1
|
Goerling U, Ernst J, Esser P, Haering C, Hermann M, Hornemann B, Hövel P, Keilholz U, Kissane D, von dem Knesebeck O, Lordick F, Springer F, Zingler H, Zimmermann T, Engel C, Mehnert-Theuerkauf A. Estimating the prevalence of mental disorders in patients with newly diagnosed cancer in relation to socioeconomic status: a multicenter prospective observational study. ESMO Open 2024; 9:103655. [PMID: 39088984 DOI: 10.1016/j.esmoop.2024.103655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND The purpose of this study was to provide the 4-week prevalence estimates of mental disorders in newly diagnosed cancer patients in relation to socioeconomic status (SES). PATIENTS AND METHODS We enrolled newly diagnosed patients with a confirmed solid tumor within 2 months of diagnosis. We calculated patients' SES on the basis of their educational level, professional qualification, income and occupational status. We used the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-Clinical Version (SCID-5-CV) to assess the 4-week prevalence of mental disorders in addition to a comorbidity questionnaire to assess the level of physical impairment. RESULTS We identified a total of 1702 patients with mixed cancers after reviewing their medical records and contacting them in person or by post due to coronavirus pandemic patient safety restrictions. 1030 patients (53.2% men, mean age 60.2 years) had completed SCID-5-CV. When weighted according to the SES distribution to account for over- and under-sampling of SES groups, 20.9% [95% confidence interval (CI) 18.1% to 23.6%] of patients were diagnosed with any mental disorder. The most prevalent were depressive disorders (9.9%, 95% CI 7.9% to 11.9%), trauma and stress-related disorders (6.3%, 95% CI 4.7% to 7.9%) and anxiety disorders (4.2%, 95% CI 2.9% to 5.6%). We found no difference in any mental disorder between patients with high, medium or low SES. Multivariate logistic regression analyses revealed higher proportion of patients with any mental disorder in patients younger than 60 years [odds ratio (OR) 0.42; P < 0.001], in patients without a partner (OR 1.84; P < 0.001), in women with tumor in female genital organs (OR 2.45; P < 0.002) and in those with a higher level of impairment (OR 1.05, 95% CI 1.03-1.07; P < 0.001). CONCLUSIONS SES had no significant influence on mental comorbidity in early cancer survivorship.
Collapse
Affiliation(s)
- U Goerling
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Berlin
| | - J Ernst
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig
| | - P Esser
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig
| | - C Haering
- Comprehensive Cancer Center, University Clinic Centre Dresden, Dresden, Germany
| | - M Hermann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Berlin
| | - B Hornemann
- Comprehensive Cancer Center, University Clinic Centre Dresden, Dresden, Germany
| | - P Hövel
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig
| | - U Keilholz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Berlin
| | - D Kissane
- School of Medicine, University of Notre Dame Australia, Sydney; Departments of Palliative Care, Cabrini Health, Melbourne; Department of Palliative Care, St Vincent's Hospital Sydney, Sydney; School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - O von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - F Lordick
- Department of Medicine II (Oncology, Gastroenterology, Hepatology, and Pulmonology), Comprehensive Cancer Center Central Germany (CCCG), University of Leipzig Medical Center, Leipzig
| | - F Springer
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig
| | - H Zingler
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover
| | - T Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover
| | - C Engel
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - A Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig.
| |
Collapse
|
2
|
Tryfonos C, Pavlidou E, Vorvolakos T, Alexatou O, Vadikolias K, Mentzelou M, Tsourouflis G, Serdari A, Antasouras G, Papadopoulou SK, Aggelakou EP, Giaginis C. Association of Higher Mediterranean Diet Adherence With Lower Prevalence of Disability and Symptom Severity, Depression, Anxiety, Stress, Sleep Quality, Cognitive Impairment, and Physical Inactivity in Older Adults With Multiple Sclerosis. J Geriatr Psychiatry Neurol 2024; 37:318-331. [PMID: 38018355 DOI: 10.1177/08919887231218754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
A good nutritional status and healthy diets may decelerate disease disability and symptom severity and quality of life of peoples with multiple sclerosis (MS). Mediterranean diet (MD) can prevent several chronic diseases, including neurodegenerative disease. This is an observational, cross-sectional study on 279 older adults with MS, aiming to investigate the effects of MD against several aspects of mental health. Qualified questionnaires were used to assess disability and symptom severity, depression, anxiety, stress, sleep quality, cognitive status, physical activity, and MD adherence. Multivariate analysis showed that enhanced MD adherence was independently associated with lower prevalence of disability and symptom severity (P = .0019), depression (P = .0201), anxiety (P = .0287), perceived stress (P = .0021), inadequate sleep quality (P = .0033), cognitive impairment (P = .0018) and physical inactivity (P = .0028). Adopting MD may ameliorate mental health disturbances in older adults with MS. Future public health policies should inform older adults with MS for the favorable impacts of MD in improving the mental health MS comorbidities.
Collapse
Affiliation(s)
- Christina Tryfonos
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Greece
| | - Theofanis Vorvolakos
- Department of Geriatric Psychiatry, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Greece
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Greece
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, Athens, Greece
| | - Aspasia Serdari
- Department of Geriatric Psychiatry, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | | | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Greece
| |
Collapse
|
3
|
Kowalec K, Harder A, Dolovich C, Fitzgerald KC, Salter A, Lu Y, Bernstein CN, Bolton JM, Cutter G, Fisk JD, Gelernter J, Graff LA, Hägg S, Hitchon CA, Levey DF, Lublin FD, McKay KA, Patten S, Patki A, Stein MB, Tiwari HK, Wolinsky JS, Marrie RA. Polygenic liability for anxiety in association with comorbid anxiety in multiple sclerosis. Ann Clin Transl Neurol 2024; 11:1393-1404. [PMID: 38715244 PMCID: PMC11187942 DOI: 10.1002/acn3.52025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/03/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Comorbid anxiety occurs often in MS and is associated with disability progression. Polygenic scores offer a possible means of anxiety risk prediction but often have not been validated outside the original discovery population. We aimed to investigate the association between the Generalized Anxiety Disorder 2-item scale polygenic score with anxiety in MS. METHODS Using a case-control design, participants from Canadian, UK Biobank, and United States cohorts were grouped into cases (MS/comorbid anxiety) or controls (MS/no anxiety, anxiety/no immune disease or healthy). We used multiple anxiety measures: current symptoms, lifetime interview-diagnosed, and lifetime self-report physician-diagnosed. The polygenic score was computed for current anxiety symptoms using summary statistics from a previous genome-wide association study and was tested using regression. RESULTS A total of 71,343 individuals of European genetic ancestry were used: Canada (n = 334; 212 MS), UK Biobank (n = 70,431; 1,390 MS), and the USA (n = 578 MS). Meta-analyses identified that in MS, each 1-SD increase in the polygenic score was associated with ~50% increased odds of comorbid moderate anxious symptoms compared to those with less than moderate anxious symptoms (OR: 1.47, 95% CI: 1.09-1.99). We found a similar direction of effects in the other measures. MS had a similar anxiety genetic burden compared to people with anxiety as the index disease. INTERPRETATION Higher genetic burden for anxiety was associated with significantly increased odds of moderate anxious symptoms in MS of European genetic ancestry which did not differ from those with anxiety and no comorbid immune disease. This study suggests a genetic basis for anxiety in MS.
Collapse
Affiliation(s)
- Kaarina Kowalec
- Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Arvid Harder
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Casandra Dolovich
- Department of Internal MedicineMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | | | - Amber Salter
- Department of NeurologyUT SouthwesternDallasTexasUSA
| | - Yi Lu
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Charles N. Bernstein
- Department of Internal MedicineMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - James M. Bolton
- Department of PsychiatryMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Gary Cutter
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - John D. Fisk
- Nova Scotia Health and Departments of Psychiatry, Psychology & Neuroscience, and MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Joel Gelernter
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryVA Connecticut Healthcare SystemNew HavenConnecticutUSA
| | - Lesley A. Graff
- Department of Clinical Health PsychologyMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Sara Hägg
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Carol A. Hitchon
- Department of RheumatologyMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Daniel F. Levey
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryVA Connecticut Healthcare SystemNew HavenConnecticutUSA
| | - Fred D. Lublin
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kyla A. McKay
- Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden
| | - Scott Patten
- Department of Community Health SciencesCumming School of Medicine, University of CalgaryCalgaryCanada
| | - Amit Patki
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Murray B. Stein
- Department of PsychiatryMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Hemant K. Tiwari
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jerry S. Wolinsky
- Department of NeurologyMcGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Ruth A. Marrie
- Department of Internal MedicineMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
- Department of Community Health SciencesMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| |
Collapse
|
4
|
Pierret C, Mainguy M, Leray E. Prevalence of multiple sclerosis in France in 2021: Data from the French health insurance database. Rev Neurol (Paris) 2024; 180:429-437. [PMID: 38423846 DOI: 10.1016/j.neurol.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND France is among the countries with high prevalence of multiple sclerosis (MS). The most recent estimates are from 2012 and need to be updated because MS prevalence has increased worldwide. OBJECTIVE To estimate MS prevalence in France on December 31, 2021 and to describe the characteristics of the French MS population using data from the French national health insurance database (SNDS). MATERIAL AND METHODS Persons with MS (PwMS) were identified in the SNDS database (99% of national coverage) using an algorithm with three criteria: long-term disease status, hospitalizations, and MS-specific drug reimbursements. Crude and sex- and age-stratified prevalence rates were calculated with their 95% confidence intervals as well as the standardized prevalence stratified on the region of residence. RESULTS In total, 134,062 PwMS were identified (71.8% of women, median age 53.0±14.8years) yielding a prevalence of 197.6 per 100,000 (95% CI [196.5-198.7]). Prevalence rates in women and men were respectively 274.9 (95% CI [273.2-276.6]) and 115.2 (95% CI [114.0-116.4]). In metropolitan France, the highest prevalence rates were observed in the northeastern regions (e.g.>230 PwMS per 100,000 in Grand Est and Hauts-de-France), and the lowest rates in the southwestern regions (∼180 PwMS per 100,000 in Nouvelle-Aquitaine and Occitanie). Overall, 32.1% of PwMS had another long-term disease and 51.8% received at least one MS-specific drug in 2021. CONCLUSION MS prevalence in France has increased by ∼30% in the last 10years. This increase is probably linked to population ageing, longer survival of PwMS, and the long observation period. The part attributable to a possible increase in MS risk remains to be determined with incidence studies.
Collapse
Affiliation(s)
- C Pierret
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France.
| | - M Mainguy
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
| | - E Leray
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
| |
Collapse
|
5
|
Henderson K, Reihm J, Koshal K, Wijangco J, Sara N, Miller N, Doyle M, Mallory A, Sheridan J, Guo CY, Oommen L, Rankin KP, Sanders S, Feinstein A, Mangurian C, Bove R. A Closed-Loop Digital Health Tool to Improve Depression Care in Multiple Sclerosis: Iterative Design and Cross-Sectional Pilot Randomized Controlled Trial and its Impact on Depression Care. JMIR Form Res 2024; 8:e52809. [PMID: 38488827 PMCID: PMC10980989 DOI: 10.2196/52809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND People living with multiple sclerosis (MS) face a higher likelihood of being diagnosed with a depressive disorder than the general population. Although many low-cost screening tools and evidence-based interventions exist, depression in people living with MS is underreported, underascertained by clinicians, and undertreated. OBJECTIVE This study aims to design a closed-loop tool to improve depression care for these patients. It would support regular depression screening, tie into the point of care, and support shared decision-making and comprehensive follow-up. After an initial development phase, this study involved a proof-of-concept pilot randomized controlled trial (RCT) validation phase and a detailed human-centered design (HCD) phase. METHODS During the initial development phase, the technological infrastructure of a clinician-facing point-of-care clinical dashboard for MS management (BRIDGE) was leveraged to incorporate features that would support depression screening and comprehensive care (Care Technology to Ascertain, Treat, and Engage the Community to Heal Depression in people living with MS [MS CATCH]). This linked a patient survey, in-basket messages, and a clinician dashboard. During the pilot RCT phase, a convenience sample of 50 adults with MS was recruited from a single MS center with 9-item Patient Health Questionnaire scores of 5-19 (mild to moderately severe depression). During the routine MS visit, their clinicians were either asked or not to use MS CATCH to review their scores and care outcomes were collected. During the HCD phase, the MS CATCH components were iteratively modified based on feedback from stakeholders: people living with MS, MS clinicians, and interprofessional experts. RESULTS MS CATCH links 3 features designed to support mood reporting and ascertainment, comprehensive evidence-based management, and clinician and patient self-management behaviors likely to lead to sustained depression relief. In the pilot RCT (n=50 visits), visits in which the clinician was randomized to use MS CATCH had more notes documenting a discussion of depressive symptoms than those in which MS CATCH was not used (75% vs 34.6%; χ21=8.2; P=.004). During the HCD phase, 45 people living with MS, clinicians, and other experts participated in the design and refinement. The final testing round included 20 people living with MS and 10 clinicians including 5 not affiliated with our health system. Most scoring targets for likeability and usability, including perceived ease of use and perceived effectiveness, were met. Net Promoter Scale was 50 for patients and 40 for clinicians. CONCLUSIONS Created with extensive stakeholder feedback, MS CATCH is a closed-loop system aimed to increase communication about depression between people living with MS and their clinicians, and ultimately improve depression care. The pilot findings showed evidence of enhanced communication. Stakeholders also advised on trial design features of a full year long Department of Defense-funded feasibility and efficacy trial, which is now underway. TRIAL REGISTRATION ClinicalTrials.gov NCT05865405; http://tinyurl.com/4zkvru9x.
Collapse
Affiliation(s)
- Kyra Henderson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Reihm
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kanishka Koshal
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jaeleene Wijangco
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Narender Sara
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nicolette Miller
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Marianne Doyle
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Alicia Mallory
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Judith Sheridan
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Chu-Yueh Guo
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Lauren Oommen
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine P Rankin
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Stephan Sanders
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
6
|
Henderson K, Reihm J, Koshal K, Wijangco J, Miller N, Sara N, Doyle M, Mallory A, Sheridan J, Guo CY, Oommen L, Feinstein A, Mangurian C, Lazar A, Bove R. Pragmatic phase II clinical trial to improve depression care in a real-world diverse MS cohort from an academic MS centre in Northern California: MS CATCH study protocol. BMJ Open 2024; 14:e077432. [PMID: 38401894 PMCID: PMC10895222 DOI: 10.1136/bmjopen-2023-077432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/25/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Depression occurs in over 50% of individuals living with multiple sclerosis (MS) and can be treated using many modalities. Yet, it remains: under-reported by patients, under-ascertained by clinicians and under-treated. To enhance these three behaviours likely to promote evidence-based depression care, we engaged multiple stakeholders to iteratively design a first-in-kind digital health tool. The tool, MS CATCH (Care technology to Ascertain, Treat, and engage the Community to Heal depression in patients with MS), closes the communication loop between patients and clinicians. Between clinical visits, the tool queries patients monthly about mood symptoms, supports patient self-management and alerts clinicians to worsening mood via their electronic health record in-basket. Clinicians can also access an MS CATCH dashboard displaying patients' mood scores over the course of their disease, and providing comprehensive management tools (contributing factors, antidepressant pathway, resources in patient's neighbourhood). The goal of the current trial is to evaluate the clinical effect and usability of MS CATCH in a real-world clinical setting. METHODS AND ANALYSIS MS CATCH is a single-site, phase II randomised, delayed start, trial enrolling 125 adults with MS and mild to moderately severe depression. Arm 1 will receive MS CATCH for 12 months, and arm 2 will receive usual care for 6 months, then MS CATCH for 6 months. Clinicians will be randomised to avoid practice effects. The effectiveness analysis is superiority intent-to-treat comparing MS CATCH to usual care over 6 months (primary outcome: evidence of screening and treatment; secondary outcome: Hospital Anxiety Depression Scale-Depression scores). The usability of the intervention will also be evaluated (primary outcome: adoption; secondary outcomes: adherence, engagement, satisfaction). ETHICS AND DISSEMINATION University of California, San Francisco Institutional Review Board (22-36620). The findings of the study are planned to be shared through conferences and publishments in a peer-reviewed journal. The deidentified dataset will be shared with qualified collaborators on request, provision of CITI and other certifications, and data sharing agreement. We will share the results, once the data are complete and analysed, with the scientific community and patient/clinician participants through abstracts, presentations and manuscripts. TRIAL REGISTRATION NUMBER NCT05865405.
Collapse
Affiliation(s)
- Kyra Henderson
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Reihm
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Kanishka Koshal
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jaeleene Wijangco
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Nicolette Miller
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Narender Sara
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Marianne Doyle
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Alicia Mallory
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Judith Sheridan
- Patient Stakeholder, University of California San Francisco, San Francisco, California, USA
| | - Chu-Yueh Guo
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Lauren Oommen
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christina Mangurian
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Ann Lazar
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
7
|
Dakanalis A, Tryfonos C, Pavlidou E, Vadikolias K, Papadopoulou SK, Alexatou O, Vorvolakos T, Chrysafi M, Fotiou D, Mentzelou M, Serdari A, Chatzidimitriou M, Dimoliani S, Tsourouflis G, Giaginis C. Associations between Mediterranean Diet Adherence, Quality of Life, and Mental Health in Patients with Multiple Sclerosis: A Cross-Sectional Study. J Pers Med 2024; 14:199. [PMID: 38392632 PMCID: PMC10890719 DOI: 10.3390/jpm14020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The Mediterranean diet (MD) is well-known as a diet which may exert a protective effect against neurodegenerative diseases, including multiple sclerosis (MS). To date, only a few clinical surveys have assessed the potential effects of the MD in patients with MS. The purpose of the present study is to evaluate the potential effects of MD compliance on disease disability, quality of life, physical activity, depressive symptomatology, and blood biochemical parameters related to nutritional status in MS patients, considering several socio-demographic, anthropometric, and lifestyle characteristics. METHODS This is a cross-sectional study conducted on 558 adults with MS aged 18-64 years. Relevant questionnaires were utilized to evaluate socio-demographic and anthropometric parameters, disease disability (Expanded Disability Status Scale, EDSS), multidimensional health-related quality (MS Quality of Life-54, MSQOL-54), physical activity levels (International Physical Activity Questionnaire, IPAQ), depression (Beck Depression Inventory II, BDI-II), and MD adherence (MedDietScore), while several blood biochemical parameters were retrieved from the patients' medical records. RESULTS Enhanced MD compliance was independently associated with a decreased frequency of overweight/obesity, as well as abdominal obesity, in patients suffering from MS. Elevated MD compliance was also independently associated with a decreased incidence of advanced disease disability, a higher prevalence of elevated physical activity, an improved quality of life, and lower depressive symptoms, as well as higher levels of certain blood biochemical parameters, which are effective indicators of iron deficiency and malnutrition. CONCLUSIONS The present study found that higher MD adherence may slow down disease disability, promoting a better quality of life and mental health in adults with MS. Future prospective surveys are required to obtain conclusive results.
Collapse
Affiliation(s)
- Antonios Dakanalis
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Christina Tryfonos
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Chrysafi
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Dimitrios Fotiou
- Department of Neurology, School of Medicine, Aristoteleio University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Aspasia Serdari
- Department of Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Chatzidimitriou
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Sophia Dimoliani
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Gerasimos Tsourouflis
- Second Department of Surgery, Propedeutic, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| |
Collapse
|
8
|
Sun D, Wang R, Du Q, Zhang Y, Chen H, Shi Z, Wang X, Zhou H. Causal relationship between multiple sclerosis and cortical structure: a Mendelian randomization study. J Transl Med 2024; 22:83. [PMID: 38245759 PMCID: PMC10800041 DOI: 10.1186/s12967-024-04892-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/13/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Observational studies have suggested an association between multiple sclerosis (MS) and cortical structure, but the results have been inconsistent. OBJECTIVE We used two-sample Mendelian randomization (MR) to assess the causal relationship between MS and cortical structure. METHODS MS data as the exposure trait, including 14,498 cases and 24,091 controls, were obtained from the International Multiple Sclerosis Genetics Consortium. Genome-wide association study (GWAS) data for cortical surface area (SAw/nw) and thickness (THw/nw) in 51,665 individuals of European ancestry were obtained from the ENIGMA Consortium. The inverse-variance weighted (IVW) method was used as the primary analysis for MR. Sensitivity analyses were conducted to evaluate heterogeneity and pleiotropy. Enrichment analysis was performed on MR analyses filtered by sensitivity analysis. RESULTS After IVW and sensitivity analysis filtering, only six surviving MR results provided suggestive evidence supporting a causal relationship between MS and cortical structure, including lingual SAw (p = .0342, beta (se) = 5.7127 (2.6969)), parahippocampal SAw (p = .0224, beta (se) = 1.5577 (0.6822)), rostral middle frontal SAw (p = .0154, beta (se) = - 9.0301 (3.7281)), cuneus THw (p = .0418, beta (se) = - 0.0020 (0.0010)), lateral orbitofrontal THw (p = .0281, beta (se) = 0.0025 (0.0010)), and lateral orbitofrontal THnw (p = .0417, beta (se) = 0.0029 (0.0014)). Enrichment analysis suggested that leukocyte cell-related pathways, JAK-STAT signaling pathway, NF-kappa B signaling pathway, cytokine-cytokine receptor interaction, and prolactin signaling pathway may be involved in the effect of MS on cortical morphology. CONCLUSION Our results provide evidence supporting a causal relationship between MS and cortical structure. Enrichment analysis suggests that the pathways mediating brain morphology abnormalities in MS patients are mainly related to immune and inflammation-driven pathways.
Collapse
Affiliation(s)
- Dongren Sun
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Ying Zhang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China.
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China.
| |
Collapse
|
9
|
Pollock NM, Fernandes JP, Woodfield J, Moussa E, Hlavay B, Branton WG, Wuest M, Mohammadzadeh N, Schmitt L, Plemel JR, Julien O, Wuest F, Power C. Gasdermin D activation in oligodendrocytes and microglia drives inflammatory demyelination in progressive multiple sclerosis. Brain Behav Immun 2024; 115:374-393. [PMID: 37914099 DOI: 10.1016/j.bbi.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023] Open
Abstract
Neuroinflammation coupled with demyelination and neuro-axonal damage in the central nervous system (CNS) contribute to disease advancement in progressive multiple sclerosis (P-MS). Inflammasome activation accompanied by proteolytic cleavage of gasdermin D (GSDMD) results in cellular hyperactivation and lytic death. Using multiple experimental platforms, we investigated the actions of GSDMD within the CNS and its contributions to P-MS. Brain tissues from persons with P-MS showed significantly increased expression of GSDMD, NINJ1, IL-1β, and -18 within chronic active demyelinating lesions compared to MS normal appearing white matter and nonMS (control) white matter. Conditioned media (CM) from stimulated GSDMD+/+ human macrophages caused significantly greater cytotoxicity of oligodendroglial and neuronal cells, compared to CM from GSDMD-/- macrophages. Oligodendrocytes and CNS macrophages displayed increased Gsdmd immunoreactivity in the central corpus callosum (CCC) of cuprizone (CPZ)-exposed Gsdmd+/+ mice, associated with greater demyelination and reduced oligodendrocyte precursor cell proliferation, compared to CPZ-exposed Gsdmd-/- animals. CPZ-exposed Gsdmd+/+ mice exhibited significantly increased G-ratios and reduced axonal densities in the CCC compared to CPZ-exposed Gsdmd-/- mice. Proteomic analyses revealed increased brain complement C1q proteins and hexokinases in CPZ-exposed Gsdmd-/- animals. [18F]FDG PET imaging showed increased glucose metabolism in the hippocampus and whole brain with intact neurobehavioral performance in Gsdmd-/- animals after CPZ exposure. GSDMD activation in CNS macrophages and oligodendrocytes contributes to inflammatory demyelination and neuroaxonal injury, offering mechanistic and potential therapeutic insights into P-MS pathogenesis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Laura Schmitt
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton AB, Canada.
