Effect of Cognitive Impairments in Multiple Sclerosis on Caregivers’ Quality of Life: A Review

Abstract

Multiple sclerosis (MS), which has symptoms like balance problems, fatigue, numbness, loss of vision and tremors, also leads to impairment in cognitive functions. Most patients with MS have difficulties with numbers of cognitive domains including memory, attention, information processing and executive functions. These difficulties also negatively affect the daily life of individuals. As cognitive impairments in MS have been investigated, the impact of these difficulties on both the patients themselves and their caregivers has begun to be recognized. The aim of this study is to overview cognitive impairment in MS patients within the context of caregiver quality of life (QoL). As studies have shown, impairment in cognitive abilities negatively affects the QoL of both patients and caregivers. In conclusion cognitive abilities have an important role in the integration of MS patients and their caregivers into daily life.

Keywords

• multiple sclerosis
• cognitive impairment
• caregiver
• quality of life

Multipl Sklerozda Bilişsel Bozuklukların Bakım Verenlerin Yaşam Kalitesi Üzerindeki Etkisi: Bir Gözden Geçirme

Öz

Denge problemleri, yorgunluk, uyuşukluk, görme kaybı ve tremor gibi semptomları olan multipl skleroz (MS), bilişsel işlevlerde de bozulmaya yol açmaktadır. MS hastalarının önemli bir kısmı bellek, dikkat, bilgi işleme ve yürütücü işlevler de dahil olmak üzere çok sayıda bilişsel alanda zorluk yaşamaktadır. Yaşanan bu zorluklar kişilerin günlük yaşamını da olumsuz yönde etkilemektedir. MS’deki bilişsel bozulmanın araştırılmasıyla birlikte, bu becerilerdeki eksikliklerin hem hastaların kendileri hem de bakım verenlerin üzerindeki etkisi fark edilmeye başlanmıştır. Bu çalışma, MS hastalarında bilişsel bozukluklara bakım verenlerinin yaşam kalitesi bağlamında genel bir bakış sunmayı amaçlamaktadır. Çalışmaların ortaya koyduğu üzere, bilişsel becerilerdeki bozulma hem hastaların hem de bakım verenlerin yaşam kalitesini olumsuz yönde etkilemektedir. Bu bulgular ışığında, MS hastaları ve bakım verenleri için bilişsel becerilerin günlük yaşama entegrasyonda önemli bir role sahip olduğu sonucuna varılmaktadır.

Anahtar Kelimeler

• multipl skleroz
• bilişsel bozulma
• bakım veren
• yaşam kalitesi

References

1. Achiron A, Barak, Y (2003) Cognitive impairment in probable multiple sclerosis. J Neurol Neurosurg Psychiatry, 74:443-446.
2. Amato MP, Ponziani G, Pracucci G, Bracco L, Siracusa G, Amaducci L (1995) Cognitive impairment in early-onset multiple sclerosis: pattern, predictors, and impact on everyday life in a 4-year follow-up. Arch Neurol, 52:168-172.
3. Amato M P, Ponziani G, Siracusa G, Sorbi S. (2001) Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Arch Neurol, 58:1602-1606.
4. Amato MP, Goretti B, Ghezzi A, Lori S, Zipoli V, Moiola L et al. (2010) Cognitive and psychosocial features in childhood and juvenile MS: two-year follow-up. Neurology, 75:1134-1140.
5. Andaloro A, Russo M, Pastura C, Sessa E, Calatozzo P, Maggio MG, Bramanti P (2021) Is there a correlation between dyslipidemia and cognitive impairment in patients with multiple sclerosis?. Int J Neurosci, 132:201-206.
6. Arnett PA, Higginson CI, Voss WD, Wright B, Bender WI, Wurst JM, Tippin JM (1999) Depressed mood in multiple sclerosis: relationship to capacity-demanding memory and attentional functioning. Neuropsychology, 13:434.
7. Arnett PA, Strober, LB (2011) Cognitive and neurobehavioral features in multiple sclerosis. Expert Rev Neurother, 11:411-424.
8. Aronson K J (1997) Quality of life among persons with multiple sclerosis and their caregivers. Neurology, 48:74-80.

