients with multiple sclerosis.  Can J Neurol Sci. 1994;  21 9-14
    CrossrefPubMedGoogle Scholar
  • 29 Flachenecker P. et al. . Fatigue in multiple sclerosis. Development and validation of the „Würzburger Fatigue Inventory for MS”.  Nervenarzt. 2006;  77 165-174
    CrossrefPubMedGoogle Scholar
  • 30 Flachenecker P. et al. . Fatigue in MS is related to sympathetic vasomotor dysfunction.  Neurology. 2003;  61 851-853
    PubMedGoogle Scholar
  • 31 Freal JE. et al. . Symptomatic fatigue in multiple sclerosis.  Arch Phys Med Rehabil. 1984;  65 135-138
    PubMedGoogle Scholar
  • 32 Goebel MU. et al. . Acute interferon beta-1b administration alters hypothalamic-pituitary-adrenal axis activity, plasma cytokines and leukocyte distribution in healthy subjects.  Psychoneuroendocrinology. 2002;  27 881-892
    CrossrefPubMedGoogle Scholar
  • 33 Gottberg K. et al. . Interferon-beta treatment for patients with multiple sclerosis: the patient's perceptions of the side-effects.  Mult Scler. 2000;  6 349-354
    PubMedGoogle Scholar
  • 34 Gottschalk M. et al. . Fatigue and regulation of the hypothalomo-pituitary-adrenal axis in multiple sclerosis.  Arch Neurol. 2005;  62 277-280
    CrossrefPubMedGoogle Scholar
  • 35 Grafman J. et al. . Automatic memory processes in patients with MS.  Arch Neurol. 1991;  48 1072-1075
    PubMedGoogle Scholar
  • 36 Heaton RK. et al. . Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis.  J Consult Clin Psychol. 1985;  53 103-110
    PubMedGoogle Scholar
  • 37 Heesen C. et al. . Fatigue in multiple sclerosis: an example of cytokine mediated sickness behaviour?.  J Neurol Neurosurg Psychiatry.. 2006;  77
    PubMedGoogle Scholar
  • 38 Iriarte J. et al. . The fatigue descriptive scale (FDS): a useful tool to evaluate fatigue in multiple sclerosis.  Mult Scler. 1999;  5 10-16
    PubMedGoogle Scholar
  • 39 Jongbloed L.. Disability income: the experiences of women with multiple sclerosis.  Canadian Journal of Occupational Therapy and Physiotherapy. 1998;  65 193-201
    PubMedGoogle Scholar
  • 40 Krupp LB. et al. . Fatigue in multiple sclerosis.  Arch Neurol. 1988;  45 435-437
    CrossrefPubMedGoogle Scholar
  • 41 Krupp LB. et al. . Fatigue therapy in multiple sclerosis: results of a double blind, randomised parallel trial of amantadine, pemoline and placebo.  Neurology. 1995;  45 1956-1961
    CrossrefPubMedGoogle Scholar
  • 42 Krupp LB. et al. . The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus.  Arch Neurol. 1989;  46 1121-1123
    CrossrefPubMedGoogle Scholar
  • 43 Kujala P. et al. . Automatic and controlled information processing in MS.  Brain. 1994;  117 1115-1126
    CrossrefPubMedGoogle Scholar
  • 44 Lensch E. et al. . Identification and management of cognitive disorders in multiple sclerosis.  J Neurol. 2006;  253 29-31
    PubMedGoogle Scholar
  • 45 Merkelbach S. et al. . Cardiovascular autonomic dysregulation and fatigue in multiple sclerosis.  Mult Scler. 2001;  7 320-326
    PubMedGoogle Scholar
  • 46 Miller RG. et al. . Excessive muscular fatigue in patients with spastic paraparesis.  Neurology. 1990;  40 1271-1274
    PubMedGoogle Scholar
  • 47 Minden SL, Schiffer RB.. Affective disorders in multiple sclerosis. Review and recommendations for clinical research.  Arch Neurol. 1990;  47 98-104
    CrossrefPubMedGoogle Scholar
