Prospective memory in patients with relapsing remitting Multiple Sclerosis

La Memoria Prospectiva (MP) es un conjunto de habilidades cognitivas que permite recordar y realizar acciones planeadas o intenciones demoradas. El objetivo de este estudio fue investigar la MP en pacientes con Esclerosis Múltiple Recaídas y Remisiones (EMRR) con dos pruebas experimentales que evalúan distintos aspectos de la MP. Se evaluaron 36 pacientes con EMRR y un grupo control de 35 voluntarios sanos (GC), apareados por edad y escolaridad. Se administró una batería de tests neuropsicológicos que incluye dos técnicas que evalúan la MP: El Cóndor y el Test de Memoria Prospectiva de Tareas Múltiples (MTPM). Los pacientes obtuvieron un puntaje más bajo que el GC (en puntaje total de El Cóndor, p = .007, d = 0.7). En el MTPM, el GC obtuvo significativamente más puntos en la Fase de Formación de la intención (p = .027, d = .5). El 63% de los pacientes versus el 88.5% del GC, autoiniciaron la intención (p = .014). Los pacientes que obtuvieron mejor puntaje en Formación, autoiniciaron más la acción proyectada (p = .012). La educación, la duración de la enfermedad y la depresión correlacionaron leve y significativamente con el Cóndor y el MTPM. La discapacidad física se relacionó sólo con la capacidad de autoiniciar del MTPM. Se concluye que la MP parece estar afectada negativamente en pacientes con EMRR. Se encontró un deterioro de la planificación y la autoiniciación de la intención. La autoniciación fue influenciada por la calidad de la planificación. Los resultados destacan la necesidad de evaluar objetivamente la MP en pacientes con EMRR para poder detectar cualquier alteración en las etapas iniciales de la enfermedad y comenzar una rehabilitación apropiada.

Prospective Memory (PM) is a set of cognitive abilities that allow us to remember to perform planned actions or delayed intentions. It requires the recall of the content of the planned task in the form of an intention to be able to execute it at the appropriate moment. Previous studies have yielded conflicting results as some show that MS patients have difficulty in remembering the content of intentions and others in the process of self-initiation of delayed intentions. Moreover, the relationship between PM and clinical variables also remains unclear. The aim of this study was to investigate PM in Relapsing-Remitting Multiple Sclerosis (RRMS) with two experimental tests that evaluate different aspects of the MP. Another aim of the current study was to analyse the relationship between PM and demographic variables and clinical variables. 36 outpatients with a diagnosis of RRMS attending to two centers specialized in multiple sclerosis clinics, were recruited. Thirty five healthy volunteers formed the contrast group (CG), matched for age, gender and education with the MS patients. A neuropsychological test battery that included two techniques for measuring PM was administered. The Condor Test consists of reading a text whilst simultaneously executing many actions. In the Multitask Prospective Memory (MTPM), the participant must remember to initiate a complex intention, which was previously planned. The test yields formation scores of the intention, initiation, plan retention capacity and finally two execution scores. A depression scale (Beck Depression Inventory, BDI-II) was administered and physical disability was revealed using the Expanded Disability Status Scale. In the RRMS group, the majority of patients (80.6%) had none or minimal signs of depression according to BDI-II classification criteria. Seventy five % of patients were in full- or half-time employment, 13.9% were unemployed or in occasional employment and 11.1% were house wives or retired on grounds of age. With respect to cognitive performance 47.2% of MS patients presented cognitive impairment. RRMS patients and the CG did not differ significantly on age and years of formal education. Groups showed no significant differences in distribution of Gender. Patients scored significantly lower than the CG on the Condor's total score, p = .007, d = .7. On the MTPM, the CG obtained significantly more points for intention formation than patients, p = .027, d = .5. Sixty-three percent of patients versus 88.5% of the CG self-initiated the intention, p = .014. Patients who obtained a higher score on Formation, self-initiated more often, p = .012. Education, disease progression and depression measure with the Beck Depression Inventory, significantly and mildly correlated with the Condor and the MTPM. Physical disability was only associated with the intention planning phase of MTPM. PM appears to be impaired in patients with RRMS. A deficit was found in planning and self-initiation of planned actions. Self-initiation was influenced by planning quality. Education, disease progression and depression were shown to influence recall and execution of future intentions. Physical disability was only associated with the intention planning phase. Some previous studies have not found a significant relationship between physical disability and cognitive measures. This study suggests that PM can be affected in patients with a low level of physical impairment. Results highlight the need for objective assessment of PM in RRMS patients to be able to detect any disorder in the initial stages of the disease and start appropriate rehabilitation. Amongst the limitations of this study, the observational, non-blind design must be acknowledged, as well as the small sample size. Also, the instruments used to assess PM are relatively new and studies of their psychometric properties are lacking. Nevertheless, the use of an instrument like The Condor is notable, given that it was developed for local population.

