ANALOGICAL REASONING IN MULTIPLE SCLEROSIS

Abstract

Objective Cognitive impairment is common in multiple sclerosis (MS) and occurs at all stages of the disease with a significant negative effect on daily life activities, vocation, social relationships and quality of life. Analogical reasoning involves identifying a common relational system between two situations and then generating further inferences driven by these shared commonalities that is a fundamental aspect of human cognition people routinely use in everyday life, in a wide range of problem-solving contexts and decision making. The aim of the study is to evaluate analogical reasoning skills in individuals with MS. Material and Method This observational case-control study covers 30 MS patients without any cognitive complaint and 30 age-, sex- and education-matched healthy person. All participants were underwent a thorough neuropsychological evaluation with emphasis on working memory, attention, executive functions and concept formation and analogical reasoning. Results MS patients’ performance on working memory, attention and executive functions were worse in comparison to the control group. In general no difference was observed regarding concept formation, abstraction, cognitive flexibility and analogical reasoning between MS patients and healthy controls. However MS patients with advanced age exhibited a poor performance in these tasks which also showed a moderate correlation with disease duration. Conclusion Cognitive dysfunction can be detected even in MS patients who are relatively young and have low disability, without any cognitive complaints. Although early cognitive reserves are sufficient for performance in analogical reasoning tasks similar to that of healthy controls, they show significant deterioration with advancing age.

Keywords

• multiple sclerosis
• cognitive functions
• analogical reasoning

MULTİPL SKLEROZDA ANALOJİK AKIL YÜRÜTME

Abstract

Amaç Multipl sklerozda yaygın olan bilişsel bozukluk hastalığın tüm evrelerinde gelişebilir ve günlük yaşam aktivitelerini, mesleki, sosyal ilişkileri ve yaşam kalitesini önemli ölçüde olumsuz etkiler. İki durum arasındaki ortak ilişkiyi tanımlama ve bu ortak benzerlikler üzerinden yeni çıkarımlar üretebilme becerisi olan analojik akıl yürütme, insanların günlük yaşamda çok çeşitli problem çözme bağlamlarında ve karar vermede rutin olarak kullandıkları, insan bilişinin temel ögelerinden birisidir. Çalışmanın amacı MS’li bireylerde analojik akıl yürütme becerilerini değerlendirmektir. Gereç ve Yöntem Bu gözlemsel, olgu-kontrol çalışması herhangi bir bilişsel yakınması olmayan 30 MS hastası ve yaş, cinsiyet ve eğitim açısından eşleştirilmiş 30 sağlıklı kişiyi kapsamaktadır. Tüm katılımcılara çalışma belleği, dikkat, yürütücü işlevler ve kavram oluşturma ve analojik akıl yürütmeye vurgu yapılan kapsamlı bir nöropsikolojik değerlendirme yapılmıştır. Bulgular MS’li hastaların çalışma belleği, dikkat ve yürütücü işlevlerdeki performansları daha kötüydü. Genel olarak MS hastaları ve sağlıklı kontroller arasında kavram oluşturma, soyutlama, bilişsel esneklik ve analojik akıl yürütme açısından bir fark gözlenmedi. Bununla birlikte, bu ödevlerde ilerleyen yaşla birlikte ve hastalık süresi ile orta derecede bir bağıntı gösteren daha kötü bir performans izlenmiştir. Sonuç Herhangi bir bilişsel yakınması olmayan, görece genç ve özürlülüğü düşük MS hastalarında bile bilişsel işlev bozukluğu saptanabilmektedir. Erken dönemdeki kognitif rezervler analojik akıl yürütme görevlerinde sağlıklı kontrollere benzer bir performans için yeterli olsa da ilerleyen yaşla birlikte önemli bir bozulma gösterirler. Analojik akıl yürütme görevlerinde sağlıklı kontrollere benzer bir performans için yeterli olsa da ilerleyen yaşla birlikte önemli bir bozulma gösterirler.