| | | | | | | | - Christopher Power
- Department of Medicine (Neurology), Canada; Department of Medical Microbiology & Immunology, Canada.
| |
Collapse
|
10
|
Hunter EA, Meyer JM, Brown GM, Hanks MA. Stress indicators in minorities with multiple sclerosis. Mult Scler Relat Disord 2023; 78:104914. [PMID: 37499341 DOI: 10.1016/j.msard.2023.104914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/12/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023]
Abstract
Black Americans with multiple sclerosis (MS) experience higher levels of disease-related disability compared to White Americans (Marrie et al., 2006). Comorbidities such as depression and anxiety, which are underdiagnosed and undertreated in this population, negatively impact quality of life and treatment outcomes for people living with multiple sclerosis (plwMS) (D'Alisa et al., 2006; Marrie et al., 2009; Stepleman et al., 2014). Acts of discrimination toward Black Americans is associated with stress, which is a contributing factor for depression (Carter, 2017; Nadimpalli, 2015; Williams and Mohammed, 2009). This study compared the severity of multiple sclerosis symptoms amongst Black Americans and White Americans, and whether worsened MS symptoms in Black Americans are associated with increased experiences of discrimination. Data was analyzed from 143 plwMS in the Stress Indicators in Minorities with Multiple Sclerosis (SiMMS) study. Using the Mann-Whitney U test, significant differences were found on the NIH Emotional Distress - Anxiety measure (U = 1466.500, p = 0.045) and NIH Sleep Disturbance measure (U = 1467.000, p = 0.044) between the Black participant and the White participant groups. Discrimination was significantly correlated with both NIH Emotional Distress - Anxiety (r = 0.677, p < .001) and NIH Sleep Disturbance (r = 0.446, p = .007) in Black MS individuals. Additionally, several physiological condition and psychological outcome measures were correlated with the NIH Emotional Distress - Anxiety and NIH Sleep Disturbance measures. This study contributes to literature highlighting the negative impacts of discrimination and race related stress on the physical and mental health of Black Americans.
Collapse
Affiliation(s)
- Evelyn A Hunter
- Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, United States.
| | - J M Meyer
- Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, United States
| | - G M Brown
- Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, United States
| | - M A Hanks
- Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, United States
| |
Collapse
|
11
|
Uher T, Adzima A, Srpova B, Noskova L, Maréchal B, Maceski AM, Krasensky J, Stastna D, Andelova M, Novotna K, Vodehnalova K, Motyl J, Friedova L, Lindner J, Ravano V, Burgetova A, Dusek P, Fialova L, Havrdova EK, Horakova D, Kober T, Kuhle J, Vaneckova M. Diagnostic delay of multiple sclerosis: prevalence, determinants and consequences. Mult Scler 2023; 29:1437-1451. [PMID: 37840276 PMCID: PMC10580682 DOI: 10.1177/13524585231197076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Early diagnosis and treatment of patients with multiple sclerosis (MS) are associated with better outcomes; however, diagnostic delays remain a major problem. OBJECTIVE Describe the prevalence, determinants and consequences of delayed diagnoses. METHODS This single-centre ambispective study analysed 146 adult relapsing-remitting MS patients (2016-2021) for frequency and determinants of diagnostic delays and their associations with clinical, cognitive, imaging and biochemical measures. RESULTS Diagnostic delays were identified in 77 patients (52.7%), including 42 (28.7%) physician-dependent cases and 35 (24.0%) patient-dependent cases. Diagnosis was delayed in 22 (15.1%) patients because of misdiagnosis by a neurologist. A longer diagnostic delay was associated with trends towards greater Expanded Disability Status Scale (EDSS) scores (B = 0.03; p = 0.034) and greater z-score of the blood neurofilament light chain (B = 0.35; p = 0.031) at the time of diagnosis. Compared with patients diagnosed at their first clinical relapse, patients with a history of >1 relapse at diagnosis (n = 63; 43.2%) had a trend towards greater EDSS scores (B = 0.06; p = 0.006) and number of total (B = 0.13; p = 0.040) and periventricular (B = 0.06; p = 0.039) brain lesions. CONCLUSION Diagnostic delays in MS are common, often determined by early misdiagnosis and associated with greater disease burden.
Collapse
Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Adrian Adzima
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Libuse Noskova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland/Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland/Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Aleksandra Maleska Maceski
- Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan Krasensky
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Dominika Stastna
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Klara Novotna
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jiri Motyl
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Lucie Friedova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jiri Lindner
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland/Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland/Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Andrea Burgetova
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic/Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Lenka Fialova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland/Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland/Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Manuela Vaneckova
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| |
Collapse
|
12
|
Guerrero KS, Horton MK, Choudhary V, Bellesis KH, Dorin P, Mei J, Chinn T, Meyers TJ, Schaefer CA, Barcellos LF. Adverse childhood experiences in early life increase the odds of depression among adults with multiple sclerosis. Mult Scler J Exp Transl Clin 2023; 9:20552173231202638. [PMID: 37808459 PMCID: PMC10552460 DOI: 10.1177/20552173231202638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Adverse childhood experiences are demonstrated risk factors for depression, a common co-morbidity of multiple sclerosis, but are understudied among people with multiple sclerosis. Objective Estimate the association between adverse childhood experiences and depression among 1,990 adults with multiple sclerosis. Methods Participants were members of Kaiser Permanente Northern California from two studies between 2006 and 2021 and were diagnosed with multiple sclerosis by a neurologist. Adverse childhood experiences were assessed using two instruments, including the Behavioral Risk Factor Surveillance System. Participants self-reported ever experiencing a major depressive episode. Meta-analysis random effects models and logistic regression were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the relationship between adverse childhood experiences and a history of depression across study samples. Adverse childhood experiences were expressed as any/none, individual events, and counts. Models adjusted for sex, birth year, race, and ethnicity. Results Exposure to any adverse childhood experiences increased the odds of depression in people with multiple sclerosis (OR: 1.71, 95% CI: 1.21-2.42). Several individual adverse childhood experiences were also strongly associated with depression, including "significant abuse or neglect" (OR: 2.79, 95% CI: 2.11-3.68). Conclusion Findings suggest that adverse childhood experiences are associated with depression among people with multiple sclerosis. Screening for depression should be done regularly, especially among people with multiple sclerosis with a history of adverse childhood experiences.
Collapse
Affiliation(s)
| | - Mary K Horton
- Division of Epidemiology, School of Public Health, University of California Berkeley, CA, USA
| | | | | | | | | | | | | | | | - Lisa F Barcellos
- Division of Epidemiology, School of Public Health, University of California Berkeley, CA, USA
| |
Collapse
|
13
|
Torrillas-de la Cal A, Torres-Sanchez S, Bravo L, Llorca-Torralba M, Garcia-Partida JA, Arroba AI, Berrocoso E. Chemogenetic activation of locus coeruleus neurons ameliorates the severity of multiple sclerosis. J Neuroinflammation 2023; 20:198. [PMID: 37658434 PMCID: PMC10474779 DOI: 10.1186/s12974-023-02865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/30/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Most current disease-modifying therapies approved for multiple sclerosis (MS) are immunomodulatory drugs that counteract the aberrant activity of the immune system. Hence, new pharmacological interventions that drive anti-inflammatory activity and neuroprotection would represent interesting alternative therapeutic approaches or complementary strategies to treat progressive forms of MS. There is evidence of reduced noradrenaline levels and alterations to locus coeruleus (LC) noradrenergic neurons in MS patients, as well as in animal models of this disease, potentially factors contributing to the pathophysiology. Drugs that enhance noradrenaline appear to have some beneficial effects in MS, suggesting their potential to dampen the underlying pathology and disease progression. METHODS Therefore, we explored the consequences of chronic LC noradrenergic neurons activation by chemogenetics in experimental autoimmune encephalomyelitis (EAE) mice, the most widely used experimental model of MS. LC activation from the onset or the peak of motor symptoms was explored as two different therapeutic approaches, assessing the motor and non-motor behavioral changes as EAE progresses, and studying demyelination, inflammation and glial activation in the spinal cord and cerebral cortex during the chronic phase of EAE. RESULTS LC activation from the onset of motor symptoms markedly alleviated the motor deficits in EAE mice, as well as their anxiety-like behavior and sickness, in conjunction with reduced demyelination and perivascular infiltration in the spinal cord and glial activation in the spinal cord and prefrontal cortex (PFC). When animals exhibited severe paralysis, LC activation produced a modest alleviation of EAE motor symptoms and it enhanced animal well-being, in association with an improvement of the EAE pathology at the spinal cord and PFC level. Interestingly, the reduced dopamine beta-hydroxylase expression associated with EAE in the spinal cord and PFC was reversed through chemogenetic LC activation. CONCLUSION Therefore, clear anti-inflammatory and neuroprotective effects were produced by the selective activation of LC noradrenergic neurons in EAE mice, having greater benefits when LC activation commenced earlier. Overall, these data suggest noradrenergic LC neurons may be targets to potentially alleviate some of the motor and non-motor symptoms in MS.
Collapse
Grants
- #FPU20-03072 "Agencia Estatal de Investigación-Ministerio de Ciencia, Innovación y Universidades"; FPU fellowship
- PID2022-1427850B-I00 "Fondo Europeo de Desarrollo Regional" (FEDER)-UE "A way to build Europe" from the "Ministerio de Economía y Competitividad
- PDC2022-133987-I00 "Fondo Europeo de Desarrollo Regional" (FEDER)-UE "A way to build Europe" from the "Ministerio de Economía y Competitividad
- PY20_00958 "Consejería de Transformación Económica, Industria, Conocimiento y Universidad, Junta de Andalucía"
- CTS-510 "Consejería de Transformación Económica, Industria, Conocimiento y Universidad, Junta de Andalucía"
- CEIJ-003 CEIMAR
- “CIBERSAM”: CIBER-Consorcio Centro de Investigación Biomédica en Red (CB07/09/0033), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación
- “Agencia Estatal de Investigación-Ministerio de Ciencia, Innovación y Universidades”; FPU fellowship
- “Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz-INiBICA” (IN-CO9)
- "Fondo Europeo de Desarrollo Regional” (FEDER)-UE “A way to build Europe” from the “Ministerio de Economía y Competitividad
- Universidad de Cadiz
Collapse
Affiliation(s)
- Alejandro Torrillas-de la Cal
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, 11003, Cádiz, Spain
- Ciber de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, 11009, Cádiz, Spain
| | - Sonia Torres-Sanchez
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, 11003, Cádiz, Spain
- Ciber de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, 11009, Cádiz, Spain
| | - Lidia Bravo
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, 11003, Cádiz, Spain
- Ciber de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, 11009, Cádiz, Spain
| | - Meritxell Llorca-Torralba
- Ciber de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, 11009, Cádiz, Spain
- Neuropsychopharmacology and Psychobiology Research Group, Department of Cell Biology and Histology, University of Cádiz, 11003, Cádiz, Spain
| | - Jose Antonio Garcia-Partida
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, 11003, Cádiz, Spain
- Ciber de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, 11009, Cádiz, Spain
| | - Ana I Arroba
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, 11009, Cádiz, Spain
- Department of Biomedicine, Biotechnology and Public Health (Immunology Area), University of Cádiz, 11003, Cádiz, Spain
| | - Esther Berrocoso
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, 11003, Cádiz, Spain.
- Ciber de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain.
