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Effect of Cognitive Fatigue on Language of MS Patients

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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Effect of Cognitive Fatigue on Language of MS Patients

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  1. 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

  2. Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Outline • Background • Study • Preliminary analysis • Results and Conclusions

  3. 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)

  4. 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

  5. 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)

  6. 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

  7. Types of MS

  8. 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).

  9. MS-taudin hoito • MS-tautia ei voida parantaa • Oireita voidaan lievittää -lääkehoidolla -liikuntaterapialla

  10. 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.”

  11. 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).

  12. 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.

  13. 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.

  14. 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).

  15. 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.

  16. 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).

  17. 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.

  18. 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.

  19. Perceived Fatigue in MS Patients Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo

  20. 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?

  21. Perceived Fatigue in Controls Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo

  22. 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.

  23. Individual Speech Rates Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo

  24. 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.

  25. Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo Speech Rate on Group Level

  26. 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.

  27. 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.

  28. 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.

  29. 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.

  30. 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)

  31. Comments and questions: lheikkol@abo.fi Kiitos! Thank you! Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo

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