Boston Meeting -- Part 2 -- Cognitive Function

[Guest guest]

I took especially good notes in this part of the meeting because it's

a problem that affects Rob and because Dr. Dan Press did such a good

job of explaining the issues. Here goes:

Cognitive issues:

- Occur only in some patients

- Only in " frontal lobe " tasks

- Does not correlate wtih the duration of the illness

- NOT dementia

Most types of cognition are spared in MSA. These functions usually

remain intact:

- Short term memory

- Long term memory

- Overall intelligence

- Language function (diffferent from speech)

Frontal Lobe functions can be impaired:

- The frontal lobe contains the " working memory " , or the abiltiy to

maintian information on-line.

- This includes the executive function, which is the ability to

order and manipulate tasks for maximum efficiency.

Working Memory

- Served by a frontal-subcortical network of regions of the brain.

- DOPAMINE CRITICAL FOR WORKING MEMORY FUNCTION (emphasis is mine!)

Possible contributors to working memory deficits:

- Normal aging (having a senior moment!)

- Depression

- Sleep problems

Additional causes in MSA

- Related to MSA pathology

- Subcortical deficit due to basal ganglia dysfunction

- Other medications

Treatment for working memory deficit

- Behavioral

- Pharmacological

Behavioral

- Avoid multi-tasking

- Break up tasks into parts, write them out, use as a checklist

- Use organizers (electronic or paper)

- Avoid sleep depravation

Pharmacological

- Stimulants

- Ritalin

- Adderal

- Antdepressants

- Not SSRI's

- Wellbutrin or Effexor

- Provigil (modafinil)

On to part 3....