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, 11009, Cádiz, Spain.
| |
Collapse
|
14
|
Yue H, Shah SB, Modzelewski KL, Knobel M, Copeli F, Kao L. A Grave Set of Diagnoses: A Case of Mania with Comorbid Autoimmune Thyroiditis Precipitated by Multiple Sclerosis Treatment. Harv Rev Psychiatry 2023; 31:242-247. [PMID: 37615524 DOI: 10.1097/hrp.0000000000000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Han Yue
- From Department of Psychiatry, Tufts Medical Center, Boston, MA (Dr. Yue); Harvard Medical School (Dr. Shah); Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston Medical Center, Boston, MA (Dr. Modzelewski); Department of Endocrinology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA (Dr. Modzelewski); Department of Psychiatry, Veteran Affairs Boston Healthcare System, Boston, MA (Drs. Knobel and Kao); BrightView Health, Boston, MA (Dr. Copeli); Power of Recovery, Revere, MA (Dr. Copeli); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA (Dr. Kao)
| | | | | | | | | | | |
Collapse
|
15
|
Alswat AM, Altirkistani BA, Alserihi AR, Baeshen OK, Alrushid ES, Alkhudair J, Aldbas AA, Wadaan OM, Alsaleh A, Al Malik YM, Abulaban AA, Makkawi S. The prevalence of major depression and generalized anxiety disorder in patients with multiple sclerosis in Saudi Arabia: a cross-sectional multicentered study. Front Psychiatry 2023; 14:1195101. [PMID: 37706033 PMCID: PMC10496114 DOI: 10.3389/fpsyt.2023.1195101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/04/2023] [Indexed: 09/15/2023] Open
Abstract
Background Multiple sclerosis (MS) is an autoimmune disease characterized by chronic, progressive neurodegeneration of the central nervous system (CNS), and it is the most common inflammatory neurological disease affecting young adults. Given the chronic, progressive nature of the disease, psychiatric disorders are more prevalent among these patients, as reported in the literature; however, data in Saudi Arabia are limited. This study aimed to estimate the prevalence of major depression and generalized anxiety disorder in patients with MS and their association with different patient demographics. Methods This was a cross-sectional, multicentered study that included adult patients with MS from 30 June 2021 to 30 June 2022. Participants were interviewed in person and asked to complete a survey that included general demographics, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire. Other variables related to the patients' conditions, such as MS type and Expanded Disability Status Scale (EDSS) score, were collected from the patient's electronic records. Descriptive statistics were performed, and associations were made using the chi-square, Fisher's exact, and analysis of variance tests, as appropriate. Results A total of 192 participants were included in this study. Based on a cutoff score of >10 on the GAD-7 and PHQ-9 scales, the prevalence of generalized anxiety disorder was 26.1% (50), with the majority of participants having minimal anxiety (40%); meanwhile, the prevalence of major depression was 42.7% (n = 82), and most of them had mild depression (30%). Female participants scored significantly higher compared to men on the GAD-7 scale (p = 0.0376), but not on the PHQ-9 scale (p = 0.1134). In addition, no statistically significant association was detected between functional disability (EDSS score) and prevalence of anxiety and depression. Conclusion This study demonstrated a high prevalence of generalized anxiety disorder and major depression among patients with MS compared with that in the general population, with women being more affected. As these comorbid disorders could negatively affect the disease course, screening is of paramount significance.
Collapse
Affiliation(s)
- Anas M. Alswat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Bsaim A. Altirkistani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Anas R. Alserihi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Osama K. Baeshen
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Eythar S. Alrushid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Joud Alkhudair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz A. Aldbas
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Osama M. Wadaan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmad Alsaleh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Yaser M. Al Malik
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmad A. Abulaban
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia
| |
Collapse
|
16
|
Filser M, Buchner A, Fink GR, Gold SM, Penner IK. The manifestation of affective symptoms in multiple sclerosis and discussion of the currently available diagnostic assessment tools. J Neurol 2023; 270:171-207. [PMID: 36129540 PMCID: PMC9813146 DOI: 10.1007/s00415-022-11359-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In addition to physical and cognitive symptoms, patients with multiple sclerosis (MS) have an increased risk of experiencing mental health problems. METHODS This narrative review provides an overview of the appearance and epidemiology of affective symptoms in MS such as depression, anxiety, bipolar disorder, euphoria, and pseudobulbar affect. Furthermore, the association between affective symptoms and quality of life and the currently used diagnostic instruments for assessing these symptoms are considered whereby relevant studies published between 2009 and 2021 were included in the review. RESULTS Patients with mild and moderate disability more frequently reported severe problems with depression and anxiety than severe mobility problems. Apart from the occurrence of depression, little is known about the association of other affective symptoms such as anxiety, bipolar disorder, euphoria, and pseudobulbar affect and subsyndromal symptoms, which fail to meet the diagnostic criteria but are nevertheless a significant source of distress. Although there are a few recommendations in the research to perform routine screenings for diagnosable affective disorders, a standardized diagnostic procedure to assess subsyndromal symptoms is still lacking. As the applied measurements are diverse and show low accuracy to detect these symptoms, patients who experience affective symptoms are less likely to be identified. DISCUSSION In addition to the consideration of definite psychiatric diagnoses, there is an unmet need for a common definition and assessment of disease-related affective symptoms in MS. Future studies should focus on the improvement and standardization of a common diagnostic procedure for subsyndromal affective symptoms in MS to enable integrated and optimal care for patients.
Collapse
Affiliation(s)
- Melanie Filser
- Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany.,COGITO Centre for Applied Neurocognition and Neuropsychological Research, Life Science Centre, Düsseldorf, Germany
| | - Axel Buchner
- Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Centre, Cognitive Neuroscience, Jülich, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin Berlin, Berlin, Germany.,Medical Department, Section Psychosomatics, Charité Universitätsmedizin Berlin, Berlin, Germany.,Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany. .,COGITO Centre for Applied Neurocognition and Neuropsychological Research, Life Science Centre, Düsseldorf, Germany. .,Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
17
|
Korupolu R, Malik A, Ratcliff C, Robinson-Whelen S, Taylor HB. Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review. Arch Phys Med Rehabil 2022; 103:2410-2428. [PMID: 35760105 DOI: 10.1016/j.apmr.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This systematic review aims to gain a comprehensive understanding of the feasibility, acceptability, and efficacy of mindfulness-based interventions (MBIs) on depression, anxiety, fatigue, and health-related quality of life among individuals with upper motor neuron disorders (UMNDs). DATA SOURCES PubMed, PsycINFO, Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant studies published between January 2001 and June 2021. STUDY SELECTION Clinical trials published in English evaluating MBIs in adults with the 4 most common UMNDs (multiple sclerosis, brain injury including stroke, spinal cord injury, amyotrophic lateral sclerosis) were included. DATA EXTRACTION Two reviewers independently performed the risk of bias assessment using standardized tools and extracted desired data electronically. DATA SYNTHESIS A total of 44 studies were included: 26 randomized controlled trials, 10 nonrandomized controlled trials, and 8 pre-post intervention studies. The average ± SD duration of MBIs was 8±2 weeks. On average, 85%±14% of participants completed the MBI, and the retention rate at follow-up was 80%±16%. Only 14% of the studies delivered MBIs virtually, and feasibility metrics were similar to in-person studies. Among studies reporting acceptability data, most participants reported satisfaction with the MBI. Randomized controlled trials that evaluated the effects of MBI on depression, anxiety, fatigue, and quality of life revealed greater relative improvement in these outcomes among MBI participants compared with controls, with differences greater when compared with passive control than active control participants. None of the studies included in this review studied dose response. CONCLUSIONS Based on current data, MBIs are feasible and offer a promising approach to address the biopsychosocial needs of individuals with UMNDs. MBIs are associated with a high acceptance rate among participants, with notable improvements in depression, anxiety, fatigue, and quality of life post intervention. Future studies are needed to evaluate alternate models of delivery of MBIs and the dose-response relationship.
Collapse
Affiliation(s)
- Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas.
| | - Aila Malik
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Chelsea Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas
| | - Susan Robinson-Whelen
- TIRR Memorial Hermann, Houston, Texas; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Heather B Taylor
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas
| |
Collapse
|
18
|
Khan A, Lin P, Kamdar N, Peterson M, Mahmoudi E. Potentially preventable hospitalizations and use of preventive services among people with multiple sclerosis: Large cohort study, USA. Mult Scler Relat Disord 2022; 68:104105. [PMID: 36031692 PMCID: PMC10424261 DOI: 10.1016/j.msard.2022.104105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) report barriers to accessing care, including receipt of preventive services. Potentially preventable hospitalization (PPH) is an important marker for access to, and receipt of timely care. However, few national studies have examined PPH risk in people with MS or considered the role of preventive care in reducing PPH risk among this patient population. Our objective was to examine PPH risk among adults with MS compared with their counterparts without MS. METHODS Optum® Clinformatics® Data Mart (2007-2017) was used to identify 6198 individuals with an MS diagnosis and their propensity-score matched counterparts without MS. Diagnostic and procedural codes were used to identify the presence of preventive hospitalizations, which were defined as quality indicators by the Agency for Healthcare Research and Quality (AHRQ) during the 4-year follow-up period since the diagnosis of MS. Information on receipt of preventive services and office visits was also extracted. Adjusted generalized estimating equations were used to examine the association between MS diagnosis and PPHs. To examine the role of preventive services on odds of PPH amongst people with MS, we reported the adjusted marginal odds ratio (OR) and 95% confidence intervals (CI). RESULTS The rate of any PPH among people with MS was double that of those without MS (131.6 vs 62.5 per 10,000). We identified higher odds of specific PPH indicators among people with MS compared to those without. Individuals with MS had 65% higher odds of hospitalization for pneumonia (OR=1.65, 95% CI: 1.01, 2.30), with similar significant findings observed for urinary tract infections (OR=4.90, 95% CI: 2.51, 9.57). In MS patients, receipt of preventive services, namely cholesterol screening (OR=0.76, 95% CI: 0.60, 0.95) and annual wellness visits were associated with lower odds of any PPH (OR=0.57, 95% CI: 0.43, 0.76). CONCLUSION People with MS were at a higher risk for PPHs compared with their counterparts without MS. Use of appropriate preventive services reduced the risk of PPH among the general population and among those with MS. More efforts are needed to encourage and facilitate the use of preventive care among people with MS. Receipt of timely and appropriate preventive care in this population may reduce the risk for PPH.
Collapse
Affiliation(s)
- Anam Khan
- School of Public Health, University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109, USA; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, USA; Department of Emergency Medicine, Michigan Medicine, University of Michigan, USA; Department of Surgery, Michigan Medicine, University of Michigan, USA; Department of Neurosurgery, Michigan Medicine, University of Michigan, USA
| | - Mark Peterson
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109, USA; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elham Mahmoudi
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109, USA; Department of Family Medicine, Michigan Medicine, University of Michigan, USA.
| |
Collapse
|
19
|
Identification of cognitive impairment, depression, and fatigue among multiple sclerosis patients in a large comprehensive care center: A mixed-methods, qualitative study. Mult Scler Relat Disord 2022; 68:104117. [PMID: 36037754 DOI: 10.1016/j.msard.2022.104117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/30/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite studies suggesting a high prevalence of cognitive impairment, depression, and fatigue (CDF) among patients with multiple sclerosis (MS), standardized CDF tools are used infrequently in clinical practice, potentially resulting in underdiagnosis. We documented the use of standardized tools to identify CDF in MS and sought to understand provider attitudes toward the tools and their use. METHODS This mixed-methods study analyzed electronic health records (EHRs) from a large US urban MS center to determine the frequency and types of CDF screenings and numbers of MS treatment encounters (January 2018-December 2019). Participants included neurologists and nurse practitioners with ≥30 eligible patients and a convenience sample of adult MS patients (≥18 years) with at least outpatient encounters during the study period. Semistructured provider interviews (n = 6; the principal investigator and 1 provider were excluded) were conducted, transcribed, coded, and analyzed to characterize screening patterns. Assessments included proportions of encounters and patients who had standardized CDF screenings, positive screening results, and documentation of a treatment recommendation, as well as provider attitudes toward tools and reported barriers and facilitators for use. Bivariate analysis was used to evaluate the relationship between screening rates and patient and provider covariates for groups with sufficient sample size (n = 30). RESULTS The final population included 260 unique patients, 489 outpatient encounters, and 8 providers. Of 260 patients (75% female, 83% aged <65 years), 24% (n = 63) were screened with a depression tool. Only 2% (n = 4) were screened with a tool measuring cognitive impairment, and none were screened with a tool measuring fatigue. Screening rates varied little by provider type. Higher depression screening rates were associated with white race (difference: 13.2%; 95% CI: 2.8-23.5%; P = .01), ≤2 visits during the study period (difference: 7.6%; 95% CI: 0.6-14.5%; P = .03), and provider experience >10 years (difference: 14.6%; 95% CI: 3.5-25.8%; P = .01). Lack of support staff and perception of limited treatment options were commonly cited barriers to standardized screening in provider interviews. The higher rate of depression screening is likely driven by institutional culture and priorities. CONCLUSION Providers recognize the importance of CDF to patients, despite infrequent use of standardized screening. Integrating screening into institutional practices may enable ongoing tracking of assessment scores and provide a more comprehensive and longitudinal picture of symptom progression.