9. Ayromlou H, Hosseini S, Khalili M, Ayromlou S, Khamudchiyan S, Farajdokht F et al. (2023) Insulin resistance is associated with cognitive dysfunction in multiple sclerosis patients: A cross‐sectional study. J Neuroendocrinol, 35:e13288.
10. Barker-Collo SL (2006) Quality of life in multiple sclerosis: does information-processing speed have an independent effect?. Arch Clin Neuropsychol, 21:167-174.
11. Bayen E, Papeix C, Pradat-Diehl P, Lubetzki C, Joël, ME (2015) Patterns of objective and subjective burden of informal caregivers in multiple sclerosis. Behav Neurol, 2015:648415.
12. Beatty WW, Monson N (1996) Problem solving by patients with multiple sclerosis comparison of performance on the Wisconsin and California Card Sorting Tests. J Int Neuropsychol Soc, 2:134-140.
13. Beatty WW, Wilbanks SL, Blanco CR, Hames K A, Tivis R, Paul R H (1996) Memory disturbance in multiple sclerosis: reconsideration of patterns of performance on the selective reminding test. J Clin Exp Neuropsychol 18:56-62.
14. Beer S, Khan F, Kesselring J (2012) Rehabilitation interventions in multiple sclerosis: an overview. J Neurol, 259:1994–2008.
15. Benedict RH, Zivadinov R (2011) Risk factors for and management of cognitive dysfunction in multiple sclerosis. Nat Rev Neurol, 7:332-342.
16. Benedict RH, Amato MP, DeLuca J, Geurts JJ (2020) Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. Lancet Neurol, 19:860-871.
17. Ben‐Zacharia AB (2011) Therapeutics for multiple sclerosis symptoms. Mt Sinai J Med, 78:176-191.
18. Bogosian A, Moss-Morris R, Yardley L, Dennison L (2009) Experiences of partners of people in the early stages of multiple sclerosis. Mult Scler, 15:876-884.
19. Brandstadter R, Fabian M, Leavitt VM, Krieger S, Yeshokumar A, Katz Sand I et al. (2020) Word-finding difficulty is a prevalent disease-related deficit in early multiple sclerosis. Mult Scler, 26:1752-1764.
20. Browne P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor BV, Thompson A J (2014) Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity. Neurology, 83:1022-1024.
21. Buchanan RJ, Radin D, Huang C (2011) Caregiver burden among informal caregivers assisting people with multiple sclerosis. Int J MS Care, 13:76–83.
22. Chiaravalloti ND, DeLuca J (2008) Cognitive impairment in multiple sclerosis. Lancet Neurol, 7:1139-1151.
23. Chipchase SY, Nadina BL, (2001) Factors associated with carer strain in carers of people with multiple sclerosis. Disabil Rehabil, 23:768-776.
24. Corry M, While A (2009) The needs of carers of people with multiple sclerosis: a literature review. Scand J Caring Sci, 23:569-588.
25. Dayapoğlu N, Tan M (2017) The care burden and social support levels of caregivers of patients with multiple sclerosis. Kontakt, 19:e17-e23.
26. DeSousa EA, Albert RH, Kalman B (2002) Cognitive impairments in multiple sclerosis: a review. Am J Alzheimers Dis Other Demen, 17:23-29.
27. Dewis MME, Niskala H (1992) Nurturing a valuable resource: family caregivers in multiple sclerosis. Axon, 13:87–94
28. Diamond BJ, DeLuca J, Kim H, Kelley SM (1997) The question of disproportionate impairments in visual and auditory information processing in multiple sclerosis. J Clin Exp Neuropsychol, 19:34-42.
29. Diamond BJ, Johnson SK, Kaufman M, Graves L (2008) Relationships between information processing, depression, fatigue and cognition in multiple sclerosis. Arch Clin Neuropsychol, 23:189-199.
30. Drew M, Tippett LJ, Starkey NJ, Isler RB (2008) Executive dysfunction and cognitive impairment in a large community-based sample with Multiple Sclerosis from New Zealand: a descriptive study. Arch Clin Neuropsychol, 23:1-19.
31. Drulovic J, Pekmezovic T, Matejic B, Mesaros S, Manigoda M, Dujmovic I et al. (2007) Quality of life in patients with multiple sclerosis in Serbia. Acta Neurol Scand, 115:147-152.
