Anomia in people with Relapsing - Remitting Multiple Sclerosis: Investigating the nature and extent of the problem and taking steps toward better assessment and treatment.

Abstract

Multiple Sclerosis (MS) is a neurodegenerative inflammatory disease characterised by demyelination and axonal loss in both, white and grey matter. It affects motor, sensory, cognitive and language functions. Language impairments have only recently been studied as a clinical manifestation, with word retrieval deficits as the most common symptoms. Anomia is also the most self-reported language feature between people with MS and even subtle deficits can affect communicative participation and quality of life. This thesis investigated the extent and nature of anomia in people with Relapsing – Remitting (RR) MS through behavioural and imaging analyses and evaluated the use of a word retrieval software-based treatment as a form of self-management of anomic symptoms. In order to explore the scope of anomia in the context of cognitive, linguistic and speech production skills, 151 participants with RR MS were assessed using general cognition tasks and a bespoke picture test which focused on accuracy and latency. Next, in order to understand the factors involved in the anomic symptoms, a wide array of neuropsychological and communication assessments were conducted with the RR MS participants (n=21). Later, the efficacy of a novel word retrieval software-based treatment for anomic symptoms was examined in participants (n=13), which focused on combined accuracy and speed intervention. Finally, grey matter (GM) volumes of 105 participants with RR MS were assessed and compared with healthy individuals as well their relationship with verbal fluency tests outcomes, as a means to a better understanding of the neural nature of verbal fluency in RR MS. Results showed that participants with RR MS often present with anomic symptoms characterised as word retrieval inaccuracy and delayed latency. It was established that anomia could not be fully explained by speech deficits such as dysarthria and that difficulties in naming retrieval may have stemmed from a disruption in the systems of working memory and speed of information processing, and deficits in the semantic access, search and/or memory store. Furthermore, MRI on GM volumes suggested that low scores in verbal fluency tasks showed a general decline in information processing skills. Finally, we observed that word retrieval therapy produced gains in naming accuracy and latency and these could be generalised to connected speech task. However, the speeded therapy did not give an advantage for improving confrontational naming. In conclusion, anomia is a common symptom in RR MS and could be described as a cognitive-communication disorder rather than a pure language deficit. Targeted early interventions could help to improve or maintain language abilities in people with RR-MS which may enhance their quality of life.

Date of Award	1 Aug 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Paul Conroy (Supervisor), David Rog (Supervisor) & Nils Muhlert (Supervisor)