Collapse
|
20
|
Peres DS, Rodrigues P, Viero FT, Frare JM, Kudsi SQ, Meira GM, Trevisan G. Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis. Brain Behav Immun Health 2022; 24:100484. [PMID: 35856061 PMCID: PMC9287158 DOI: 10.1016/j.bbih.2022.100484] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 06/28/2022] [Indexed: 10/31/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neurodegenerative and autoimmune disease. Motor, sensory and cognitive deficits in MS are commonly accompanied by psychiatric disorders. Depression and anxiety affect the quality of life of MS patients, and the treatment is still not well-established. Prevalence rates in MS patients for depression and anxiety vary widely between studies. However, the prevalence of these psychiatric disorders in the subgroups of MS patients and their association with a disability has not been studied yet. Therefore, this systematic review and meta-analysis proposes to estimate the prevalence of depression and anxiety in MS and to perform subgroup analyses (study type, Extended Disability Status Scale/EDSS, duration of MS, region, type of MS) on observational studies. The protocol was registered in PROSPERO (4202125033). A computerized search on PubMed, EMBASE and Scopus for studies on depression and anxiety in MS was performed from 2015 to 2021, and 12 articles were included. Most of the studies in the meta-analysis had a low risk of bias. The prevalence of depression was 27.01% (MS), 15.78% (relapsing-remitting multiple sclerosis/RRMS), and 19.13% (progressive multiple sclerosis/PMS). For anxiety the prevalence was 35.19% (MS), 21.40% (RRMS), and 24.07% (PMS). The prevalence of depression/anxiety for patients with EDSS <3 was 26.69/45.56% and for EDSS >3 was 22.96/26.70%. Using HADS-A (8) the prevalence was 38.5% and for depression was 22.4%. Then, our study brought together current data regarding psychiatric disorders in MS patients, which are comorbidities that affect the quality of life of these patients. Prevalence of depression/anxiety for the MS patients was 27.01%/35.19%. Prevalence of depression was 15.78% (RRMS) and 19.13% (PMS). Prevalence of anxiety was 21.40% (RRMS) and 24.07% (PMS). Prevalence of depression/anxiety for the patients with EDSS <3 was 26.69/45.56% and for EDSS >3 was 22.96/26.70%. Prevalence of anxiety using HADS-A (8) was 38.5% and for depression was 22.4%.
Collapse
|
21
|
Patejdl R, Zettl UK. The pathophysiology of motor fatigue and fatigability in multiple sclerosis. Front Neurol 2022; 13:891415. [PMID: 35968278 PMCID: PMC9363784 DOI: 10.3389/fneur.2022.891415] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple Sclerosis (MS) is a heterogeneous immune mediated disease of the central nervous system (CNS). Fatigue is one of the most common and disabling symptom of MS. It interferes with daily activities on the level of cognition and motor endurance. Motor fatigue can either result from lesions in cortical networks or motor pathways (“primary fatigue”) or it may be a consequence of detraining with subsequent adaptions of muscle and autonomic function. Programmed exercise interventions are used frequently to increase physical fitness in MS-patients. Studies investigating the effects of training on aerobic capacity, objective endurance and perceived fatigability have yielded heterogenous results, most likely due to the heterogeneity of interventions and patients, but probably also due to the non-uniform pathophysiology of fatigability among MS-patients. The aim of this review is to summarize the current knowledge on the pathophysiology of motor fatigability with special reference to the basic exercise physiology that underlies our understanding of both pathogenesis and treatment interventions.
Collapse
Affiliation(s)
- Robert Patejdl
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
- *Correspondence: Robert Patejdl
| | - Uwe K. Zettl
- Department of Neurology, Clinical Neuroimmunology Section, Rostock University Medical Center, Rostock, Germany
| |
Collapse
|
22
|
Andrews JA, Craven MP, Lang AR, Guo B, Morriss R, Hollis C. Making remote measurement technology work in multiple sclerosis, epilepsy and depression: survey of healthcare professionals. BMC Med Inform Decis Mak 2022; 22:125. [PMID: 35525933 PMCID: PMC9077644 DOI: 10.1186/s12911-022-01856-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background Epilepsy, multiple sclerosis (MS) and depression are long term, central nervous system disorders which have a significant impact on everyday life. Evaluating symptoms of these conditions is problematic and typically involves repeated visits to a clinic. Remote measurement technology (RMT), consisting of smartphone apps and wearables, may offer a way to improve upon existing methods of managing these conditions. The present study aimed to establish the practical requirements that would enable clinical integration of data from patients’ RMT, according to healthcare professionals. Methods This paper reports findings from an online survey of 1006 healthcare professionals currently working in the care of people with epilepsy, MS or depression. The survey included questions on types of data considered useful, how often data should be collected, the value of RMT data, preferred methods of accessing the data, benefits and challenges to RMT implementation, impact of RMT data on clinical practice, and requirement for technical support. The survey was presented on the JISC online surveys platform. Results Among this sample of 1006 healthcare professionals, respondents were positive about the benefits of RMT, with 73.2% indicating their service would be likely or highly likely to benefit from the implementation of RMT in patient care plans. The data from patients’ RMT devices should be made available to all nursing and medical team members and could be reviewed between consultations where flagged by the system. However, results suggest it is also likely that RMT data would be reviewed in preparation for and during a consultation with a patient. Time to review information is likely to be one of the greatest barriers to successful implementation of RMT in clinical practice. Conclusions While further work would be required to quantify the benefits of RMT in clinical practice, the findings from this survey suggest that a wide array of clinical team members treating epilepsy, MS and depression would find benefit from RMT data in the care of their patients. Findings presented could inform the implementation of RMT and other digital interventions in the clinical management of a range of neurological and mental health conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01856-z.
Collapse
Affiliation(s)
- J A Andrews
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK. .,Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - M P Craven
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK.,Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - A R Lang
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - B Guo
- ARC-EM, School of Medicine, University of Nottingham, Nottingham, UK
| | - R Morriss
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK.,Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.,ARC-EM, School of Medicine, University of Nottingham, Nottingham, UK
| | - C Hollis
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK.,Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
23
|
Karhula ME, Kanelisto K, Hämäläinen P, Ruutiainen J, Era P, Häkkinen A, Salminen AL. Self-reported Reasons for Changes in Performance of Daily Activities During a 2-Year Multidisciplinary Multiple Sclerosis Rehabilitation. Int J MS Care 2022; 24:110-116. [PMID: 35645629 PMCID: PMC9135369 DOI: 10.7224/1537-2073.2020-061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND Few multidisciplinary rehabilitation studies with a heterogeneous design have focused on individuals with multiple sclerosis (MS). This study compared subjective-reported changes in performance and satisfaction with daily activities among moderately and severely disabled individuals with MS during a 2-year, multidisciplinary, group-based, outpatient rehabilitation program comprising education in self-management and compensatory techniques, exercise, and guided peer support. METHODS Thirty-eight adults with moderate disability (Expanded Disability Status Scale [EDSS] score of 4.0-5.5, 74% women, mean age of 48) and 41 individuals with severe disability (EDSS 6.0-8.5, 63% women, mean age of 48) were assessed at baseline and after 12 and 21 months of outpatient rehabilitation using the Canadian Occupational Performance Measure (COPM). Group × time interactions were analyzed using mixed analysis of variance. Participants' explanations of reasons for changes in activity performance were collected via semistructured interviews and analyzed content. RESULTS Statistically significant improvements in COPM performance and satisfaction scores were reported in both groups from baseline to 21 months of rehabilitation. No significant between-group differences in improvement were observed. The self-reported reasons for improvement were mainly linked to environmental factors. CONCLUSIONS The outpatient rehabilitation program, including 4 themes-cognition, mood, energy conservation, and body control-improved the self-reported performance of patients with MS with moderate and severe disabilities. Environmental factors warrant consideration during rehabilitation.
Collapse
Affiliation(s)
- Maarit E. Karhula
- From the GeroCenter Foundation for Aging Research and Development (MEK, KK, PE), University of Jyväskylä, Jyväskylä, Finland
- From the South-Eastern Finland University of Applied Sciences, Mikkeli, Finland (MEK)
| | - Katja Kanelisto
- From the GeroCenter Foundation for Aging Research and Development (MEK, KK, PE), University of Jyväskylä, Jyväskylä, Finland
| | - Päivi Hämäläinen
- From the Masku Neurological Rehabilitation Centre, Masku, Finland (PH)
- From the Finnish Neuro Society, Masku, Finland (PH, JR)
- From the University of Turku, Turku, Finland (PH, JR)
| | - Juhani Ruutiainen
- From the Finnish Neuro Society, Masku, Finland (PH, JR)
- From the University of Turku, Turku, Finland (PH, JR)
| | - Pertti Era
- From the GeroCenter Foundation for Aging Research and Development (MEK, KK, PE), University of Jyväskylä, Jyväskylä, Finland
| | - Arja Häkkinen
- From the Faculty of Sport and Health Sciences (AH), University of Jyväskylä, Jyväskylä, Finland
- From the Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyvaskyla, Finland (AH)
| | - Anna-Liisa Salminen
- From the Research Department, Social Insurance Institution of Finland, Helsinki, Finland (A-LS)
| |
Collapse
|
24
|
Gelinas D, Parvin-Nejad S, Phillips G, Cole C, Hughes T, Silvestri N, Govindarajan R, Jefferson M, Campbell J, Burnett H. The humanistic burden of myasthenia gravis: A systematic literature review. J Neurol Sci 2022; 437:120268. [DOI: 10.1016/j.jns.2022.120268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/25/2022]
|
25
|
Talwar A, Earla JR, Hutton GJ, Aparasu RR. Prescribing of disease modifying agents in older adults with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103308. [PMID: 35158421 DOI: 10.1016/j.msard.2021.103308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of disease-modifying agents (DMAs) to treat Multiple Sclerosis (MS) in older adults is debated as the disease activity decreases with aging. However, limited data exist regarding prescribing patterns of DMAs among older adults with MS. OBJECTIVE To examine prescribing patterns of DMAs and the factors associated with DMA prescribing practices among older adults with MS using electronic medical records (EMR) data. METHODS A retrospective longitudinal cohort study was conducted using the TriNetX, a federated EMR network from the US, data from 2016 to 2019. The study included older adults (≥60 years) with MS diagnosis and at least one prescription record during the study period. Patients with DMA prescriptions were identified and further classified into injectable, oral, or infusion users based on their last DMA prescription. A multivariable logistic regression model was used to evaluate the factors associated with prescribing of DMAs. A multinomial logistic regression model was also used to determine the factors associated with prescribing a particular dosage form of DMA. RESULTS The study cohort consisted of 12,922 older adults with MS, with 2,455 (18.99%) receiving DMA prescriptions. The commonly prescribed DMAs were injectables (10.46%), followed by orals (6.06%) and infusions (2.40%). Multivariable logistic regression revealed that older adults between 60- to 64 years (Adjusted Odds Ratio [aOR]= 2.38) and 65-69 years (aOR=1.60) had higher odds of receiving DMA compared to older adults of 70 years and above. African Americans (aOR=1.71) had higher odds of receiving DMA prescriptions compared to Caucasians. The presence of symptoms (pain, fatigue, speech, walking difficulty) and use of symptomatic medication (anti-fatigue medication, bladder dysfunction medication, antispasmodics, antidepressants, and relapse medication) increased the odds of being prescribed DMAs. Multinomial logistic regression found that patients 60-64 years of age had higher odds of being prescribed infusion (aOR, 95% Confidence Interval [CI] =2.06, 1.35-3.15) and oral (65-69 years: aOR=1.60, 1.24-2.07) over injectable DMAs compared to the older adults aged 70 years and above.Older males (aOR=1.68, 95% CI: 1.23-2.30) were associated with increased odds of being prescribed infusion DMA over injectable DMA compared to females. The presence of comorbidities such as coagulopathy and peripheral vascular disorders decreased the odds of being prescribed oral DMA over injectable DMA. Patients with cerebellar symptoms had an increased likelihood of being prescribed with an infusion DMA over injectable DMA. Patients using drugs for treating relapses had higher odds of being prescribed an infusion DMA over an injectable DMA. In terms of healthcare utilization, older adults with outpatient visits had higher odds of being prescribed an infusion DMA over an injectable DMA, while older adults with inpatient visits had lower odds of being prescribed an infusion DMA over an injectable DMA. CONCLUSION Nearly one in five older adults with MS are prescribed DMAs, with a majority receiving injectable DMAs. Several demographic and clinical factors were associated with DMA prescribing . This study fills the data gap regarding the utilization of DMAs in older adults with MS.
