1. Multiple Sclerosis: A Neuropsychological Perspective National Multiple Sclerosis Society: Eastern North Carolina Chapter Antonio E. Puente, Ph.D. University of North Carolina Wilmington 11.18.10 Puente 11.18.101

2. Outline Traditional Perspectives of Cognitive & Emotional Changes in MS Cognitive Changes Emotional Changes System Changes Summary & An Alternative Perspective Puente 11.18.102

3. Defining MS: The National Multiple Sclerosis Society: MS is a chronic, often disabling disease that attacks the central nervous system. Symptoms vary from mild, (numbness in the limbs) to severe (paralysis, loss of vision). The progress, severity, and specific symptoms are unpredictable and vary from one person to another. New treatments and advances in research are giving new hope to people affected by the disease. SOURCE: nationalmssociety.org 3Puente 11.18.10

4. Neuropsychology & MS: Sampling the Traditional Sources Medline – Neuropsychology is not listed as a search term – If searched, 0 citations Multiple Sclerosis Foundation – Neuropsychology cannot be found using search National MS Society: Research News – Website 75 citations, 0 involving neuropsychology Searching for neuropsychology, 0 references Puente 11.18.104

5. MS Symptoms WebMD Common and Uncommon Symptoms of MS The most common early symptoms of MS include: Tingling Numbness Loss of balance Weakness in one or more limbs Blurred or double vision Less common symptoms of MS may include: Slurred speech Sudden onset of paralysis Lack of coordination Cognitive difficulties Puente 11.18.105

6. MS Symptoms Mayo Clinic Numbness or weakness in one or more limbs, which typically occurs on one side of your body at a time or the bottom half of your body Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement (optic neuritis) Double vision or blurring of vision Tingling or pain in parts of your body Electric-shock sensations that occur with certain head movements Tremor, lack of coordination or unsteady gait Fatigue Dizziness Puente 11.18.106

7. MS Symptoms: Looking for Cognitive Changes MS Society 5-10% may experience: Memory (acquiring, retaining, and retrieving new information) Attention and concentration (particularly divided attention) Information processing (dealing with information gathered by the five senses) Executive functions (planning and prioritizing) Visuospatial functions (visual perception and constructional abilities) Verbal fluency (word-finding) Likely to remain intact: General intellect Long-term (remote) memory Conversational skill Reading comprehension Puente 11.18.107

8. MS Symptoms: Looking for Emotional Changes MS Society Major depressive episodes as well as less severe depressive symptoms Grieving for losses related to the disease Stress and reactions to stressful situations Generalized distress and anxiety Emotional lability or mood swings Pseudobulbar Affect - uncontrollable laughing and/or crying Inappropriate behavior such as sexual aggressiveness Puente 11.18.108

9. Neuropsychological Evaluation Components – Record Review – Interviews (including collateral) – Testing Time (5-10 hours) Costs (typical medical co-pay) Outcomes – Understanding of deficits and abilities – Treatment recommendations – Possible trajectory Puente 11.18.109

10. Measuring Cognitive Changes Orientation Attention Fluency Visuo-Motor Communication Reasoning/Problem Solving Memory Intellectual Effort Puente 11.18.1010

11. Typical Neuropsychological Findings Findings Affected by Length & Type of MS Probable Mediating Factors – Cognitive Loading – Fatigue Major Reliable Changes; – Attention – Processing Speed – Verbal Memory – Problem Solving (Executive Dysfunction) – “Automaticity” Puente 11.18.1011

12. Cognitive Deficits and Everyday Functional Activities Using neuropsychological testing, Kalmar, et al. (2008) reported: That individuals with and without cognitive impairment differ in functional status, and the aspects of cognition are predictive of the functional status of the individuals with MS. 12Puente 11.18.10

13. Measuring Emotional Changes in MS Measures – MMPI – Beck – History (collateral information) Major Reliable Symptoms – Depression (15-50%) – Mania/Disregulation/Inappropriate Behavior/Disinhibition Puente 11.18.1013

14. Co-Morbidity of Depression & Cognitive Alterations – Prevalence Estimates from 0 to 96%. Most often report by individuals with Mild Cognitive Impairment. – Significance Prodromal – Depression could represent early dementia. Risk Factor – Persons experiencing depression have approximately double the risk of developing dementia as those without a prior history of depression. – Depression could exacerbate their dementia. Puente 11.18.1014

15. System Alterations in MS Family Friends Vocational Financial Legal Puente 11.18.1015

16. Treating MS Interdisciplinary Approach Support Groups Traditional Psychological Approaches Neuropsychological Approaches Lifestyle Modifications Caregiver Focus & Assistance Puente 11.18.1016

17. Summary & An Alternative Perspective Traditional Perspectives Minimize Cognitive & Emotional Changes Significant Percentage Experience Both Cognitive Changes are Subtle & Difficult to Measure and Understand Emotional Changes May Be Primary Problems How Do I Know Why? Puente 11.18.1017

18. Contact Information Antonio E. Puente, Ph.D. University: Department of Psychology University of North Carolina Wilmington Wilmington, NC 28403 910.962.3812 puente@uncw.edu Practice: 1508 Military Cutoff Road, Suite #303 Wilmington, North Carolina 28403 910.509.9371 clinicalneuropsychology@gmail.com Puente 11.18.1018