Keywords

• multipl skleroz
• bilişsel işlevler
• analojik akıl yürütme

References

1. Referans1. Achiron A, Barak Y. Cognitive changes in early MS: a call for common framework. J Neurol Sci 2006;245:47-55.
2. Referans2. Amato MP, Zipoli V, Portaccio E. Multiple sclerosis-related cognitive changes: A review of cross-sectional and longitudinal studies. J Neurol Sci 2006;245:41-6.
3. Referans3. Brochet B, Ruet A. Cognitive impairment in multiple sclerosis with regards to disease duration and clinical phenotypes. Front Neurol 2019;10:261.
4. Referans4. Benedict RHB, Amato MP, DeLuca J, Geurts JJG. Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. Lancet Neurol 2020;19(10):860-71.
5. Referans5. Langdon D. Cognitive impairment in multiple sclerosis- recent advances and future prospects. Eur Neurol Rev 2010;5:69-72.
6. Referans6. Strober L, Englert J, Munschauer F, et al. Sensitivity of con¬ventional memory tests in multiple sclerosis: comparing the Rao Brief Repeatable Neuropsychological Battery and the Minimal Assessment of Cognitive Function in MS. Mult Scler 2009;15(9):1077-84.
7. Referans7. Kleeberg J, Bruggimann L, Annoni JM, van Melle G, Bogousslavsky J, Schluep M. Altered decision-making in multiple sclerosis: a sign of impaired emotional reactivity? Ann Neurol 2004;56(6):787-95.
8. Referans8. Gentner D. Bootstrapping the mind: analogical processes and symbol systems. Cogn Sci 2010; 34(5):752-75.