Collapse
Affiliation(s)
- Ashna Talwar
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, United States
| | | | | | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, United States.
| |
Collapse
|
26
|
The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort. Mult Scler Relat Disord 2022; 58:103451. [PMID: 34953410 PMCID: PMC9308106 DOI: 10.1016/j.msard.2021.103451] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Psychiatric symptoms are common in multiple sclerosis (MS) and may contribute to worse MS outcomes. Previous studies suggest the burden of symptoms may vary by race, ethnicity and socioeconomic status (SES). Our objective was to expand upon this previous work and explore the associations between SES, race, and ethnicity, as predictors of psychiatric symptoms, mental health attitudes, and health-seeking behavior in patients with MS. METHODS Persons with MS answered a national web-based survey including demographic characteristics (including race, ethnicity and measures of SES), mental health attitudes, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Modified Fatigue Impact Scale 5-item version (MFIS-5), and the Alcohol Use Disorders Identification Test (AUDIT). The survey also queried mental health availability and perceptions of care. We measured neighborhood-level SES (nSES) of each participant using the Agency for Healthcare Research and Quality (AHRQ) index that was calculated from 5-digit postal codes. Other indicators of participant-level SES included education level and self-reported household income. We assessed the association between race, ethnicity, and neighborhood/participant-level SES indicators and affective symptom burden using generalized linear models that were adjusted for age, sex, and MS characteristics. RESULTS 2095 participants answered the survey (mean AHRQ index 54.6 ± 5.4, age 51.3 ± 12.2 years, 7% Black/African American, 5.4% Hispanic/Latino, and 81.8% female). Those in the lowest quartile of nSES (most disadvantaged) were more likely to be either Black/African American or Hispanic/Latino as compared to those in highest quartile (least disadvantaged). Those in the lowest quartile of nSES had higher mean MFIS-5 (1.02 points; 95% CI: 0.39, 1.43), PHQ-9 (1.24 points; 95% CI: 0.49, 1.98), and GAD-7 (0.69 points; 95% CI: -0.01, 1.38) scores relative to those in the highest quartile. Of those who consumed alcohol (n = 1489), participants in the lowest AHRQ quartile had lower mean AUDIT scores (-0.73 points; 95% CI: -1.18, -0.29) as compared to those in higher quartiles. Race and ethnicity were not associated with self-reported psychiatric symptom burden in this cohort. SES was also associated with self-reported improvement of symptoms after receiving mental health care. A higher proportion of Black/African American (44.1% vs 30.2%, p = 0.003) and Hispanic/Latino (49.1% vs 30.6%, p<0.001) participants were more likely to report they would "definitely go" receive mental health care if services were co-located with their MS care as compared to white and Non-Hispanic/Latino participants, respectively. CONCLUSION Higher SES was associated with a lower burden of psychiatric symptoms and with a higher likelihood of self-reported symptom recovery after receiving mental health treatment. Attitudes regarding mental health care delivery in MS varied according to racial and ethnic background. Future longitudinal studies in more diverse populations should assess whether co-location of mental health services with MS care helps to reduce the gap between access and need of mental health care in MS.
Collapse
|
27
|
Quality of life of patients with multiple sclerosis and neuromyelitis optica spectrum disorders: Cross-sectional and longitudinal analysis. Mult Scler Relat Disord 2022; 58:103500. [PMID: 35032884 DOI: 10.1016/j.msard.2022.103500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/08/2021] [Accepted: 01/03/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders (NMOSD), which have different pathogenic mechanisms, both negatively affect patients during their lifetime. We aimed to analyze and compare the quality of life (QoL) of patients with MS and NMOSD, its longitudinal course, and associated factors between the two diseases. METHODS Between June 2018 and April 2020, patients with MS and NMOSD who visited a tertiary hospital were prospectively enrolled. The EuroQoL-5 Dimension (EQ-5D) utility index, of which low values represent poor QoL, Expanded Disability Status Scale (EDSS), and the Hospital Anxiety and Depression Scale (HADS) were collected at enrollment and at follow-up with a 6-12-month interval. At baseline, the degree of QoL and its determinants were analyzed and compared between the MS and NMOSD groups. We also analyzed the longitudinal alteration of the EQ-5D utility indices over time and the factors associated with the follow-up QoL. RESULTS During the study period, 171 patients (MS, 120; NMOSD, 51) were included. The median age was 46 years, and median EDSS score and follow-up duration were 2.5 and 8 months, respectively. At baseline, the EQ-5D utility indices were low and comparable between the MS and NMOSD groups (median: 0.86 vs. 0.82, p = 0.823). A higher HADS total score (more severe anxiety/depression symptoms) showed an independent and significant association with the baseline EQ-5D utility index in both disease groups. Longitudinally, the EQ-5D utility indices remained low. Although they did not significantly change over time at a group level, more than 50% of patients showed a longitudinal change in their EQ-5D indices in both disease groups. Of note, a higher HADS total score at enrollment was an independent predictor for poor QoL at follow-up in both disease groups. CONCLUSIONS The QoL was similarly impaired between patients with MS and those with NMOSD and remained low during the follow-up period. A higher total scale of HADS was an independent risk factor for a lower QoL at baseline and at follow-up in both disease conditions, suggesting that clinicians should pay more attention to anxiety and depression in patients with MS and those with NMOSD in the long term.
Collapse
|
28
|
Digiovanni A, Ajdinaj P, Russo M, Sensi SL, Onofrj M, Thomas A. Bipolar spectrum disorders in neurologic disorders. Front Psychiatry 2022; 13:1046471. [PMID: 36620667 PMCID: PMC9811836 DOI: 10.3389/fpsyt.2022.1046471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Psychiatric symptoms frequently predate or complicate neurological disorders, such as neurodegenerative diseases. Symptoms of bipolar spectrum disorders (BSD), like mood, behavioral, and psychotic alterations, are known to occur - individually or as a syndromic cluster - in Parkinson's disease and in the behavioral variant of frontotemporal dementia (FTD). Nonetheless, due to shared pathophysiological mechanisms, or genetic predisposition, several other neurological disorders show significant, yet neglected, clinical and biological overlaps with BSD like neuroinflammation, ion channel dysfunctions, neurotransmission imbalance, or neurodegeneration. BSD pathophysiology is still largely unclear, but large-scale network dysfunctions are known to participate in the onset of mood disorders and psychotic symptoms. Thus, functional alterations can unleash BSD symptoms years before the evidence of an organic disease of the central nervous system. The aim of our narrative review was to illustrate the numerous intersections between BSD and neurological disorders from a clinical-biological point of view and the underlying predisposing factors, to guide future diagnostic and therapeutical research in the field.
Collapse
Affiliation(s)
- Anna Digiovanni
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Center for Advanced Studies and Technology (CAST), "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Paola Ajdinaj
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Center for Advanced Studies and Technology (CAST), "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Center for Advanced Studies and Technology (CAST), "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Center for Advanced Studies and Technology (CAST), "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Center for Advanced Studies and Technology (CAST), "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
29
|
Mintz KT, Gammer B, Khan AJ, Shaub G, Levine S, Sisti D. Physical Disability and Psychedelic Therapies: An Agenda for Inclusive Research and Practice. Front Psychiatry 2022; 13:914458. [PMID: 35693959 PMCID: PMC9174510 DOI: 10.3389/fpsyt.2022.914458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
Over the past decade, there has been an increase in the number of clinical trials for psychedelic therapies as treatments for a wide range of psychiatric conditions. We are concerned that research organizations overseeing these trials have neglected the inclusion of individuals with physical and sensory disabilities. We suggest that psychedelic research organizations should prioritize and plan for the inclusion of individuals with physical and sensory disabilities to address the mental health burdens they confront. Not doing so risks reinforcing structural ableism in healthcare: the discriminatory manifestation of lowered expectations toward people with disabilities on the part of medical providers. Drawing on scholarship from disability studies and medical ethics, we offer four recommendations for disability inclusion in research. We recognize particular populations shoulder significant mental health burdens; these populations deserve priority and should be given a range of accommodations. We emphasize the need for extensive disability awareness training for those facilitating psychedelic therapies and encourage psychedelic researchers and therapists to exercise cultural humility toward individuals with physical and sensory disabilities. This article should be the impetus for further scholarship and debate about how psychedelic research and therapies can be made accessible to members of disability communities who might benefit.
Collapse
Affiliation(s)
- Kevin T Mintz
- Stanford University, Center for Biomedical Ethics, Stanford, CA, United States
| | - Brinn Gammer
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| | - Amanda J Khan
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.,Sage Integrative Health, Berkeley, CA, United States
| | | | | | - Dominic Sisti
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
30
|
Leekoff M, Culpepper W, Jin S, Lee-Wilk T, Wallin M. Impact of comorbid post traumatic stress disorder on multiple sclerosis in military veterans: A population-based cohort study. Mult Scler 2021; 28:1257-1266. [PMID: 34854320 DOI: 10.1177/13524585211058361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Very little is known regarding the impact of post traumatic stress disorder (PTSD) on the course of multiple sclerosis (MS). OBJECTIVES To explore the impact of pre-existing PTSD on MS relapses, magnetic resonance imaging (MRI) activity, and disability in a large population-based cohort. METHODS Military Veterans with MS and PTSD prior to symptom onset (MSPTSD, n = 96) were identified using the Department of Veterans Affairs MS databases. MSPTSD cases were matched to MS controls without PTSD (n = 95). Number of relapses, number of new T2 lesions and new gadolinium lesions on brain MRI, and neurological disability were abstracted between 2015 and 2019. RESULTS The mean annualized relapse rate was greater in the MSPTSD group versus controls (0.23 vs 0.06, respectively; p < 0.05), as was the annualized mean number of new T2 and gadolinium-enhancing lesions on brain MRI (0.52 vs 0.16 and 0.29 vs 0.08, respectively; p < 0.05). Disability accrual (time to Disability Status Scale 6.0) was more rapid (23.7 vs 29.5 years, p < 0.05) in relapsing MS patients with PTSD. CONCLUSION Patients with MSPTSD have higher disease activity and reach disability endpoints more rapidly than controls. This is the first study to show PTSD as a potentially modifiable risk factor for MS relapses, MRI activity, and disability.
