Uticaj kognitivnih i motoričkih sposobnosti na stepen socijalne participacije kod obolelih od multiple skleroze

Abstract

Multipla skleroza (MS) je hronična, inflamatorna, demijelinizaciona i degenerativna bolest centralnog nervnog sistema koja rezultuje širokim spektrom invaliditeta. U sklopu bolesti mogu da se pojave brojni simptomi koji se ispoljavaju kroz poremećaje kognitivnih i motoričkih sposobnosti. Efekti kognitivne i motoričke disfunkcije su veliki i ne utiču samo na obolelog već i na člano e porodice i udruženi su sa socijalnom participacijom osoba sa MS. Ciljevi istraživanja su: utvrditi stepen socijalne participaci je, prisutnost poremećaja kognitivnih sposobnosti (pamćenja, verbalne fluentnosti, vizuo prostorne funkcije, govora i pažnje) i poremećaja motoričkih sposobnosti (manuelnih sposobnosti i hoda) kod obolelih od MS. Istraživanje je sprovedeno tokom 2013. i 2014. godine na Klinici za neurologi ju, Kliničkog centra Vojvodi ne. Uzorak je činilo 108 ispitanika obolelih od MS (relapsno-remitentna forma) starosti od 20 do 53 godine (AS 39,86 godina; SD 8,20 godina). Metode primenjene u istraživanju su: Opšti upitnik, Kognitivni skrining audio zapisom (Audio Recorded Cognitive Screen – ARCS), Tempom uslovljen auditivni test serijskog sabiranja (Paced Auditory Serial Additional Test – PASAT), Test 9 rupa (9 Hole Peg Test), Test 25 koraka (25 Foot Walk Test), Skala za procenu neurološkog deficita (Expanded Disability Status Scale – EDSS), Upitnik za procenu socijalne participacije i Skala za procenu invaliditeta 2.0 Svetske zdravstvene organizacije (World Health Organization Disability Assessment Schedule – WHO DAS 2.0). Prema našim rezultatima, niži stepen neurološkog deficita praćen je višom participacijom i višim nivoom aktuelnog funkcionisanja i obrnuto (r=0,43, p=0,00). Ispitanici sa blagim neurološkim deficitom imaju bolju participaciju (niži skor na WHO DAS 2.0 skali) od osoba sa izraženim neurološkim deficitom. Pozitivna korelacija postoji između stepena poremećaja kognitivnih sposobnosti i stepena neurološkog deficita kod obolelih od MS, odnosno veći neurološki deficit je praćen pri sutnošću kognitivnih deficita (r=-0,27, p=0,00). Osobe bez neurološkog deficita i osobe sa blagim neurološkim deficitom imaju značajno niže skorove odnosno bo lje motoričke sposobnosti i gornjih i donjih ekstremiteta od osoba sa izraženim neurološkim deficitom (p=0,00). Korelacije izme đu kognitivnog funkcionisanja merenog ARCS i aktuelnog nivoa funkcionisanja (invaliditeta) su negativne. Viši stepen invalidnosti praćen je i lošijim kognitivnim statusom. Hijerarhijskom regresionom analizom se proveravao zajednički doprinos svih prediktorskih varijabli u objašnjavanju ukupne participacije osoba sa MS. Najveći doprinos imaju starost ispitanika, kognitivne sposobnosti i motoričke sposobnosti gornjih ekstremiteta. Rezultati omogućavaju uvid u motoričke i kognitivne sposobnosti obolelih od MS kao i saznanja o faktorima koji utiču na stepen socijalne participacije. Na osnovu ovih rezultata moguće je planiranje programa rehabilitacije i psiho socijalne podrške obolelima od MS. ARCS može da se primenju je kao nova, jednostavna, efikasna i jeftina metoda u skriningu kognitivnih sposobnosti kod obolelih od MS.

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating degenerative disease of the central nervous system that results in a vast spectrum of disabilities. As part of the disease, many symptoms can occur that manifest as impairments of cognitive and motor abilities. The effects of cognitive and motor dysfunctions are significant and affect not only the patient but also his/her family, and are associated with the social participation of people with MS. The research objectives were to determine the degree of social participation, the presence of cognitive abilities (memory, verbal fluency, visuo spatial functions, speech and attention) and disorders of motor skills (manual skills and gait) in patients with MS. The study was conducted in 2013 and 2014 at the Neurology Clinic, Clinical Center of Vojvodina. The sample consisted of 108 patients suffering from the relapsing-remitting form of MS, aged 20-53 years (AS 39,86 years; SD 20,8 years). The methods applied in the study were the General Questionnaire, the Audio Recorded Cognitive Screen (ARCS), the Paced Auditory Serial Additional Test (PASAT), the 9 Hole Peg Test, the 25 Foot Walk Test, the Expanded Disability Status Scale (EDSS), and the World Health Organization Disability Assessment Schedule (WHO DAS 2.0). According to our results, a lower degree of neurological deficit was associated with a higher degree of participation and a higher level of current functioning, and vice versa (r= 0,43, p= 0,00). Subjects with mild neurological deficits had better social participation (a lower score on the WHO DAS 2.0 scale) compared with subjects with severe neurological deficits. A positive correlation was found between the degree of cognitive ability and the degree of neurological deficit in patients with MS, i.e. a greater neurological deficit was accompanied by the presence of cognitive deficits (r = -0,27, p= 0,00). Subjects with no neurological deficits and those with mild neurological deficits had significantly lower scores and better motor skills of both upper and lower extremities, compared with those with severe neurological deficits (p = 0,00). Correlations between cognitive functioning as measured by the ARCS and the current level of functioning (disability) were negative. A higher degree of disability was associated by a worse cognitive status. The hierarchical regression analysis was used to test the joint contribution of all predictor variables to the overall participation of people with MS. The highest contribution was found forage and cognitive and motor skills of upper extremities. The results provide insights in to the motor and cognitive abilities of patients with MS, as well as in formation about the factors influencing the level of their social participation. Based on these results it is possible to plan a program of rehabilitation and psychosocial support to patients with MS. The ARCS may be utilized as a new, simple, efficient and inexpensive method in the screening of cognitive abilities of people with MS.