Neuropsychological Aspects of Multiple Sclerosis

Since S. Rao's [Neuropsychology of Multiple Sclerosis: A Critical Review, A Journal of Clinical and Experimental Neuropsychology, Vol. 85, pp. 503–542] (1986) seminal review, considerable research has been undertaken on the neuropsychological consequences of multiple sclerosis. This review incorporates the research literature of the last decade in presenting an overview of the current state of our knowledge concerning the etiology, course, symptoms, assessment, consequences, and treatment of multiple sclerosis (MS). The concept of subcortical dementia is revisited in light of the most recent literature documenting the neuropsychological deficits in patients with MS. The view that cognitively heterogeneous patient groups may disguise more specific patterns of focal neuropsychological impairment is considered. A critical review of the recent literature is also presented, detailing the degree to which recent research has addressed the areas of research need identified by Rao in 1986. Given recent advances in our knowledge, the need for more attention to be directed toward the evaluation of rehabilitation and psychological intervention is highlighted.     

多发性硬化诊疗指南评析

我国无统一的多发性硬化（MS）诊断标准,MS的诊断依据Poser标准和McDonald标准。McDonald标准是建立在Poser标准基础上,但更注意利用包括MRI在内的相关实验室检查来证明多发性硬化在时间和空间上的多发性,有利于MS的早期诊断及治疗。对于没有MRI仪器的地方或不能承担MRI检查费用者,可用Poser标准进行诊断,但要注意行视觉诱发电位检查及脑脊液寡克隆IgG区带测定。     

Quality of Life and Multiple Sclerosis: Comparison Between People with Multiple Sclerosis and People from the General Population

This paper evaluated the quality of life (QOL) of people with multiple sclerosis (MS) and people from the general population. Gender differences between the 2 groups of respondents and the influence of coping style on adjustment were also evaluated. The participants were 381 (144 males, 237 females) people with MS, and 291 (101 males, 190 females) people from the general population. The results demonstrated that people with MS experienced lower levels of QOL than people from the general population for both the objective and subjective dimensions of all domains (physical health, psychological adjustment, social relationships, environmental adjustment). All coping strategies (problem-focused, focusing on the positive, detachment, wishful thinking, seeking social support) were important predictors of QOL for both males and females with MS, with wishful thinking being the strongest predictor of poor QOL. These results are discussed in terms of the various factors that impact on QOL among people with MS, and the types of coping strategies that are most adaptive in improving the QOL of people with this illness.     

Changes in Multidigit Synergies and Their Feed-Forward Adjustments in Multiple Sclerosis

The authors explored the changes in multidigit synergies in patients with multiple sclerosis (MS) within the framework of the uncontrolled manifold hypothesis. The specific hypotheses were that both synergy indices and anticipatory synergy adjustments prior to the initiation of a self-paced quick action would be diminished in the patients compared to age-matched controls. The MS patients and age-matched controls (n = 13 in both groups) performed one-finger and multifinger force production tasks involving both accurate steady-state force production and quick force pulses. The patients showed significantly lower maximal finger forces and a tendency toward slower force pulses. Enslaving was increased in MS, but only in the lateral fingers (index and little). Indices of multifinger synergies during steady-state force production were lower in MS, mainly due to the lower amount of intertrial variance that did not affect total force. Anticipatory synergy adjustments were significantly delayed in MS. The results show that MS leads to significant changes in multidigit synergies and feed-forward adjustments of the synergies prior to a quick action. The authors discuss possible contributions of subcortical structures to the impaired synergic control.     

Multiple Sclerosis and Economic Well-Being: Role of Health, Age, and Duration of Illness

This study used quantitative and qualitative techniques to examine the role of health, age, and duration of illness among people with multiple sclerosis (MS) in their economic well-being. Participants were 113 adults (31 males and 82 females) with MS who lived in urban and rural regions of Australia. The results demonstrated that health and age had a significant impact on both the economic well-being and psychological adjustment of people who contract this disorder. Different health variables predicted different aspects of economic well-being. Fatigue was the major health variable that predicted costs of MS and economic pressure, with age also predicting economic pressure, whereas income levels were predicted by cognitive confusion and mobility problems. Duration of illness, gender, and urban/rural location were not significant predictors of the economic variables. These results demonstrate the importance of obtaining multiple measures of economic well-being, as well as a broad range of health-related measures, in determining the impact of MS on the economic well-being of people with this disorder.     