9. Referans9. Krawczyk DC. The cognition and neuroscience of relational reasoning. Brain Research 2012;1428;13-23.
10. Referans10. Schiff R, Bauminger N, Toledo I. Analogical problem solving in children with verbal and nonverbal learning disabilities. J Learn Disabil 2009;42(1):3-13.
11. Referans11. Krawczyk DC, McClelland MM, Donovan CM, Tillman GD, Maguire MJ. An fMRI investigation of cognitive stages in reasoning by analogy. Brain Res 2010;1342:63-73.
12. Referans12. Denaes C. Analogical matrices in young children and students with intellectual disability: reasoning by analogy or reasoning by association? J Appl Res Intellect Disabil 2012;25:271-81.
13. Referans13. Giovannoni G, Southam E, Waubant E. Systematic review of disease-modifiying therapies to assess unmet needs in multipls sclerosis: tolerability and adherence. Mult Scler 2012;18(7):932-46.
14. Referans14. Remington G, Rodriguez Y, Logan D, Williamson C, Treadaway K. Facilitating medication adherence in patients with multiple sclerosis. Int J MS Care 2013;15(1):36-45.
15. Referans15. Haase R, Kullmann JS, Ziemssen T. Therapy satisfaction and adherence in patients with relapsing-remitting multiple sclerosis: the THEPA-MS survey. Ther Adv Neurol Disord 2016; 9(4): 250-263.
16. Referans16. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, Correale J, Fazekas F et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018;17(2):162-173.
17. Referans17. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
18. Referans18. Güngen C, Ertan T, Eker E, Yaflar R, Engin F. Standardize mini mental testin Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi 2002;13(4):273-81.
19. Referans19. Cangöz B, Demirci S, Uluç S. Turkish Journal of Geriatrics 2013; 16 (1) 69-76.
20. Referans20. Lezak MD. Neuropsychological Assessment. New York : Oxford University Press, 1995.
21. Referans21. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry 1961; 4(6): 561-571.
22. Referans22. Hisli N. Beck depresyon envanterinin üniversite öğrencileri için geçerliği ve güvenirliği. Psikoloji Derg 1989;7(23):3-13.
23. Referans23. Bilker WB, Hansen JA, Brensinger CM, Richard J, Gur RE, Gur RC. Development of abbreviated nine-item forms of the Raven's Standard Progressive Matrices Test. Assessment 2012;19(3):354-369.
24. Referans24. Smits CHM, Smit JH, van den Heuvel N, Jonker C. Norms for an abbreviated Raven’s Coloured Progressive Matrices in an older sample. J Clin Psychol 1997;53(7):687-97.
25. Referans25. Wharton CM, Grafman J, Flitman SS, Hansen EK, Brauner J, Marks A, Honda M. Toward Neuroanatomical models of analogy: a positron emission tomography study of analogical mapping. Cog Psychol 2000;40:173-197.
26. Referans26. Weintraub S. Neuropsychological assessment of mental state. Principles of cognitive and behavioral neurology. 2. Ed, Mesulam MM (Ed), New York: Oxford University Press,2000, s.121-73.
27. Referans27. Wicklund AH, Johnson N, Weintraub S. Preservation of reasoning in primary progressive aphasia: further differentiation from Alzheimer's disease and the behavioral presentation of frontotemporal dementia. J Clin Exp Neuropsychol 2004;26 (3):347-55.
28. Referans28. Kudiaki C, Aslan A. Executive functions in a Turkish sample: associations with demographic variables and normative data. Appl Neuropsychol 2008;15(3):194-204.
29. Referans29. Huijbregts SCJ, Kalkers NF, de Sonneville LMJ, de Groot V, Polman CH. Cognitive impairment and decline in different MS subtypes. J Neurol Sci 2006;245:187-94.
30. Referans30. Tuncer N, Midi İ, Feyzioglu A. Cognitive impairment in relapsing remitting multiple sclerosis. J Neurol Sci (Turkish) 2012;29(3):444-57.
31. Referans31. Jennekens-Schinkel A, van der Velde EA, Sanders EA, Lanser JB. Visuospatial problem solving, conceptual reasoning and sorting behaviour in multiple sclerosis out-patients. J Neurol Sci 1989;90(2):187-201.
32. Referans32. Rao SM, Hammeke TA, Speech TJ. Wisconsin Card Sorting Test performance in relapsing-remitting and chronic-progressive multiple sclerosis. J Consult Clin Psychol 1987;55(2);263-65.
33. Referans33. Swirsky-Sacchetti T, Mitchell DR, Seward J, Gonzales C, Lublin F, Knobler R, et al. Neuropsychological and structural brain lesions in multiple sclerosis: a regional analysis. Neurology 1992;42(7):1291-5.
34. Referans34. Cho S, Holyoak KJ, Cannon TD. Analogical reasoning in working memory: resources shared among relational integration, interference resolution, and maintenance. Mem Cognit 2007;35 (6):1445-55.
35. Referans35. Krawczyk DC, McClelland MM, Donovan CM, Tillman GD, Maguire MJ. An fMRI investigation of cognitive stages in reasoning by analogy. Brain Res 2010;1342:63-73.
36. Referans36. Westphal AJ, Reggente N, Ito KL, Rissman J. Shared and distinct contributions of rostrolateral prefrontal cortex to analogical reasoning and episodic memory retrieval. Hum Brain Mapp 2016;37(3):896-912.
37. Referans37. Watson CE, Chatterjee A. A bilateral frontoparietal network underlies visuospatial analogical reasoning. Neuroimage 2012; 59(3):2831-38.
38. Referans38. Hammer R, Paul EJ, Hillman CH, Kramer AF, Cohen NJ, Barbey AK. Individual differences in analogical reasoning revealed by multivariate task-based functional brain imaging. Neuroimage 2019;184:993-1004.
39. Referans39. Knowlton BJ, Morrison RG, Hummel JE, Holyoak KJ. A neurocomputational system for relational reasoning. Trends in Cognitive Sciences 2012;16(7):373-81.