Collapse
Affiliation(s)
- Mark Leekoff
- Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA/Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.,Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William Culpepper
- Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA/Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.,Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shan Jin
- Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA /Department of Neurology,School of Medicine,University of Maryland,Baltimore, MD, USA.,Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Terry Lee-Wilk
- Multiple Sclerosis Center of Excellence, Veterans Affairs, Baltimore, MD, USA /Department of Neurology,School of Medicine,University of Maryland,Baltimore, MD, USA.,Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mitchell Wallin
- Multiple Sclerosis Center of Excellence, Veterans Affairs, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
31
|
Evagorou O, Arvaniti A, Angelopoulou C, Mavraki E, Mikellides G, Samakouri M. "Sleeping Beauty Syndrome" and Psychosis as Precursory Symptoms of Multiple Sclerosis: A Rare Case and Literature Review. J Nerv Ment Dis 2021; 209:933-935. [PMID: 34846357 DOI: 10.1097/nmd.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Frequently, patients with multiple sclerosis (MS) experience comorbid psychiatric symptoms. Mental disorders primarily occur simultaneously with or after an MS diagnosis; however, the probability of them being the initial manifestation of the disease is rare. We describe the case of a 22-year-old man who had previously been hospitalized because a single psychotic episode alongside symptoms of Kleine-Levin syndrome and a diagnosis of "acute and transient psychotic disorders." Two years later, he was diagnosed with MS. A literature review of the possibility of a psychiatric episode overshadowing an MS diagnosis is then presented. Clinicians should always consider the possibility of an underlying organicity in a case of psychiatric presentation with atypical features, with special attention being given during the investigation process. This approach will lead to the early diagnosis of an organic disease, which can be treated accordingly and as early as possible.
Collapse
Affiliation(s)
- Olympia Evagorou
- Department of Psychiatry, Medical School, Democritus University of Thrace
| | | | | | - Eleni Mavraki
- Neurology, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | |
Collapse
|
32
|
Chan CK, Tian F, Pimentel Maldonado D, Mowry EM, Fitzgerald KC. Depression in multiple sclerosis across the adult lifespan. Mult Scler 2021; 27:1771-1780. [PMID: 33307963 PMCID: PMC8200363 DOI: 10.1177/1352458520979304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study is to examine the burden of depressive symptoms across the adult age span in people with multiple sclerosis (MS) and test if the relationship between depressive symptoms and MS characteristics vary across age groups. METHODS In analyses of the MS Partners Advancing Technology and Health Solutions (MS PATHS) network of adults with MS, we compared the prevalence of depression in MS PATHS with non-MS controls across age and evaluated for effect modification by age in the association between depressive symptoms and clinical and neuroperformance measures via multivariable-adjusted regression models. RESULTS In total, 13,821 individuals with MS were included. The prevalence of depression was higher in MS versus non-MS controls, but was similar between men/women across age. The association between depression and processing speed (PST; p for interaction = 0.009) or walking speed (p for interaction = 0.04) varied by age. For example, younger depressed individuals had 0.45 standard deviation (SD) (95% confidence interval (CI) = -0.62, -0.29) worse PST Z-scores versus non-depressed younger participants, whereas older depressed individuals had 0.20 SD (95% CI = -0.32, -0.08) worse PST Z-scores versus non-depressed older participants. CONCLUSION Depressive symptoms and age should be considered when interpreting measures of walking speed and cognitive function; these findings may have implications for analyses of neuroperformance change.
Collapse
Affiliation(s)
- Carol K Chan
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fan Tian
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Ellen M Mowry
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
33
|
Dworsky-Fried Z, Chadwick CI, Kerr BJ, Taylor AMW. Multiple Sclerosis and the Endogenous Opioid System. Front Neurosci 2021; 15:741503. [PMID: 34602975 PMCID: PMC8484329 DOI: 10.3389/fnins.2021.741503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/26/2021] [Indexed: 01/10/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease characterized by chronic inflammation, neuronal degeneration and demyelinating lesions within the central nervous system. The mechanisms that underlie the pathogenesis and progression of MS are not fully known and current therapies have limited efficacy. Preclinical investigations using the murine experimental autoimmune encephalomyelitis (EAE) model of MS, as well as clinical observations in patients with MS, provide converging lines of evidence implicating the endogenous opioid system in the pathogenesis of this disease. In recent years, it has become increasingly clear that endogenous opioid peptides, binding μ- (MOR), κ- (KOR) and δ-opioid receptors (DOR), function as immunomodulatory molecules within both the immune and nervous systems. The endogenous opioid system is also well known to play a role in the development of chronic pain and negative affect, both of which are common comorbidities in MS. As such, dysregulation of the opioid system may be a mechanism that contributes to the pathogenesis of MS and associated symptoms. Here, we review the evidence for a connection between the endogenous opioid system and MS. We further explore the mechanisms by which opioidergic signaling might contribute to the pathophysiology and symptomatology of MS.
Collapse
Affiliation(s)
- Zoë Dworsky-Fried
- Department of Pharmacology, University of Alberta, Edmonton, AB, Canada
| | - Caylin I. Chadwick
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Bradley J. Kerr
- Department of Pharmacology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anna M. W. Taylor
- Department of Pharmacology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
34
|
Abdulla FA, Albagmi FM, Al-Khamis FA. Factors that influence quality of life in patients with multiple sclerosis in Saudi Arabia. Disabil Rehabil 2021; 44:4775-4783. [PMID: 33966564 DOI: 10.1080/09638288.2021.1919929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the factors which may contribute to quality of life (QOL) in patients with multiple sclerosis (pwMS) in Saudi Arabia. METHODS 175 pwMS and 71 age-, gender-, and BMI-matched healthy subjects participated in this cross-sectional study. QOL was studied by the multiple sclerosis quality of life-54 (MSQOL-54) while depression, disability, and fatigue were measured by the beck depression inventory-II (BDI-II), the expanded disability status scale (EDSS), and the modified fatigue impact scale (MFIS), respectively. The effects of demographic and clinical characteristics on MSQOL-54 were studied. RESULTS QOL was worse in pwMS. A better QOL in pwMS was linked to being male, having relapsing-remitting MS, having lower BMI, being employed, having a low disability, having no or minimal depression, and not fatigued. Age, disease duration, marital status, living status, and level of education did not affect the QOL. QOL showed a moderate to strong correlation with depression and fatigue and a weak correlation with EDSS. Depression and fatigue were the strongest predictors of QOL. Other predictors included gender and BMI but not EDSS. CONCLUSIONS Many of the factors which seem to influence QOL in pwMS are modifiable. Evaluation and management of such factors may improve QOL in pwMS.Implications for rehabilitationAssessment of QOL (using a proper tool) should be part of every pwMS evaluation.Depression and fatigue are the main predictors of QOL in pwMs, therefore, attention should be paid for their evaluation and management.Sexual dysfunction and pain should be assessed and managed early in the course of the disease.
Collapse
Affiliation(s)
- Fuad A Abdulla
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Neuroscience, Institute for Research and Medical Consultation, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal M Albagmi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Public Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fahd A Al-Khamis
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
35
|
Joseph B, Nandakumar AL, Ahmed AT, Gopal N, Murad MH, Frye MA, Tobin WO, Singh B. Prevalence of bipolar disorder in multiple sclerosis: a systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2021; 24:88-94. [PMID: 33328183 PMCID: PMC10231514 DOI: 10.1136/ebmental-2020-300207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disabling, demyelinating disease of the central nervous system and is often associated with psychiatric comorbidities. Some studies suggest increased prevalence of bipolar disorder (BD) in MS. OBJECTIVE To conduct a systematic review and meta-analysis assessing the prevalence of BD in adults with MS. METHODS We registered this review with PROSPERO and searched electronic databases (Ovid MEDLINE, Central, Embase, PsycINFO and Scopus) for eligible studies from earliest inception to October 2020. Prevalence data of BD in adult patients with MS were extracted. Meta-analysis was conducted using random-effects model. FINDINGS Of the 802 articles that were screened, 23 studies enrolling a total of 68 796 patients were included in the systematic review and meta-analysis. The pooled prevalence rate of BD in patients with MS was 2.95% (95% CI 2.12% to 4.09%) with higher prevalence in the Americas versus Europe. The lifetime prevalence of BD was 8.4% in patients with MS. Subgroup analysis showed a higher prevalence of BD in MS in females (7.03%) than in males (5.64%), which did not reach statistical significance (p=0.53). CONCLUSIONS This meta-analysis suggests a high lifetime prevalence of BD in patients with MS. Patients with MS should be routinely screened for BD. Further assessment of bipolar comorbidity in MS through prospective studies may help in developing effective management strategies and may improve treatment outcomes in patients with MS.
Collapse
Affiliation(s)
- Boney Joseph
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ahmed T Ahmed
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Clinical and Translational Science Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
36
|
Ferreira AM, Leal B, Ferreira I, Brás S, Moreira I, Samões R, Sousa AP, Santos E, Silva B, Costa PP, Cavaco S, Martins da Silva A. Depression and anxiety in multiple sclerosis patients: The role of genetic variability of interleukin 1β. Mult Scler Relat Disord 2021; 52:102982. [PMID: 34004436 DOI: 10.1016/j.msard.2021.102982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/26/2021] [Accepted: 04/22/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Mood disorders, as depression and anxiety, are frequent in Multiple Sclerosis (MS) patients. High pro-inflammatory cytokine levels (e.g. IL-1β) have been reported in depressed individuals. OBJECTIVE We aimed to investigate the role of the rs16944 (IL-1β-511 C>T) polymorphism in the development of anxiety and depression symptoms in a Portuguese cohort of MS patients. METHODS 393 MS patients answered the Hospital Anxiety and Depression Scale (HADS) at T1. This questionnaire was reapplied to a subgroup of 175 MS patients approximately three years later (T2). HADS cut-off scores for anxiety and depression were respectively ≥11 and ≥8. RESULTS At T1, anxiety was found in 106 MS patients (27.0%) and 11 controls (16.7%); whereas depression was identified in 116 (29.5%) MS patients and 9 controls (13.6%). Persistent anxiety and depression were respectively recorded in 12% and 20% of MS patients. The rs16944TT genotype was found to be a susceptibility factor for the occurrence of depression at T1 (OR = 3.16, p=0.002) and the development of persistent depression (OR = 5.63, p=0.003) in MS. CONCLUSION Study results support the hypothesis that inflammation is a significant factor in psychopathology development.