Relations Between Coping and Positive and Negative Outcomes in Carers of Persons with Multiple Sclerosis (MS)

This study examined relations between stress and coping predictors and negative and positive outcomes in MS caregiving. A total of 222 carers and their care-recipients completed questionnaires at Time 1 and three months later, Time 2 (n = 155). Predictors included care-recipient characteristics (age, time since diagnosis, course and life satisfaction), and Times 1 and 2 carer problems, stress appraisal and coping. Dependent variables were Time 2 negative (anxiety, depression) and positive outcomes (life satisfaction, positive affect, benefits). Regressions indicated that, overall, the hypothesised direct effects of stress appraisal and coping strategies on positive and negative outcomes were supported. The hypothesised stress-buffering effects of positive reframing coping were also supported. All but one of the coping strategies were related to both positive and negative outcomes; specifically, practical assistance coping emerged as a unique predictor of distress. Of the model predictors, care-recipient life satisfaction emerged as the strongest and most consistent predictor of both positive and negative outcomes except benefit finding. Findings support the role of care-recipient characteristics and the carers appraisal and coping processes in shaping both positive and negative outcomes. The guiding framework and findings have the potential to inform interventions designed to promote well-being in carers.     

The Relationship Between Religion, Spirituality, Psychological Adjustment, and Quality of Life Among People with Multiple Sclerosis

The present research was comprised of two studies that aimed to explore the role of religious and spiritual variables in the psychological adjustment and quality of life of people with Multiple Sclerosis (MS). In study 1, religious behavior and objective levels of spirituality and religiosity were not significantly related to psychological adjustment or quality of life among people with MS. Positive religious coping was negatively related to psychological adjustment and quality of life. In study 2, Intrinsic religious orientation and Quest religious orientation were related to poor psychological adjustment. Implications of the present research for people with MS and other chronic illnesses are discussed.     

A Longitudinal Study of Coping Strategies and Quality of Life Among People with Multiple Sclerosis

The current study was designed to examine the role of coping strategies on quality of life (QOL) of people with multiple sclerosis (MS) over a period of 12 months. Respondents were 321 people with MS and 239 people from the general population who completed measures of QOL on two occasions, 12 months apart. People with MS also completed measures of how they coped with their illness. The results demonstrated that people with MS experienced lower levels of QOL at both points in time. For people with MS, QOL domains strongly predicted other QOL domains at both time 1 and time 2. The coping strategies of social support, focusing on the positive and wishful thinking were consistent predictors of physical QOL, psychological QOL, social QOL and environmental QOL. These findings indicate that coping strategies play an important role in predicting the QOL of people with MS.     

A Meta-Analysis of Cognitive Deficits in Adults with a Diagnosis of Schizophrenia

This review identified 1275 studies examining cognitive deficits in people with schizophrenia, published between 1990 and 2003. Data from 113 studies (4365 patients and 3429 controls) were combined in a meta-analysis carried out on the five cognitive domains of IQ, memory, language, executive function, and attention. Studies were excluded where they lacked a suitable control group or failed to present complete information. In all five cognitive domains, analysis indicated a consistent trend for patients to perform more poorly than healthy controls, with significant heterogeneity across studies. Sources of heterogeneity were analyzed and a need to ensure more appropriate composition of patient and control groups and to adopt a more refined and methodologically correct, hypothesis-driven approach was identified.     

脐血干细胞移植治疗肌萎缩侧索硬化伦理问题的思考

肌萎缩侧索硬化症是神经系统一种致死性疾病,目前尚无有效治疗方法,脐血干细胞移植为其生存带来了希望。详细论述了脐血、干细胞与伦理学,肌萎缩侧索硬化与生命伦理学的关系,以及如何在肌萎缩侧索硬化治疗中体现生命伦理学的核心精神。面对脆弱的生命,医务人员、伦理学者和管理部门应该如何为此类疾病患者生命和健康作出应尽的职责。     

Assessment of 'subcortical dementia' in patients with Huntington's disease, Parkinson's disease, multiple sclerosis and AIDS by a neuropsychological screening battery

Four diagnostic groups categorized as 'subcortical dementia' were studied using a neuropsychological screening battery. The specificity of the battery in disclosing characteristic patterns of impairment in subgroups within the category, and the correspondence between natural subgroups generated by an unsupervised statistical classification technique and the diagnostic labels were investigated. All cognitive affected subgroups demonstrated impairment on tests of sensomotor function, congnitive efficiency and/or memory, and were characterized in terms of severity of impairment as well as a progressive involvement of functional areas. The diagnostic groups were not evenly represented in all natural subgroups. Affected AIDS-patients seemed to resemble patients with Huntington's disease more than the other diagnostic groups. The screening battery could give a general characterization of the pattern of 'subcortical dementia' and different levels of impairment, but more specific process-oriented tasks are needed to contrast diagnostic groups within the concept of 'subcortical dementia'.     

