Monthly Archives: September 2009

Review: Review Article on Cognitive Dysfunction in Multiple Sclerosis

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The featured paper is ‘Cognition in Multiple Sclerosis: A Review of Neuropsychological and fMRI Research’ by Genova and colleagues. As the title suggests the authors examine the characteristics of cognition in Multiple Sclerosis. I could not identify a stated methodology. However the authors cite 140 papers throughout the paper which is reflected in both the breadth and depth of  relevant material covered. Broadly speaking the paper is divided into a section on neuropsychological profiles and another on the findings in functional MRI studies. In terms of neuropsychological profiling, the authors cover constructs ranging from working memory through to fatigue. They focus on the relationship of processing speed to a number of other constructs and suggest that clarifying this relationship further would be an important aim for future research as it would have implications for therapeutic strategies. Essentially if processing speed impacts on working memory and complex task completion then research in this area would be expected to inform therapeutic strategies. On the other hand, if there are confounders then they suggest that this would necessitate multiple treatment approaches. The authors explain a number of concepts as they cover material and I found this quite helpful. I find that this approach works really well in review articles and more so in those that cover many domains. With regards to fMRI studies, the authors emphasise the neuropsychology. Again their arguments are easier to follow as the article is to some extent self-contained allowing referencing to previously explained concepts. The authors draw attention to some of the conflicting findings in the field and the reader is able to use this information to facilitate selection and interpretation of future studies in this area.

The authors have written a clear exposition of the subject, carefully explaining important concepts and leaving the impression that the subject has been comprehensively covered in the neuropsychological domain. The relevance of processing speed to cognitive dysfunction looks to be one of the big questions in this field at the moment.

References

Genova H M, Sumowksi J F, Chiaravalloti N, Voelbel G T and DeLuca J. Cognition in multiple sclerosis: a review of neuropsychological and fMRI research.

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The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog

Index

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Review: Frontal-Subcortical Dementias

Model Brain

The article reviewed here is itself a review article ‘Frontal-Subcortical Dementias’ by Raphael Bonelli and Jeffrey L Cummings. Cummings is a prominent figure in the field of Subcortical Dementia and has edited a book on the subject. This article is what I would term an expert review. Although there is no stated methodology there is a carefully considered overview of the field with the authors demonstrating a deep understanding of the field. They argue for the existence of a frontal-subcortical dementia. Thus they group an extensive list of conditions under this heading for the purpose of identifying common clinical features. While the section on anatomical circuits of frontal-subcortical dementia is useful, I found the discussion of neuropsychological features in the frontal-subcortical dementias to be particularly interesting. One of the tables in the paper covers ‘contrasting characteristics of cortical and frontal-subcortical dementia syndromes’ and distills a lot of material into an easily understandable format. The two types of dementia are contrasted in domains such as memory, visuospatial skills, calculation and mood. Even the simple presentation of the material in this way offers the reader a new perspective on a heterogenous conditions which they demonstrate have just as many shared properties as they do differences. The concept of a frontal-subcortical dementia may become more influential and it will be interesting to see how this develops.

References

Raphael Bonelli and Jeffrey L Cummings. Frontal-Subcortical Dementias. Review Article. The Neurologist. Vol 14. Number 2. 2008. 100-107.

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Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog