The characteristics of a national register of people with multiple sclerosis (MS): a comparison between the ARMS (Action for Research into Multiple Sclerosis) register and 10 British MS populations

Multiple sclerosis: disability profile and quality of life in an Australian community cohort

The objective of this study was to determine the experience of disability and reported symptoms in multiple sclerosis in an Australian community sample, comparing the perceptions of patients, carers and treating doctors, and to examine effects on quality of life, carer stress and utilization of health services. The study design used a prospective cross sectional community survey. The participants were persons with a confirmed diagnosis of multiple sclerosis, with quantified neurological, mobility and cognitive deficits, from a tertiary hospital database (n=101), who lived at home, and their carers and doctors. The study method used demographic, diagnostic and disease severity data extracted from the database. Structured interviews conducted at home included: (1) open questionnaires for participant, carer and general practitioner, prioritizing symptoms/problems affecting daily living; and (2) standardized assessments for patient quality of life, caregiver strain and perceived burden of care. The mean age was 49 years (range 28-64). Those more severely affected had a significantly reduced quality of life and increased carer burden than those with milder disability, but discordance between patients, carers and doctors was noted in their perception of problems and symptom experience. Rates of depression (67%) and work-related problems were high, but vocational support was rarely provided. Forty persons used interferon, of whom 20 had secondary progressive multiple sclerosis; 39% reported difficulty in accessing rehabilitation services and only 10% were referred to medical rehabilitation units. In conclusion, the rates of disability and symptom experience were similar to other series; however, access and utilization of appropriate rehabilitation and support services appears to be lacking. There were higher reported rates of depression and poor quality of life. Opportunities may possibly exist to re-deploy resources to develop vocational support, counselling and rehabilitation.

The Danish Multiple Sclerosis Registry: a 50-year follow-up

The Danish Multiple Sclerosis Registry was established in 1948 in continuation with a nationwide survey of the prevalence of Multiple Sclerosis (MS) in Denmark. The register has since collected information on MS patients from all Danish departments of neurology, practising neurologists, MS rehabilitation centres, the National Patient Registry, the Danish MS Society, and departments of neuropathology. The registry is linked with the Danish Central Population Registry. The completeness has been estimated at more than 90%. All cases are reclassified by two neurologists as to diagnosis and year of onset. 12 070 cases with a confirmed diagnosis of MS are kept in the databases. They were prevalent in 1949 or have had onset in the period 1948 - 1993. The registry is continuously updated with new information on registered cases and new cases. The crude average annual incidence rate 1980 - 89 was 4.99/105; the prevalence rate was 112/105 by 1 January 1990. Cross-linking with other registers have enabled analytical prospective epidemiological studies, and the registry has provided population based unbiased samples of patients for a number of clinical studies.

The role of executive function in imagery mnemonics: evidence from multiple sclerosis

The use of imagery in learning and memory involves metacognitive skills that seem to depend upon executive function as well as motivational mechanisms. This implies that the efficacy of imagery mnemonics should be impaired in neurological patients who show either executive dysfunction or affective disorders. This hypothesis was tested in patients with multiple sclerosis. Imagery instructions led to improved recall in three different tasks, although experimenter-generated imagery proved to be more effective than subject-generated imagery and there was little evidence that patients maintained the use of imagery mnemonics on follow-up testing. Three other tasks defined a unitary trait of executive processing efficiency, and this was significantly correlated with the benefit obtained from the use of the Method of Loci in a free-recall tasks, but not with the benefit gained from other imagery mnemonics. The patients' scores, on a widely used depression inventory, were not significantly correlated with the benefit obtained from the use of imagery mnemonics. Nonetheless, it is concluded that executive processing capacity determines the benefit that is derived from the use of more complex forms of imagery mnemonic in verbal-learning tasks.

Experiencing symptoms in chronic illness: fatigue in multiple sclerosis

This paper examines the various ways in which symptoms of chronic illness may be experienced. With particular reference to fatigue in multiple sclerosis, it discusses how the conceptualization of symptoms as discrete entities requiring targeted action (common in much current writing on chronic illness) is only one form in which physical disorder may be recognized by those directly affected, and one which probably applies little in the course of everyday life. The paper draws attention to the significance of personal and social context in symptom definition and to the implications for the measurement of symptoms and for advice to patients on management.