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Leena Maria Heikkola, Åbo Akademi University Päivi Hämäläinen, Juhani Ruutiainen, Masku Neurological Rehabilitation Center The First Nordic Conference of Clinical Linguistics, Joensuu, February 9-10, 2008. Effect of Cognitive Fatigue on Language of MS Patients. Outline. Background Study
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Leena Maria Heikkola, Åbo Akademi University Päivi Hämäläinen, Juhani Ruutiainen, Masku Neurological Rehabilitation Center The First Nordic Conference of Clinical Linguistics, Joensuu, February 9-10, 2008 Effect of Cognitive Fatigue on Language of MS Patients Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Outline • Background • Study • Preliminary analysis • Results and Conclusions
Multiple Sclerosis (MS) • Multiple Sclerosis is a long-term disease of the central nervous system in which plaques • MS-tauti eli pesäkekovettumatauti on pitkäaikainen keskushermoston sairaus, jossa aivojen ja selkäytimen valkeaan aineeseen syntyy rappeuma-alueita.” (Tohtorin lääkärikirja) • Suomessa yleisin nuorten invalidisoiva keskushermoston sairaus • Suomessa tautia sairastaa n. 7 000 henkilöä • Kaksi kertaa yleisempää naisilla kuin miehillä • Keskimääräinen sairastumisikä 30 vuotta • Oireet ilmaantuvat 15-50 vuoden iässä • Etiologia tuntematon, mutta sairastumiseen voivat vaikuttaa: - lapsuudessa sairastetut virusinfektiot - perintötekijät - myeliinin poikkeava rakenne (Wikström 2002)
Plaques • Oireet aiheutuvat demyelinisaatiosta pesäkkeissä eli plakeissa aivojen, näköhermon ja selkäytimen alueella • Oireet määräytyvät plakkien sijainnin, koon ja iän mukaan • Plakit sijaitsevat eri puolilla keskushermoston valkeaa ainetta, joten oireet ovat monimuotoisia
MS-taudin yleisimmät oireet Ms-taudin yleisimpiä oireita: • Näön epätarkkuus toisessa tai molemmissa silmissä • katkokävely • ryhdyntävapina • erilaiset tunto- ja tasapainohäiriöt • häiriöt virtsarakon ja suolen toiminnassa • impotenssi • kaksoiskuvat • huimaus ja pahoinvointi • puhehäiriö, yleensä dysartria • taipumus fatiikkiin (Wikström 2002, 1214–1215) • lihasten voimattumuus • raajojen puutuminen • lihasjäykkyys (Tohtorin lääkärikirja) • Epätavallisempia oireita mm.: kognitiiviset häiriöt (Wikström 2002, 1214–1215)
Diagnosis and Types of MS • Diagnoosi tehdään potilaan oireiden kuvauksen ja neurologin kliinisen tutkimuksen perusteella, apuna magneettikuvaus eli MRI • MS-taudille tyypillistä aalloittainen eteneminen • Luhtasaari (2004, 26) jakaa MS-taudin neljään päätyyppiin: • relapsoiva-remittoiva • sekundaarisesti progressoiva • primaarisesti progressoiva • hyvänlaatuinen MS
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo MS and Cognitive Disorders • Traditional MS research has been based on medical and biological aspects of MS. • Cognitive aspects have attracted attention only during the last decades (LaRocca & Kalb 2006). • Up to 50-60% of MS patients show cognitive difficulty (Peyser et al. 1990).
MS-taudin hoito • MS-tautia ei voida parantaa • Oireita voidaan lievittää -lääkehoidolla -liikuntaterapialla
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo MS and Communication Disorders • Research has concentrated on motor disorders of speech, and not on language difficulties. Murdoch & Lethlean (2000): ”…there exists a need for more specific assessment of high-level language abilities in the MS population using tests specifically developed for that purpose so to describe fully the proposed language disorder.”
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Cognitive fatigue • Decrease in tolerance of strenuous activity. • May present itself before a diagnosis of MS. • Severity not dependent on the extent of other symptoms. (www.ms-liitto.fi) • Reported to be one of the three most disabling symptoms for (up to 80% of) persons with MS (Krupp 2004; Krupp & Elkins 2000; LaRocca & Kalb 2006). • No research has explored the relationship between cognitive fatigue and language disorders (cf. Krupp & Elkins 2000).