32. Figved N, Myhr KM, Larsen JP, Aarsland D (2007) Caregiver burden in multiple sclerosis: the impact of neuropsychiatric symptoms. J Neurol Neurosurg Psychiatry, 78:1097-1102.
33. Fenu G, Fronza M, Lorefice L, Arru M, Coghe G, Frau, J et al. (2018) Performance in daily activities, cognitive impairment and perception in multiple sclerosis patients and their caregivers. BMC Neurol, 18:212.
34. Finlayson M, Cho C (2008) A descriptive profile of caregivers of older adults with MS and the assistance they provide. Disabil Rehabil, 30:1848-1857.
35. Foong J, Rozewicz L, Quaghebeur G, Davie CA, Kartsounis LD, Thompson AJ et al. (1997) Executive function in multiple sclerosis. The role of frontal lobe pathology. Brain, 120:15-26.
36. Gil-González I, Martín-Rodríguez A, Conrad R, Pérez-San-Gregorio MÁ (2020) Quality of life in adults with multiple sclerosis: a systematic review. BMJ Open, 10:e041249.
37. Glad SB, Aarseth JH, Nyland H, Riise T, Myhr KM (2010) Benign multiple sclerosis: a need for a consensus. Acta Neurol Scand, 122:44-50.
38. Glanz BI, Healy BC, Rintell DJ, Jaffin SK, Bakshi R, Weiner HL (2010) The association between cognitive impairment and quality of life in patients with early multiple sclerosis. J Neurol Sci, 290:75-79.
39. Goverover Y, Genova HM, DeLuca J, Chiaravalloti ND (2017) Impact of multiple sclerosis on daily life. In Changes in the Brain (Eds N Chiaravalloti, Y Goverover):145-165. New York, NY, Springer.
40. Graves JS, Krysko KM, Hua LH, Absinta M, Franklin RJ, Segal BM (2023) Ageing and multiple sclerosis. Lancet Neurol, 22:66-77.
41. Gregory RJ, Disler P, Firth S (1996) Caregivers of people with multiple sclerosis: a survey in New Zealand. Rehabil Nurs, 21:31-37.
42. Grzegorski T, Losy J (2017) Cognitive impairment in multiple sclerosis–a review of current knowledge and recent research. Rev Neurosci, 28:845-860.
43. Gupta S, Goren A, Phillips A L, Stewart M (2012) Self-reported burden among caregivers of patients with multiple sclerosis. Int J MS Care, 14:179-187.
44. Halstead EJ, Stanley J, Fiore D, Mueser KT (2021) Impact of cognitive impairment on adults with multiple sclerosis and their family caregivers. Int J MS Care, 23:93-100.
45. Hämäläinen P, Rosti‐Otajärvi E (2016) Cognitive impairment in MS: rehabilitation approaches. Acta Neurol Scand, 134:8-13.
46. Hecker M, Bühring J, Fitzner B, Rommer PS, Zettl UK (2021) Genetic, environmental and lifestyle determinants of accelerated telomere attrition as contributors to risk and severity of multiple sclerosis. Biomolecules, 11:1510.
47. Honan CA, Brown RF, Batchelor J (2015) Perceived cognitive difficulties and cognitive test performance as predictors of employment outcomes in people with multiple sclerosis. J Int Neuropsychol Soc, 21:156-168.
48. Ikram MA, Vernooij MW, Roshchupkin GV, Hofman A, van Duijn CM, Uitterlinden AG et al. (2017) Genetic susceptibility to multiple sclerosis: Brain structure and cognitive function in the general population. Mult Scler, 23:1697-1706.
49. Jellinger KA (2024) Cognitive impairment in multiple sclerosis: from phenomenology to neurobiological mechanisms. J. Neural Transm (Vienna), 131:871-899.
50. Johnen A, Landmeyer NC, Bürkner PC, Wiendl H, Meuth SG, Holling H (2017) Distinct cognitive impairments in different disease courses of multiple sclerosis—A systematic review and meta-analysis. Neurosci Biobehav Rev, 83:568-578.
51. Jongen PJ, Ter Horst AT, & Brands A (2012) Cognitive impairment in multiple sclerosis. Minerva Med, 103:73-96.
52. Katsavos S, Artemiadis AK, Zacharis M, Argyrou P, Theotoka I, Chrysovitsanou C et al. (2017) Predicting caregiving status and caregivers’ burden in multiple sclerosis. A short report. Neurol Res, 39:13-15.
53. Khan F, Pallant J, Brand C (2007) Caregiver strain and factors associated with caregiver self-efficacy and quality of life in a community cohort with multiple sclerosis. Disabil Rehabil, 29:1241-1250.
54. King KE, Arnett PA (2005) Predictors of dyadic adjustment in multiple sclerosis. Mult Scler, 11:700-707.
55. Knight RG, Devereux RC, Godfrey HP (1997) Psychosocial consequences of caring for a spouse with multiple sclerosis. J Clin Exp Neuropsychol, 19:7-19.
56. Kujala P, Portin R, Ruutiainen J (1997) The progress of cognitive decline in multiple sclerosis. A controlled 3-year follow-up. Brain, 120:289-297.
57. Labiano-Fontcuberta A, Mitchell AJ, Moreno-García S, Benito-León J (2014) Cognitive impairment in patients with multiple sclerosis predicts worse caregiver’s health-related quality of life. Mult Scler, 20:1769-1779.
58. Litvan I, Grafman J, Vendrell P, Martinez JM (1988) Slowed information processing in multiple sclerosis. Arch Neurol, 45:281-285.
59. MacAdam ES, Berard JA, Walker LA (2023) Cognition and cognitive fatigability: association with employment status in multiple sclerosis. Can J Neurol Sci, 50:870-875.
60. Macías Islas MÁ, Ciampi E (2019) Assessment and impact of cognitive impairment in multiple sclerosis: an overview. Biomedicines, 7:22.
61. Maguire R, Maguire P (2020) Caregiver burden in multiple sclerosis: recent trends and future directions. Curr Neurol Neurosci Rep, 20:18.
62. Mahler ME (1992) Behavioral manifestations associated with multiple sclerosis. Psychiatr Clin North Am, 15:427-438.
63. Mahley RW, Rall Jr, SC (2000) Apolipoprotein E: far more than a lipid transport protein. Annu Rev Genomics Hum Genet, 1:507-537.
64. Marrie RA, Elliott L, Marriott J, Cossoy M, Tennakoon A, Yu N (2015) Comorbidity increases the risk of hospitalizations in multiple sclerosis. Neurology, 84:350-358.
65. McCarthy M, Beaumont JG, Thompson R, Peacock S (2005) Modality-specific aspects of sustained and divided attentional performance in multiple sclerosis. Arch Clin Neuropsychol, 20:705-718.
66. McKeown LP, Porter-Armstrong AP, Baxter GD (2003) The needs and experiences of caregivers of individuals with multiple sclerosis: a systematic review. Clin Rehabil, 17:234-248.
67. Migliore S, Ghazaryan A, Simonelli I, Pasqualetti P, Squitieri F, Curcio G et al. (2017) Cognitive impairment in relapsing‐remitting multiple sclerosis patients with very mild clinical disability. Behav. Neurol., 2017:7404289.
68. Migliore S, Curcio G, Couyoumdjian A, Ghazaryan A, Landi D, Moffa F et al. (2018) Executive functioning in relapsing-remitting multiple sclerosis patients without cognitive impairment: a task-switching protocol. Mult Scler, 24:1328-1336.
69. Mitchell AJ, Benito-León J, González JMM, Rivera-Navarro J (2005) Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing. Lancet Neurol, 4:556-566.
70. Morrow SA, Drake A, Zivadinov R, Munschauer F, Weinstock-Guttman B, Benedict RH (2010) Predicting loss of employment over three years in multiple sclerosis: clinically meaningful cognitive decline. Clin Neuropsychol, 24:1131-1145.
71. Naseri A, Nasiri E, Sahraian MA, Daneshvar S, Talebi M (2021) Clinical features of late-onset multiple sclerosis: a systematic review and meta-analysis. Mult Scler Relat Disord, 50, 102816.
72. O'Brien MT (1993) Multiple sclerosis: stressors and coping strategies in spousal caregivers. J Community Health Nurs, 10:123-135.
73. Opara J, Jaracz K, Brola W (2012) Burden and quality of life in caregivers of persons with multiple sclerosis. Neurol Neurochir Pol, 46:472-479.
74. Oreja-Guevara C, Ayuso Blanco T, Brieva Ruiz L, Hernández Pérez MÁ, Meca-Lallana V, Ramió-Torrentà L (2019) Cognitive dysfunctions and assessments in multiple sclerosis. Front Neurol, 10:581.
75. Öztürk B, Taşkıran E, Demir S, Tuncer MA, Kürtüncü M, Karabudak R et al. (2024) Prevalence and incidence of multiple sclerosis in Turkey: A nationwide epidemiologic study. Mult Scler, 30:790-799.
76. Patti F (2009) Cognitive impairment in multiple sclerosis. Mult Scler, 15:2-8.
77. Penwell-Waines L, Goodworth MCR, Casillas RS, Rahn R, Stepleman L (2016) Perceptions of caregiver distress, health behaviors, and provider health-promoting communication and their relationship to stress management in MS caregivers. Health Commun, 31:478-484.