Neuropsychological function in a group of patients 25 years after sustaining minor head injuries as children and adolescents

Previous studies suggest that neuropsychological impairment following mild to moderate pediatric head injury may become persistent and interrupt the normal course of intellectual development. In this study 45 subjects were assessed with a standardized neuropsychological test battery 25 years after sustaining mild to moderate head injury as children. Although the group scores in the normal range, significant relations between head injury severity and current neuropsychological function were found. The most important predictor of poor outcome was length of PTA at injury, EEG pathology, and loss of consciousness at injury. No significant influence of pre- and post-injury risk factors on current neuropsychological function was evident. The findings support the view that complicated mild and moderate paediatric head injury may heighten the risk of developing subtle neuropsychological problems later in life.     

选项具有诊断信息的多选题认知诊断测验编制

编制选项具有诊断信息的多选题是提高多选题认知诊断测验诊断效果的有效方法.研究从认知诊断的目标出发,根据认知诊断测验质量的评价标准,结合多选题的特点,探讨选项具有诊断信息的多选题认知诊断测验编制的原则.同时,结合多选题的特点和多选题采用称名计分方式的需要,对编制选项具有诊断信息的多选题提出两点要求.根据多选题认知诊断测验编制的原则和要求,给出具有可操作性的多选题认知诊断测验编制的步骤.模拟研究结果表明：根据所提出的原则和要求编制的多选题认知诊断测验具有较好的诊断效果,说明这些原则和要求合理、可行.由于这些原则、要求和步骤具有较强的可操作性,因此它对于编制多选题认知诊断测验具有一定的指导意义.     

Historical Knowledge: A Response to Hal Childs

In his book,The Myth of the Historical Jesus and the Evolution of Consciousness, Hal Childs undertakes to do something which is probably impossible. He wishes to show that my reconstruction of the historical Jesus is positivistic without becoming positivistic himself in his own reconstruction of the historical Crossan, a work which, unfortunately for him but fortunately for me, is still very much in process. Here I only use, as he does, publications up to 1995. That means, for example, that I do not cite either The Birth of Christianity or my recent memoir A Long Way from Tipperary. I discuss Hal's dissertation under three headings, moving from the less to the more fundamentally important.     

The Surveyability of Mathematical Proof: A Historical Perspective

This paper rejoins the debate surrounding Thomas Tymockzko’s paper on the surveyability of proof, first published in the Journal of Philosophy, and makes the claim that by attending to certain broad features of modern conceptions of proof we may understand ways in which the debate surrounding the surveyability of proof has heretofore remained unduly circumscribed. Motivated by these historical reflections, I suggest a distinction between local and global surveyability which I believe has the promise to open up significant new advances in the philosophy of mathematics.     

Cognitive deficits related to major organ failure: The potential role of neuropsychological testing

Until recently, little attention has been paid to the possibility of cognitive deficits in patients with disease or failure of major organs such as the liver, kidney, or heart. However, there is a growing awareness that major organ failure often has neuropsychological sequelae. These sequelae may at times be quite subtle and not detectable under gross. examination. Nevertheless, even subtle deficits may have a major impact on adherence to medical regimens, psychosocial adjustment, and quality of life of patients. Neuropsychological assessment has a potentially valuable role to play both in research and in clinical work. It can be useful in adding to our knowledge of the cognitive effects of various types, severity and duration of major organ disease, as well as sequelae associated with treatment. It also is a potentially valuable clinical tool for identifying cognitive deficits that will affect the quality of life and probability of survival for organ failure patients.     

Neuropsychological outcomes of pediatric demyelinating diseases: a review

Immune-mediated central nervous system (CNS) demyelinating diseases impact various areas of the brain, optic nerves, and/or spinal cord and can result in a wide range of neurologic symptoms including adverse cognitive outcomes. Neuropsychological outcomes in adult multiple sclerosis (MS) are well documented, while literature on such outcomes in pediatric cohorts is more limited. Furthermore, literature on neuropsychological outcomes in pediatric acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and transverse myelitis (TM) is even more limited. This paper is the first to review what is known about neuropsychological outcomes associated with immune-mediated CNS demyelinating diseases, with a focus on pediatric MS, ADEM, NMO, and TM. Additionally, this review illuminates the need to clarify differences in neuropsychological sequelae between conditions, characterize longitudinal cognitive outcomes, and investigate neuropsychological outcomes in relation to clinical variables (e.g., age of onset, disease duration, number of relapses) and psychosocial variables (e.g., fatigue, emotional problems, behavioral functioning) to better understand neuropsychological outcomes associated with these conditions.     

Youth at Risk: In Search of a Definition

The term youth at risk has been defined in numerous ways. A review of these definitions, their perspectives on predisposing conditions, and the implications for counseling are discussed.