Subscribe to RSS
DOI: 10.1055/s-2008-1038304
© 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 instrumentsPublication History
Publication Date:
18 January 2008 (online)
![](https://www.thieme-connect.de/media/psychoneuro/200712/lookinside/thumbnails/10.1055-s-2008-1038304-1.jpg)
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
- 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
- 3 American Psychiatric Association. .Diagnostic and statistical manual of mental disorders (DSMIV). Washington, DC 1994
- 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
- 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
- 6 Attarian HP. et al. . The relationship of sleep disturbances and fatigue in multiple sclerosis. Arch Neurol. 2004; 61 525-528
- 7 Bakshi R. et al. . Fatigue in multiple sclerosis and its relationship to depression and neurologic disability. Mult Scler. 2000; 6 181-185
- 8 Barak Y, Achiron A.. Cognitive fatigue in multiple sclerosis: findings from a two-wave screening project. J Neurol Sci. 2006; 245
- 9 Beatty WW. et al. . Demographic, clinical, and cognitive characteristics of MS patients who continue to work. Neurorehabil Neural repair. 1995; 9 167-173
- 10 Beatty WW, Monson N.. Picture and motor sequencing in MS. J Clin Exp Neuropsychol. 1994; 16 165-172
- 11 Benedict RHB. et al. . Reliable screening for neuropsychological impairment in multiple sclerosis. Mult Scler. 2004; 10 675-678
- 12 Benedict RHB. et al. . Screening for multiple sclerosis cognitive impairment using a self-administered 15-item questionnaire. Mult Scler. 2003; 9 95-101
- 13 Bergamaschi R. et al. . Clinical aspects of fatigue in multiple sclerosis. Funct Neurol. 1997; 12 247-251
- 14 Bertolone K. et al. . Cytokine correlates of fatigue in multiple sclerosis. Neurology. 1993; 43 356
- 15 Bobholz JA, Rao SM.. Cognitive dysfunction in multiple sclerosis: a review of recent developments. Curr Opin Neurol. 2003; 16 283-288
- 16 Calabrese P. et al. . Das Multiple Sklerose Inventarium Cognition (MUSIC). Psychoneuro. 2004; 30 384-388
- 17 Cella DF. et al. . Validation of the functional assessment of multiple sclerosis quality of life instrument. Neurology. 1996; 47 129-139
- 18 Chalder T. et al. . Development of a fatigue scale. J Psychosom Res. 1993; 37 147-153
- 19 Clark CM. et al. . Sleep disturbance, depression, and lesion site in patients with multiple sclerosis. Arch Neurol. 1992; 49 641-643
- 20 Colosimo C. et al. . Fatigue in MS is associated with specific clinical features. Acta Neurol Scand. 1995; 92 353-355
- 21 Comi G. et al. . Physiopathology and treatment of fatigue in multiple sclerosis. J Neurol. 2001; 248 174-179
- 22 Dickinson CJ.. Chronic fatigue syndrome - aetiological aspects. Eur J Clin Invest. 1997; 27 257-267
- 23 Djaldetti R. et al. . Fatigue in multiple sclerosis compared with chronic fatigue syndrome: A quantitative assessment. Neurology.. 1996; 46 632-635
- 24 Edgley K. et al. . A survey of multiple sclerosis: II Determinants of employment status. Can J Rehabil. 1991; 4 127-132
- 25 Feinstein A.. The neuropsychiatry of multiple sclerosis. Can J Psychiatry.. 2004; 49 157-163
- 26 Feinstein A.. The clinical neuropsychiatry of multiple sclerosis. CNS Spectr. 2005; 10
- 27 Filippi M. et al. . Functional magnetic resonance imaging correlates of fatigue in multiple sclerosis. Neuroimage. 2002; 15 559-567
- 28 Fisk JD. et al. . The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci. 1994; 21 9-14
- 29 Flachenecker P. et al. . Fatigue in multiple sclerosis. Development and validation of the „Würzburger Fatigue Inventory for MS”. Nervenarzt. 2006; 77 165-174
- 30 Flachenecker P. et al. . Fatigue in MS is related to sympathetic vasomotor dysfunction. Neurology. 2003; 61 851-853
- 31 Freal JE. et al. . Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil. 1984; 65 135-138
- 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
- 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
- 34 Gottschalk M. et al. . Fatigue and regulation of the hypothalomo-pituitary-adrenal axis in multiple sclerosis. Arch Neurol. 2005; 62 277-280
- 35 Grafman J. et al. . Automatic memory processes in patients with MS. Arch Neurol. 1991; 48 1072-1075
- 36 Heaton RK. et al. . Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis. J Consult Clin Psychol. 1985; 53 103-110
- 37 Heesen C. et al. . Fatigue in multiple sclerosis: an example of cytokine mediated sickness behaviour?. J Neurol Neurosurg Psychiatry.. 2006; 77
- 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
- 39 Jongbloed L.. Disability income: the experiences of women with multiple sclerosis. Canadian Journal of Occupational Therapy and Physiotherapy. 1998; 65 193-201
- 40 Krupp LB. et al. . Fatigue in multiple sclerosis. Arch Neurol. 1988; 45 435-437
- 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
- 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
- 43 Kujala P. et al. . Automatic and controlled information processing in MS. Brain. 1994; 117 1115-1126
- 44 Lensch E. et al. . Identification and management of cognitive disorders in multiple sclerosis. J Neurol. 2006; 253 29-31
- 45 Merkelbach S. et al. . Cardiovascular autonomic dysregulation and fatigue in multiple sclerosis. Mult Scler. 2001; 7 320-326
- 46 Miller RG. et al. . Excessive muscular fatigue in patients with spastic paraparesis. Neurology. 1990; 40 1271-1274
- 47 Minden SL, Schiffer RB.. Affective disorders in multiple sclerosis. Review and recommendations for clinical research. Arch Neurol. 1990; 47 98-104
- 48 Minden SL, Schiffer RB.. Depression and mood disorders in multiple sclerosis. Neuropsychiatry Neuropsychol Behav Neurol. 1991; 4 62-77
- 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
- 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
- 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
- 52 Peyser JM. et al. . Guidelines for neuropsychological research in multiple sclerosis. Arch Neurol.. 1990; 47 94-97
- 53 Rao SM. et al. . Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology. 1991; 41 685-691
- 54 Rao SM. et al. . Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology.. 1991; 41 692-696
- 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
- 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
- 57 Schwartz CE. et al. . Psychosocial correlates of fatigue in multiple sclerosis. Arch Phys Med Rehabil. 1996; 77 165-170
- 58 Schwartz JE. et al. . The measurement of fatigue: a new instrument. J Psychosom Res. 1993; 37 753-762
- 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
- 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
- 61 Taphoorn MJ. et al. . Fatigue, sleep disturbance and circadian rhythm in multiple sclerosis. J Neurol. 1993; 240 446-448
- 62 Téllez N. et al. . Fatigue in progressive multiple sclerosis is associated with low levels of dehydroepiandrosterone. Mult Scler. 2006; 12 487-494
- 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
- 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
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