78. Phillips LH, Henry JD, Nouzova E, Cooper C, Radlak B, Summers F (2014) Difficulties with emotion regulation in multiple sclerosis: Links to executive function, mood, and quality of life. J Clin Exp Neuropsychol, 36:831-842.
79. Raggi A, Covelli V, Schiavolin S, Scaratti C, Leonardi M, Willems M (2016) Work-related problems in multiple sclerosis: a literature review on its associates and determinants. Disabil Rehabil, 38:936-944.
80. Rao SM, Leo GJ, Bernardin L, Unverzagt F (1991). Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology, 41:685-691.
81. Reia A, Petruzzo M, Falco F, Costabile T, Conenna M, Carotenuto et al. (2021) A retrospective exploratory analysis on cardiovascular risk and cognitive dysfunction in multiple sclerosis. Brain Sci, 11:502.
82. Rendell PG, Jensen F, Henry JD (2007) Prospective memory in multiple sclerosis. J Int Neuropsychol Soc, 13:410-416.
83. Rogers JM, Panegyres PK (2007) Cognitive impairment in multiple sclerosis: evidence-based analysis and recommendations. J Clin Neurosci, 14:919-927.
84. Ruano L, Portaccio E, Goretti B, Niccolai C, Severo M, Patti F et al. (2017) Age and disability drive cognitive impairment in multiple sclerosis across disease subtypes. Mult Scler, 23:1258-1267.
85. Sharac J, McCrone P, Sabes-Figuera R (2010) Pharmacoeconomic considerations in the treatment of multiple sclerosis. Drugs, 70:1677-1691.
86. Smith L, Luchini C, Demurtas J, Soysal P, Stubbs B, Hamer M et al. (2019) Telomere length and health outcomes: An umbrella review of systematic reviews and meta-analyses of observational studies. Ageing Res Rev, 51:1-10.
87. Sosnoff JJ, Balantrapu S, Pilutti LA, Sandroff BM, Morrison S, Motl RW (2013) Cognitive processing speed is related to fall frequency in older adults with multiple sclerosis. Arch Phys Med Rehabil, 94:1567-1572.
88. Spiezia AL, Falco F, Manganelli A, Carotenuto A, Petracca M, Novarella F et al. (2023) Low serum 25 hydroxy-vitamin D levels are associated with cognitive impairment in multiple sclerosis. Mult Scler Relat Disord, 79:105044.
89. Tanrverdi D, Okanl A, Sezgin S, Ekinci M (2010) Quality of life in patients with multiple sclerosis in Turkey: relationship to depression and fatigue. J. Neurosci. Nurs., 42:267-273.
90. Topcu G, Buchanan H, Aubeeluck A, Garip G (2016) Caregiving in multiple sclerosis and quality of life: A meta-synthesis of qualitative research Psychol Health, 31:693-710.
91. Tramonti F, Bonfiglio L, Bongioanni P, Belviso C, Fanciullacci C, Rossi B et al. (2019) Caregiver burden and family functioning in different neurological diseases. Psychol Health Med, 24:27-34.
92. Trenova AG, Slavov GS, Manova MG, Aksentieva JB, Miteva LD, Stanilova, SA (2016) Cognitive impairment in multiple sclerosis. Folia Med, 58:157.
93. Van Schependom J, D’hooghe MB, Cleynhens K, D’hooge M, Haelewyck MC, De Keyser J et al. (2015) Reduced information processing speed as primum movens for cognitive decline in MS. Mult Scler, 21:83-91.
94. Vollmer T, Huynh L, Kelley C, Galebach P, Signorovitch J, DiBernardo A, Sasane R (2016) Relationship between brain volume loss and cognitive outcomes among patients with multiple sclerosis: a systematic literature review. Neurol Sci, 37:165-179.
95. Wallin MT, Wilken JA, Kane R (2006) Cognitive dysfunction in multiple sclerosis: Assessment, imaging, and risk factors. J Rehabil Res Dev, 43:63-72.
96. Winkelmann A, Engel C, Apel A, Zettl UK (2007) Cognitive impairment in multiple sclerosis. J Neurol, 254:II35-II42.
97. Zivadinov R, Weinstock-Guttman B, Benedict R, Tamano-Blanco M, Hussein S, Abdelrahman N et al. (2007) Preservation of gray matter volume in multiple sclerosis patients with the Met allele of the rs6265 (Val66Met) SNP of brain-derived neurotrophic factor. Hum Mol Genet, 16:2659-2668.