[Objective and subjective prospective memory in patients with relapsing remitting multiple sclerosis]. / Memoria prospectiva objetiva y subjetiva en pacientes con esclerosis múltiple, recaídas y remisiones.

INTRODUCTION: prospective memory is the ability to remember actions in the future or remember delayed intentions. OBJECTIVE: to study the relationship between prospective memory complaints with an objective measure of prospective memory and affective-emotional variables such as depression and anxiety. SUBJECTS AND MATERIALS: 51 patients with multiple sclerosis relapsing-remitting and 46 participants in the control group were evaluated with a prospective memory task called El Condor, a questionnaire on subjective complaints of prospective memory, a depression inventory and an anxiety inventory. RESULTS: the control group performed better in El Condor than patients with multiple sclerosis, t = 6263, df = 95, p = 0.000. The prospective memory questionnaire correlated with the depression and the anxiety inventories, but not with El Condor. CONCLUSIONS: subjective prospective memory is associated with depression and anxiety and not with the objective prospective memory in a group of multiple sclerosis patients. The results indicate that the subjective and objective prospective memory must be studied as separate entities or different phenomena.

[Factors associated to the work situation of patients with multiple sclerosis]. / Factores asociados con la situación laboral de pacientes con esclerosis múltiple.

INTRODUCTION: Multiple sclerosis is a demyelinating neurological disease that usually gives rise to motor, perceptive, affective and cognitive disorders in patients. These symptoms can lead the person to lose his or her job and lower the quality of life of both patients and their relatives. AIM: To review the literature on demographic, clinical, cognitive, psychiatric, occupational and social variables associated with the work situation. DEVELOPMENT: Cross-sectional and longitudinal studies have detected variables related with unemployment. Empirical research has shown how physical disability, fatigue and the progression of the disease exert a clear influence on the patient's work situation. Yet, the same degree of evidence is not true for gender, depression, age, duration of the disease and cognitive variables. Little attention has been given to work characteristics such as job discrimination, employer's attitude, labour laws, colleagues' attitudes and transport problems. CONCLUSIONS: Many of the factors that determine job loss in a patient with multiple sclerosis can be identified in time to allow them to be modified or offset. The knowledge provided by the studies mentioned above makes it possible to detect patients who are at risk of losing their job so that interventions can be carried out with the aim of preventing such a situation from occurring. More particularly, the vulnerability profile includes high physical disability and fatigue, progressive development of the disease and the presence of cognitive impairment, among others.