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Study - Objectives • 1) To profile language disorders in spontaneous speech of MS patients. • 2) To explore possible the effects of cognitive fatigue on the language of MS patients.
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Study - Subjects • 10 relapsing-remitting MS patients. • 10 secondary progressive MS patients. • 20 healthy controls matched for age, gender and education.
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Study - Methods • Recording of spontaneous speech based on picture material previously used in aphasia research, e.g. Frog Stories. • Neuropsychological assessments of basic cognitive and linguistic ability and (perceived) cognitive fatigue (by Päivi Hämäläinen at Masku Neurological Rehabilitation Center).
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Preliminary study - Participants • 5 female participants with relapsing-remitting MS • Mean age 45.8 years (SD=4.96) • Mean education 15.1 years (SD=1.95) • 5 controls individually matched for age (mean 45 years, SD=3.08), education (mean 14.1, SD=1.52) and gender.
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Preliminary Study - Data • The spontaneous speech produced by subjects was transcribed. • Three Frog Stories, a 6-piece comic strip, and a picture of a busy campsite. • Visual Analogue Scale (VAS).
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Preliminary Study - Hypotheses • 1) Perceived fatigue in the speech production of MS patients increases during, and towards the end of, the speech tasks. • 2) MS patients' speech rate decreases towards the end of the speech tasks.
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Perceived Fatigue in MS Patients • As a group, MS patients' perceived fatigue in speech production increases towards the end of the speech tasks. • The perceived fatigue also increases at individual level, except for MS09, see chart.
Perceived Fatigue in MS Patients Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Perceived Fatigue in Controls • As a group, controls also report an increase in perceived fatigue towards the end of the speech tasks. • Individually, 3 controls report a decrease in perceived fatigue. • Controls seem to experience less fatigue compared to MS patients. • What happens to controls CO09 and CO04?
Perceived Fatigue in Controls Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Individual Speech Rates • On individual level, the speech rate of 3/5 MS patients decreases towards the end of the speech tasks. • The speech rate of 3/5 controls increases significantly towards the end of the speech tasks.
Individual Speech Rates Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Speech Rate on Group Level • In the MS group, the speech rate is the same before the first, and after the last speech task. • In the control group, the speech rate decreases slightly towards from first to last task. • However, the overall speech rate is significantly lower in the MS than in the control group.
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Speech Rate on Group Level
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Conclusions • As hypothesized, the perceived fatigue in speech production seems to increase towards the end of the speech tasks in the MS group. • Surprisingly, 2 controls also report a significant rise in the perceived fatigue.
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Conclusions cont. • Contrary to the second hypothesis, the speech rate of MS patients as a group does not decrease towards the end of the speech tasks. • However, individually, the perceived fatigue does seem to correlate with decrease in speech rate for some MS patients. • Surprisingly, this is also the case for two controls.
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Conclusions cont. • Interestingly, the overall speech rate of the MS patients also seems to correlate with the perceived fatigue. • The MS patients show significantly lower speech rates compared to controls, both as a group and as individuals.
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo In the future • Bigger groups of MS patients and controls. • Language disorder profile looking at e.g. sentence length and grammatical structures. • Neuropsychological assessments for analysis of the relationship between cognitive fatigue and language disorders in patients with MS. • Comparison with a similar study in Australia.
Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Bibliography Krupp, L. B. (2004). Fatigue in multiple sclerosis: A guide in diagnosis and management. New York: Demos. Krupp, L. B. & Elkins, L. E. (2000). Fatigue and declines in cognitive functioning in multiple sclerosis. Neurology 55, 934–939. LaRocca, N. & Kalb, R. (2006). Multiple sclerosis: Understanding the cognitive challenges. New York: Demos. Murdoch, Bruce E. & Lehtlean, Jennifer B. (2000). Language disorders in multiple sclerosis. In Murdoch, Bruce & Theodoros, Deborah (eds.). Speech and Language Disorders in Multiple Sclerosis. London and Philadelphia: Whurr Publishers. Peyser, J. M.; Rao, S. M.; LaRocca, N. G. & Kaplan, E. (1990). Guidelines for neuropsychological research in multiple sclerosis. Arch Neurol 47, 94–97. www.ms-liitto.fi (23.01.2008)
Comments and questions: lheikkol@abo.fi Kiitos! Thank you! Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo