effect of cognitive fatigue on language of ms patients

23.01.08 Åbo Akademi - Domkyrkotorget 3 - 20500 Åbo 1

Effect of Cognitive Fatigue Effect of Cognitive Fatigue on Language of MS on Language of MS PatientsPatients

Leena Maria Heikkola, Åbo Akademi University

Päivi Hämäläinen, Juhani Ruutiainen, Masku Neurological Rehabilitation Center

The First Nordic Conference of Clinical Linguistics, Joensuu, February 9-10, 2008


OutlineOutline•Background •Study•Preliminary analysis•Results and Conclusions

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Multiple Sclerosis (MS)Multiple Sclerosis (MS)• Multiple Sclerosis is a long-term disease of the central

nervous system in which plaques • MS-tauti eli pesäkekovettumatauti on pitkäaikainen

keskushermoston sairaus, jossa aivojen ja selkäytimen valkeaan aineeseen syntyy rappeuma-alueita.” (Tohtorin lääkärikirja)

• Suomessa yleisin nuorten invalidisoiva keskushermoston sairaus

• Suomessa tautia sairastaa n. 7 000 henkilöä• Kaksi kertaa yleisempää naisilla kuin miehillä• Keskimääräinen sairastumisikä 30 vuotta• Oireet ilmaantuvat 15-50 vuoden iässä• Etiologia tuntematon, mutta sairastumiseen voivat

vaikuttaa:- lapsuudessa sairastetut virusinfektiot- perintötekijät- myeliinin poikkeava rakenne (Wikström 2002)

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PlaquesPlaques

• Oireet aiheutuvat demyelinisaatiosta pesäkkeissä eli plakeissa aivojen, näköhermon ja selkäytimen alueella

• Oireet määräytyvät plakkien sijainnin, koon ja iän mukaan

• Plakit sijaitsevat eri puolilla keskushermoston valkeaa ainetta, joten oireet ovat monimuotoisia

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MS-taudin yleisimmät MS-taudin yleisimmät oireetoireetMs-taudin yleisimpiä oireita:• Näön epätarkkuus toisessa tai molemmissa silmissä • katkokävely• ryhdyntävapina• erilaiset tunto- ja tasapainohäiriöt• häiriöt virtsarakon ja suolen toiminnassa• impotenssi• kaksoiskuvat• huimaus ja pahoinvointi • puhehäiriö, yleensä dysartria• taipumus fatiikkiin (Wikström 2002, 1214–1215)• lihasten voimattumuus• raajojen puutuminen• lihasjäykkyys (Tohtorin lääkärikirja)• Epätavallisempia oireita mm.: kognitiiviset häiriöt (Wikström

2002, 1214–1215)

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Diagnosis and Types of Diagnosis and Types of MSMS• Diagnoosi tehdään potilaan oireiden

kuvauksen ja neurologin kliinisen tutkimuksen perusteella, apuna magneettikuvaus eli MRI

• MS-taudille tyypillistä aalloittainen eteneminen

• Luhtasaari (2004, 26) jakaa MS-taudin neljään päätyyppiin: 1)relapsoiva-remittoiva2)sekundaarisesti progressoiva3)primaarisesti progressoiva 4)hyvänlaatuinen MS

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Types of MSTypes of MS


MS and Cognitive MS and Cognitive DisordersDisorders• Traditional MS research has been

based on medical and biological aspects of MS.

• Cognitive aspects have attracted attention only during the last decades (LaRocca & Kalb 2006).

• Up to 50-60% of MS patients show cognitive difficulty (Peyser et al. 1990).

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MS-taudin hoitoMS-taudin hoito

• MS-tautia ei voida parantaa• Oireita voidaan lievittää

-lääkehoidolla-liikuntaterapialla


MS and Communication MS and Communication DisordersDisorders• Research has concentrated on motor

disorders of speech, and not on language difficulties.

Murdoch & Lethlean (2000): ”…there exists a need for more specific assessment of high-level language abilities in the MS population using tests specifically developed for that purpose so to describe fully the proposed language disorder.”


Cognitive fatigueCognitive fatigue• Decrease in tolerance of strenuous activity.• May present itself before a diagnosis of MS.• Severity not dependent on the extent of

other symptoms. (www.ms-liitto.fi)

• Reported to be one of the three most disabling symptoms for (up to 80% of) persons with MS (Krupp 2004; Krupp & Elkins 2000; LaRocca & Kalb 2006).

• No research has explored the relationship between cognitive fatigue and language disorders (cf. Krupp & Elkins 2000).


Study - ObjectivesStudy - Objectives

• 1) To profile language disorders in spontaneous speech of MS patients.

• 2) To explore possible the effects of cognitive fatigue on the language of MS patients.


Study - SubjectsStudy - Subjects• 10 relapsing-remitting MS

patients.• 10 secondary progressive MS

patients.

• 20 healthy controls matched for age, gender and education.


Study - MethodsStudy - Methods• Recording of spontaneous speech

based on picture material previously used in aphasia research, e.g. Frog Stories.

• Neuropsychological assessments of basic cognitive and linguistic ability and (perceived) cognitive fatigue (by Päivi Hämäläinen at Masku Neurological Rehabilitation Center).


Preliminary study - Preliminary study - ParticipantsParticipants• 5 female participants with

relapsing-remitting MS • Mean age 45.8 years (SD=4.96)

• Mean education 15.1 years (SD=1.95)

• 5 controls individually matched for age (mean 45 years, SD=3.08), education (mean 14.1, SD=1.52) and gender.


Preliminary Study - DataPreliminary Study - Data

• The spontaneous speech produced by subjects was transcribed.

• Three Frog Stories, a 6-piece comic strip, and a picture of a busy campsite.