TITLE: Factores asociados con la situacion laboral de pacientes con esclerosis multiple.Introduccion. La esclerosis multiple es una enfermedad neurologica desmielinizante que suele provocar trastornos motrices, perceptivos, afectivos y cognitivos a quienes la padecen. Estos sintomas pueden llevar a la persona a perder su empleo, y disminuir la calidad de vida del paciente y sus familiares. Objetivo. Revisar estudios sobre variables demograficas, clinicas, cognitivas, psiquiatricas, laborales y sociales asociadas con la situacion laboral. Desarrollo. Estudios transversales y longitudinales han detectado variables relacionadas con el desempleo. Las investigaciones empiricas muestran una influencia clara de la discapacidad fisica, la fatiga y el curso de la enfermedad sobre la situacion laboral. Sin embargo, el genero, la depresion, la edad, la duracion de la enfermedad y las variables cognitivas no poseen el mismo grado de evidencia. Caracteristicas de la ocupacion, como discriminacion laboral, actitud del empleador, leyes laborales, actitud de los compañeros de trabajo y dificultades en el transporte han sido variables poco consideradas. Conclusiones. Muchos de los factores que determinan la perdida de empleo en un paciente con esclerosis multiple pueden identificarse a tiempo para poder modificarlos o compensarlos. Los conocimientos aportados por los estudios reseñados permiten detectar a aquellos pacientes que se encuentran en riesgo de perder su empleo para realizar intervenciones posibles con el objetivo de prevenir esta situacion. En particular, el perfil de vulnerabilidad incluye alta discapacidad fisica y fatiga, curso progresivo de la enfermedad y presencia de deterioro cognitivo, entre otros.

Factores asociados con la situación laboral de pacientes con esclerosis múltiple / Factors associated to the work situation of patients with multiple sclerosis

Introducción. La esclerosis múltiple es una enfermedad neurológica desmielinizante que suele provocar trastornos motrices, perceptivos, afectivos y cognitivos a quienes la padecen. Estos síntomas pueden llevar a la persona a perder su empleo, y disminuir la calidad de vida del paciente y sus familiares. Objetivo. Revisar estudios sobre variables demográficas, clínicas, cognitivas, psiquiátricas, laborales y sociales asociadas con la situación laboral. Desarrollo. Estudios transversales y longitudinales han detectado variables relacionadas con el desempleo. Las investigaciones empíricas muestran una influencia clara de la discapacidad física, la fatiga y el curso de la enfermedad sobre la situación laboral. Sin embargo, el género, la depresión, la edad, la duración de la enfermedad y las variables cognitivas no poseen el mismo grado de evidencia. Características de la ocupación, como discriminación laboral, actitud del empleador, leyes laborales, actitud de los compañeros de trabajo y dificultades en el transporte han sido variables poco consideradas. Conclusiones. Muchos de los factores que determinan la pérdida de empleo en un paciente con esclerosis múltiple pueden identificarse a tiempo para poder modificarlos o compensarlos. Los conocimientos aportados por los estudios reseñados permiten detectar a aquellos pacientes que se encuentran en riesgo de perder su empleo para realizar intervenciones posibles con el objetivo de prevenir esta situación. En particular, el perfil de vulnerabilidad incluye alta discapacidad física y fatiga, curso progresivo de la enfermedad y presencia de deterioro cognitivo, entre otros (AU)

Introduction. Multiple sclerosis is a demyelinating neurological disease that usually gives rise to motor, perceptive, affective and cognitive disorders in patients. These symptoms can lead the person to lose his or her job and lower the quality of life of both patients and their relatives. Aim. To review the literature on demographic, clinical, cognitive, psychiatric, occupational and social variables associated with the work situation. Development. Cross-sectional and longitudinal studies have detected variables related with unemployment. Empirical research has shown how physical disability, fatigue and the progression of the disease exert a clear influence on the patient’s work situation. Yet, the same degree of evidence is not true for gender, depression, age, duration of the disease and cognitive variables. Little attention has been given to work characteristics such as job discrimination, employer’s attitude, labour laws, colleagues’ attitudes and transport problems. Conclusions. Many of the factors that determine job loss in a patient with multiple sclerosis can be identified in time to allow them to be modified or offset. The knowledge provided by the studies mentioned above makes it possible to detect patients who are at risk of losing their job so that interventions can be carried out with the aim of preventing such a situation from occurring. More particularly, the vulnerability profile includes high physical disability and fatigue, progressive development of the disease and the presence of cognitive impairment, among others (AU)