Satgunasingam, Yamna; (2003) Executive function in Multiple Sclerosis. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Executive function refers to mechanisms which optimise performance in situations requiring multiple cognitive processes and is associated with the frontal lobes of the brain. There are various competing theories of executive function but current thinking in this area has moved towards identifying separable executive processes. It is well established that executive skills are compromised in patients with Multiple Sclerosis. This is thought to arise as a result of the effects of the disease process on the frontal regions of the brain, in the context of a disseminated pathology. An executive process that appears to have received relatively little attention in the MS research literature is the ability to initiate and suppress undesired verbal responses, despite clinical reports of disinhibition in some patients with MS. There is also evidence for impairment in the ability to switch between task demands and to manipulate information in working memory in this patient group. This thesis sets out to examine these executive processes in a group of people with MS. 22 participants with clinically definite or clinically probable MS, and 22 matched healthy controls, were assessed on a range of cognitive measures including tests of executive function. Participants also performed two new experimental tasks that were designed to examine the ability to switch demands and to inhibit verbal responses, particularly when the inhibitory demand was varied. The MS participants showed evidence of verbal disinhibition compared to the healthy controls, particularly when inhibitory demands were higher. There was further evidence of impairment in other executive functions in the MS group including working memory, in the context of poor performance on tasks of information processing speed. The MS group's ability to switch between task demands, however, appeared to be relatively preserved. The results partly confirm previous findings of cognitive dysfunction in MS but add to the knowledge about verbal disinhibition, set switching and working memory. There are important clinical implications that arise from these findings which are associated with improving the quality of life of people with MS.

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