• Visual Analogue Scale (VAS).


Preliminary Study - Preliminary Study - HypothesesHypotheses• 1) Perceived fatigue in the

speech production of MS patients increases during, and towards the end of, the speech tasks.

• 2) MS patients' speech rate decreases towards the end of the speech tasks.


Perceived Fatigue in MS Perceived Fatigue in MS PatientsPatients • As a group, MS patients'

perceived fatigue in speech production increases towards the end of the speech tasks.

• The perceived fatigue also increases at individual level, except for MS09, see chart.


Perceived Fatigue in MS Perceived Fatigue in MS PatientsPatients

P e rce iv e d F atig u e in M S P atie n ts

35

2 4

66

12

44 40

20

43

65

0

20

40

60

80

100

M S 03 M S 04 M S 05 M S 09 M S 17

S ubjects

Perce

ived f

atigu

e

0-100

B E FO RE TA S K A FTE R TA S K

P e rce iv e d F atig u e in M S P atie n ts

24

42

0

20

40

60

80

100


M S G roupPe

rceive

d Fati

gue

0-1

00

M S G roup


Perceived Fatigue in ControlsPerceived Fatigue in Controls

• As a group, controls also report an increase in perceived fatigue towards the end of the speech tasks.

• Individually, 3 controls report a decrease in perceived fatigue.

• Controls seem to experience less fatigue compared to MS patients.

• What happens to controls CO09 and CO04?


Perceived Fatigue in ControlsPerceived Fatigue in Controls

P e rce iv e d F atig u e in C o n tro ls

8 5

75

140

7 4

92

71

4

0

20

40

60

80

100

CO 02 CO 03 CO 04 CO 09 CO 16

Control G roup

Perce

ived F

atigu

e

0-100


P e rce iv e d fatig u e in C o n tro ls

20

36

0

20

40

60

80

100


Control G roupPe

rceive

d Fati

gue

0-1

00

Control G roup


Individual Speech RatesIndividual Speech Rates

• On individual level, the speech rate of 3/5 MS patients decreases towards the end of the speech tasks.

• The speech rate of 3/5 controls increases significantly towards the end of the speech tasks.


Individual Speech RatesIndividual Speech Rates

S p e e ch rate in M S P atie n ts

142199

145 151 168132

168130

79119

220

289233

182215

188

103

170127

163199

246217 212 214

050

100150200250300350

1st FrogS tory

Com ic s t rip 2nd FrogS tory

Cam p 3rd FrogS tory

S peech Tasks

Sylla

bles p

er mi

nute

M S 03 M S 04 M S 05 M S 09 M S 17

S p e e ch rate in C o n tro ls

255

322263 276 269

210238 243

184221

178206

175203

133171

230183

139 127

243 265238

273 261

050

100150200250300350

1st FrogS tory

Com ic s t rip 2nd FrogS tory

Cam p 3rd FrogS tory

S peech Tasks

Sylla

bles p

er mi

nute

CO 02 CO 03 CO 04 CO 09 CO 16


Speech Rate on Group Speech Rate on Group LevelLevel• In the MS group, the speech rate

is the same before the first, and after the last speech task.

• In the control group, the speech rate decreases slightly towards from first to last task.

• However, the overall speech rate is significantly lower in the MS than in the control group.


Speech Rate on Group Speech Rate on Group LevelLevel

Speech Rates in MS and Control Groups

176201

179150

176211

252220 215 202

100

150

200

250

300

1st FrogStory

Comic strip 2nd FrogStory

Camp 3rd FrogStory

Speech tasks

Syl

lab

les

per

min

ute

MS Group Control Group


ConclusionsConclusions

• As hypothesized, the perceived fatigue in speech production seems to increase towards the end of the speech tasks in the MS group.

• Surprisingly, 2 controls also report a significant rise in the perceived fatigue.


Conclusions cont.Conclusions cont.

• Contrary to the second hypothesis, the speech rate of MS patients as a group does not decrease towards the end of the speech tasks.

• However, individually, the perceived fatigue does seem to correlate with decrease in speech rate for some MS patients.

• Surprisingly, this is also the case for two controls.


Conclusions cont.Conclusions cont.

• Interestingly, the overall speech rate of the MS patients also seems to correlate with the perceived fatigue.

• The MS patients show significantly lower speech rates compared to controls, both as a group and as individuals.


In the futureIn the future

• Bigger groups of MS patients and controls.

• Language disorder profile looking at e.g. sentence length and grammatical structures.

• Neuropsychological assessments for analysis of the relationship between cognitive fatigue and language disorders in patients with MS.

• Comparison with a similar study in Australia.


BibliographyBibliographyKrupp, L. B. (2004). Fatigue in multiple sclerosis: A guide in diagnosis and management. New York: Demos.

Krupp, L. B. & Elkins, L. E. (2000). Fatigue and declines in cognitive functioning in multiple sclerosis. Neurology 55, 934–939.

LaRocca, N. & Kalb, R. (2006). Multiple sclerosis: Understanding the cognitive challenges. New York: Demos.

Murdoch, Bruce E. & Lehtlean, Jennifer B. (2000). Language disorders in multiple sclerosis. In Murdoch, Bruce & Theodoros, Deborah (eds.). Speech and Language Disorders in Multiple Sclerosis. London and Philadelphia: Whurr Publishers.

Peyser, J. M.; Rao, S. M.; LaRocca, N. G. & Kaplan, E. (1990). Guidelines for neuropsychological research in multiple sclerosis. Arch Neurol 47, 94–97.

www.ms-liitto.fi (23.01.2008)

http://www.ms-liitto.fi/


Kiitos! Thank you!Kiitos! Thank you!

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effect of cognitive fatigue on language of ms patients

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