Saturday, 31 August 2013

Clinic Speak: predicting cognitive problems and depression in MS

Are you depressed? Do you have executive dysfunction? #MSBlog #MSResearch #ClinicSpeak

"For those us who see a lot of MSers we aware that there is strong link between depression and cognitive dysfunction and that both tend to get worse with increasing MS disability. Therefore this study's results are not surprising; depression, as measured with the Beck Depression Index, was the strongest predictor of executive complaints. It is also well know that executive dysfunction is associated with depression. Therefore what comes first, depression or executive dysfunction, or vise versa? Another chicken or egg paradigm."

"What is executive dysfunction? Executive dysfunction is a disruption to the efficiency of the executive functions, which is a group of cognitive processes that regulate, control, and manage other cognitive processes. Executive dysfunction can refer to both neurocognitive deficits and behavioural symptoms, for example deficiencies in planning, abstract thinking, flexibility and behavioural control and the occurrence of impulsive, hyperactive, disorganized, and sometimes aggressive behaviour. Executive dysfunction, particularly in relation to working memory, may also lead to varying degrees of emotional dysregulation, which can manifest as chronic depression, anxiety, or a state in which you are over-emotional (hyperemotionality). Severe executive dysfunction can have devastating effects on cognition and behaviour for MSers in particular in social contexts."

"There are several measures that can be employed to assess the executive functioning capabilities of MSers. These are usually done by a neuropsychologist and include: (1) the Clock drawing test, (2) Stroop task, (3) the Wisconsin Card Sorting test, (4) the Trail-making test, etc. For more information on these tests I suggest you read the Wikipedia entry on testing for executive dysfunction."

"More importantly, are you depressed? Depression is a state of low mood that causes you to avoid activities that can affect your thoughts, behavior, feelings and sense of well-being. Depressed MSers may feel sad, anxious, empty, hopeless, worried, helpless, worthless, guilty, irritable, hurt, or restless. They typically lose interest in pleasurable activities, for example going-out, socialising with friends, loss of libido, etc., i.e. you lose your 'joie de vivre'. Depression also affects other aspects of brain function and you may develop vegetative features of depression; i.e. loss of appetite or overeating, poor concentrating, forgetfulness, poor decision making, insomnia, excessive sleeping, fatigue, loss of energy, aches & pains, digestive problems, and other systemic symptoms. MSers who are depressed may contemplate or even attempt suicide. Depression is very common in MS and if you are depressed you need to seek help as soon as possible. There are effective psychological and medical therapies and in my experience both work and they often synergise."

"How do you know if you are depressed? I have uploaded a copy of the Beck Depression Inventory for you. It is at the bottom of this post. You can download it and complete and score it yourself. Some psychiatrists don't like using the Beck Depression Inventory in MSers; they prefer the Hospital Anxiety and Depression Scale or HAD. Unfortunately the HAD is difficult to self-score and interpret yourself. What is important is to screen yourself and if you are depressed to seek help."




Epub: Hanssen et al. Predictors of executive complaints and executive deficits in multiple sclerosis.Acta Neurol Scand. 2013 Aug 23.

OBJECTIVES: To investigate executive complaints and objective executive deficits and their relations to both depression and neurological function in MS.

MATERIALS AND METHODS: 120 MSers participating in multidisciplinary rehabilitation underwent assessment with the EDSS, neuropsychological tests of executive function, self-report measures of executive function (BRIEF-A), and depression (BDI-II).

RESULTS: Multivariate regression analysis showed that moderate depression and above (BDI-II > 20) significantly predicted a high degree of subjective executive complaints. Multivariate regression analysis showed that EDSS scores above 4.3 significantly predicted executive cognitive deficit, measured by neuropsychological tests.

CONCLUSION: Among the study variables, depression was the strongest predictor of executive complaints. A high degree of neurological disability was the strongest predictor for executive deficit, measured by neuropsychological tests.

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