  • 48 Minden SL, Schiffer RB.. Depression and mood disorders in multiple sclerosis.  Neuropsychiatry Neuropsychol Behav Neurol. 1991;  4 62-77
    PubMedGoogle Scholar
  • 49 Multiple Sclerosis Council for Clinical Practice Guidelines. .Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis. Washington, DC: Paralyzed Veterans of America 1998
    Google Scholar
  • 50 Neilley LK. et al. . Side effect profile of interferon beta-1b in MS: results of an open label trial.  Neurology. 1996;  46 552-554
    CrossrefPubMedGoogle Scholar
  • 51 Penner IK. et al. .The FSMC (Fatigue Scale for Motor and Cognitive functions): A new patient-reported outcome measure for cognitive and motor fatigue in multiple sclerosis. Mult Scler 2005
    Google Scholar
  • 52 Peyser JM. et al. . Guidelines for neuropsychological research in multiple sclerosis.  Arch Neurol.. 1990;  47 94-97
    PubMedGoogle Scholar
  • 53 Rao SM. et al. . Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction.  Neurology. 1991;  41 685-691
    CrossrefPubMedGoogle Scholar
  • 54 Rao SM. et al. . Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning.  Neurology.. 1991;  41 692-696
    CrossrefPubMedGoogle Scholar
  • 55 Roelcke U. et al. . Reduced glucose metabolism in the frontal cortex and basal ganglia of multiple sclerosis patients with fatigue: a 18F-fluorodeoxyglucose positron emission tomography study.  Neurology. 1997;  48 1566-1571
    CrossrefPubMedGoogle Scholar
  • 56 Scherer P. et al. . The Faces Symbol Test: a newly developed sensitive neuropsychological screening instrument for cognitive decline related to multiple sclerosis - first results of the Berlin Multi-Centre FST Validation Study.  Mult Scler. 2007;  13 402-411
    CrossrefPubMedGoogle Scholar
  • 57 Schwartz CE. et al. . Psychosocial correlates of fatigue in multiple sclerosis.  Arch Phys Med Rehabil. 1996;  77 165-170
    CrossrefPubMedGoogle Scholar
  • 58 Schwartz JE. et al. . The measurement of fatigue: a new instrument.  J Psychosom Res. 1993;  37 753-762
    CrossrefPubMedGoogle Scholar
  • 59 Schwartz RB. et al. . Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison of MR imaging and SPECT.  Am J Roentgenol. 1994;  162 935-941
    PubMedGoogle Scholar
  • 60 Smets EM. et al. . The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue.  J Psychosom Res. 1995;  39 315-325
    CrossrefPubMedGoogle Scholar
  • 61 Taphoorn MJ. et al. . Fatigue, sleep disturbance and circadian rhythm in multiple sclerosis.  J Neurol. 1993;  240 446-448
    CrossrefPubMedGoogle Scholar
  • 62 Téllez N. et al. . Fatigue in progressive multiple sclerosis is associated with low levels of dehydroepiandrosterone.  Mult Scler. 2006;  12 487-494
    CrossrefPubMedGoogle Scholar
  • 63 Vercoulen JH. et al. . The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects.  Arch Neurol. 1996;  53 642-649
    PubMedGoogle Scholar
  • 64 Whitaker J, Mitchell G.. Clinical features of multiple sclerosis. In: Raine CS, McFarland HF, Tourtellotte WW (eds). Multiple Sclerosis Clinical and Pathogenetic Basis. London: Chapman & Hall Medical 1997: 3-19
    Google Scholar

Korrespondenz

Dr. phil. Iris-Katharina Penner

Abteilung für Kognitive Psychologie und Methodologie Schwerpunktbereich Kognitive Neurowissenschaften

Missionsstraße 60/62

4055 Basel, Schweiz

Email: ik.penner@unibas.ch

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