Collapse
Affiliation(s)
- Ana Marta Ferreira
- Laboratório de Imunogenética, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal.
| | - Bárbara Leal
- Laboratório de Imunogenética, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal.
| | - Inês Ferreira
- Unidade de Neuropsicologia, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal.
| | - Sandra Brás
- Laboratório de Imunogenética, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal.
| | - Inês Moreira
- Unidade de Neuropsicologia, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal.
| | - Raquel Samões
- Serviço de Neurologia, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal.
| | - Ana Paula Sousa
- Serviço de Neurofisiologia, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal.
| | - Ernestina Santos
- Serviço de Neurologia, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal; Serviço de Neurofisiologia, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal.
| | - Berta Silva
- Laboratório de Imunogenética, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal.
| | - Paulo Pinho Costa
- Laboratório de Imunogenética, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal; Departamento de Genética Humana, Instituto Nacional de Saúde Dr. Ricardo Jorge - Porto, Portugal.
| | - Sara Cavaco
- Unidade de Neuropsicologia, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal.
| | - Ana Martins da Silva
- Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal; Serviço de Neurologia, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Portugal.
| |
Collapse
|
37
|
Declemy A, Haddad R, Chesnel C, Charlanes A, Le Breton F, Sheikh Ismael S, Amarenco G. Prevalence of comorbidities in multiple sclerosis patients with neurogenic bladder. Prog Urol 2021; 31:732-738. [PMID: 33941463 DOI: 10.1016/j.purol.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/11/2020] [Accepted: 10/30/2020] [Indexed: 01/22/2023]
Abstract
AIMS The aim of this study was to define the prevalence of comorbidities among multiple sclerosis patients with lower urinary tract symptoms. METHODS A retrospective study of data collected prospectively from January 2000 to March 2016 was carried out using a database. Comorbidities were divided into several classes according to the International Classification of Diseases (ICD-10). RESULTS One hundred and fifty-five patients were included. All had a neurogenic bladder with 150 (96%) overactive bladder. EDSS score was≥6 in 44 patients (28%). Comorbidities were present in 79 (50,9%) and the most frequent ones were cardiovascular (14,2%), endocrinological (10,3%), urological (8,4%), abdominal (7,7%). Overweight (BMI≥25) was observed in 63 (40%). A strict relationship was found for BMI and stress urinary incontinence (P<0.001) as well as voiding dysfunction (P=0.003) without significant association for BMI and overactive bladder. CONCLUSION Prevalence of comorbidities is important in MS (more than 50%). A significant association is found between overweight, stress urinary incontinence and voiding dysfunction. Knowledge of these comorbidities in MS is important since the presence of these urinary symptoms not related to neurogenic bladder must lead to a specific treatment. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- A Declemy
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France.
| | - R Haddad
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - C Chesnel
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - A Charlanes
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - F Le Breton
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - S Sheikh Ismael
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - G Amarenco
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| |
Collapse
|
38
|
Aloizou AM, Pateraki G, Anargyros K, Siokas V, Bakirtzis C, Liampas I, Nousia A, Nasios G, Sgantzos M, Peristeri E, Dardiotis E. Transcranial magnetic stimulation (TMS) and repetitive TMS in multiple sclerosis. Rev Neurosci 2021; 32:723-736. [PMID: 33641274 DOI: 10.1515/revneuro-2020-0140] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/05/2021] [Indexed: 01/02/2023]
Abstract
Multiple sclerosis (MS) is the most well-known autoimmune disorder of the central nervous system, and constitutes a major cause of disability, especially in young individuals. A wide array of pharmacological treatments is available, but they have often been proven to be ineffective in ameliorating disease symptomatology or slowing disease progress. As such, non-invasive and non-pharmacological techniques have been gaining more ground. Transcranial magnetic stimulation (TMS) utilizes the electric field generated by a magnetic coil to stimulate neurons and has been applied, usually paired with electroencephalography, to study the underlying pathophysiology of MS, and in repetitive trains, in the form of repetitive transcranial magnetic stimulation (rTMS), to induce long-lasting changes in neuronal circuits. In this review, we present the available literature on the application of TMS and rTMS in the context of MS, with an emphasis on its therapeutic potential on various clinical aspects, while also naming the ongoing trials, whose results are anticipated in the future.
Collapse
Affiliation(s)
- Athina-Maria Aloizou
- Department of Neurology,Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Biopolis, Mezourlo Hill, 41100Larissa, Greece
| | - Georgia Pateraki
- Department of Neurology,Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Biopolis, Mezourlo Hill, 41100Larissa, Greece
| | - Konstantinos Anargyros
- Department of Neurology,Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Biopolis, Mezourlo Hill, 41100Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology,Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Biopolis, Mezourlo Hill, 41100Larissa, Greece
| | - Christos Bakirtzis
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Liampas
- Department of Neurology,Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Biopolis, Mezourlo Hill, 41100Larissa, Greece
| | - Anastasia Nousia
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Markos Sgantzos
- Department of Neurology,Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Biopolis, Mezourlo Hill, 41100Larissa, Greece
| | - Eleni Peristeri
- Department of Neurology,Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Biopolis, Mezourlo Hill, 41100Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology,Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Biopolis, Mezourlo Hill, 41100Larissa, Greece
| |
Collapse
|
39
|
Abstract
IMPORTANCE Multiple sclerosis (MS) is an autoimmune-mediated neurodegenerative disease of the central nervous system characterized by inflammatory demyelination with axonal transection. MS affects an estimated 900 000 people in the US. MS typically presents in young adults (mean age of onset, 20-30 years) and can lead to physical disability, cognitive impairment, and decreased quality of life. This review summarizes current evidence regarding diagnosis and treatment of MS. OBSERVATIONS MS typically presents in young adults aged 20 to 30 years with unilateral optic neuritis, partial myelitis, sensory disturbances, or brainstem syndromes such as internuclear ophthalmoplegia developing over several days. The prevalence of MS worldwide ranges from 5 to 300 per 100 000 people and increases at higher latitudes. Overall life expectancy is less than in the general population (75.9 vs 83.4 years), and MS more commonly affects women (female to male sex distribution of nearly 3:1). Diagnosis is made based on a combination of signs and symptoms, radiographic findings (eg, magnetic resonance imaging [MRI] T2 lesions), and laboratory findings (eg, cerebrospinal fluid-specific oligoclonal bands), which are components of the 2017 McDonald Criteria. Nine classes of disease-modifying therapies (DMTs), with varying mechanisms of action and routes of administration, are available for relapsing-remitting MS, defined as relapses at onset with stable neurologic disability between episodes, and secondary progressive MS with activity, defined as steadily increasing neurologic disability following a relapsing course with evidence of ongoing inflammatory activity. These drugs include interferons, glatiramer acetate, teriflunomide, sphingosine 1-phosphate receptor modulators, fumarates, cladribine, and 3 types of monoclonal antibodies. One additional DMT, ocrelizumab, is approved for primary progressive MS. These DMTs reduce clinical relapses and MRI lesions (new T2 lesions, gadolinium-enhancing lesions). Efficacy rates of current DMTs, defined by reduction in annualized relapse rates compared with placebo or active comparators, range from 29%-68%. Adverse effects include infections, bradycardia, heart blocks, macular edema, infusion reactions, injection-site reactions, and secondary autoimmune adverse effects, such as autoimmune thyroid disease. CONCLUSIONS AND RELEVANCE MS is characterized by physical disability, cognitive impairment, and other symptoms that affect quality of life. Treatment with DMT can reduce the annual relapse rate by 29% to 68% compared with placebo or active comparator.
Collapse
Affiliation(s)
| | | | - Alexander D Rae-Grant
- Cleveland Clinic Mellen Center, Cleveland, Ohio
- Now with Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| |
Collapse
|
40
|
Ostolaza A, Corroza J, Ayuso T. Multiple sclerosis and aging: comorbidity and treatment challenges. Mult Scler Relat Disord 2021; 50:102815. [PMID: 33581613 DOI: 10.1016/j.msard.2021.102815] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of elderly patients with MS is increasing, in conjunction with the ageing general population. This review will examine the principal characteristics of elderly patients with MS and how the concomitant pathologies affect them. Finally, it will assess the impact of the medications on these patients and whether it would be safe to discontinue the disease-modifying treatment. METHODS Searches using PubMed were conducted in October 2020 to collect studies assessing the impact of age and comorbidities on patients with MS. RESULTS Several studies showed that aged patients develop concomitant pathologies that could worsen the disease's prognosis. Also, MS itself may be closely related to cognitive impairment, even though the exact etiopathogenic mechanism of it is still unclear. To date, safety and efficacy of currently available drugs remain unassessed in elderly populations. These treatments may not be beneficial in preventing the progression of disability in ageing people with no signs of inflammatory activity, and discontinuation of treatment is often discussed in this subgroup of patients. CONCLUSIONS The presence of cardiovascular pathology, psychiatric disorders, diabetes or cancer is further associated with increased mortality in MS patients. The diagnosis and treatment of the disease is challenged by both age-related comorbidities and clinical variations compared to younger patients. It may be safe to discontinue treatment in elderly patients with no clinico-radiological activity.
Collapse
Affiliation(s)
- Aiora Ostolaza
- Department of Neurology, Complejo Hospitalario de Navarra-IdiSNA (Navarra Institute for Health Research), Pamplona, Navarra, 31008, Spain.
| | - Jon Corroza
- Department of Neurology, Complejo Hospitalario de Navarra-IdiSNA (Navarra Institute for Health Research), Pamplona, Navarra, 31008, Spain
| | - Teresa Ayuso
- Department of Neurology, Complejo Hospitalario de Navarra-IdiSNA (Navarra Institute for Health Research), Pamplona, Navarra, 31008, Spain
| |
Collapse
|
41
|
Block VJ, Gopal A, Rowles W, -Yueh C, Gelfand JM, Bove R. CoachMS, an innovative closed-loop, interdisciplinary platform to monitor and proactively treat MS symptoms: A pilot study. Mult Scler J Exp Transl Clin 2021; 7:2055217321988937. [PMID: 33796329 PMCID: PMC7970691 DOI: 10.1177/2055217321988937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background There are numerous challenges to treating co-occurring symptoms in multiple sclerosis (MS). Objective To pilot the feasibility of a novel symptom management platform, CoachMS, to monitor MS symptoms (bladder function, ambulation, and mood: BAM) and respond to changes in real-time. Methods In this 12-week randomized controlled pilot trial, participants’ symptoms were monitored using weekly questionnaires and remote ambulatory monitoring (Fitbit Flex2®). Behavioral change principles used included shared goal setting at 2 weeks. Between weeks 2-12, the CoachMS group received targeted contact and interventions if symptoms worsened; the control group were treated through usual clinic practice. Our outcomes were feasibility (retention, adherence and acceptability; primary) and proportion of recommended treatments pursued (secondary); efficacy was explored. Results Of 21 participants enrolled, 13 (62%) completed the study; protocol adherence was excellent. CoachMS participants demonstrated greater follow-through with clinical recommendations than controls (OR 9.3, 95% CI (0.9, 97.6)). As a cohort, each BAM symptom tended to improve. Suicidality was detected in one control participant, resulting in urgent evaluation and hospitalization. Conclusions The innovative CoachMS platform was feasible and acceptable in this cohort with baseline BAM symptoms. It could represent an accessible, cost-effective tool to monitor MS symptoms in real-time; a larger trial is planned.
Collapse
Affiliation(s)
- Valerie J Block
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Arpita Gopal
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA
| | - William Rowles
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Chu -Yueh
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey M Gelfand
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, MS and Neuroinflammation Clinic, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
42
|
Grech LB, Haines S, Marck CH, Hester R, Butler E. Untreated and under-treated depressive symptoms in people with multiple sclerosis in an Australian context: A secondary analysis. Collegian 2021. [DOI: 10.1016/j.colegn.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
43
|
Filser M, Baetge SJ, Balloff C, Buchner A, Fink GR, Heibel M, Meier U, Rau D, Renner A, Schreiber H, Ullrich S, Penner IK. Mental symptoms in MS (MeSyMS): Development and validation of a new assessment. Mult Scler Relat Disord 2021; 49:102744. [PMID: 33517174 DOI: 10.1016/j.msard.2021.102744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/12/2020] [Accepted: 01/05/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with Multiple Sclerosis (MS) have an increased risk of suffering from mental and neuropsychiatric symptoms. So far, a fundamental problem in the clinical care of MS patients is that these symptoms are underdiagnosed and, as a consequence, often remain untreated. Present assessment tools have not been developed to be applied in patients with MS. This study aims to develop and validate a new questionnaire to identify disease-related mental symptoms in MS patients. METHODS A questionnaire has been developed by including the following subscales: social and emotional health problems, anxiety, and depression. To evaluate test quality and internal consistency, an item analysis has been conducted. After matching MS patients and control subjects on age and gender, we conducted group comparisons, a Receiver Operating Characteristic (ROC) Curve analysis and a binary logistic regression model. RESULTS In total, 314 MS patients and 100 matched control subjects were analysed. After performed item analysis, the questionnaire revealed an excellent internal consistency (α=0.94). Compared to control subjects, MS patients showed significant mental health problems in all three dimensions. In comparison to the subscales, the dimension of social and emotional health problems revealed the highest accuracy (AUC = 0.75; d = 0.948) and turned out to be the only scale that reliably differentiated between the groups. CONCLUSIONS MeSyMS constitutes a valid screening instrument to detect mental symptoms in MS. Social and emotional health problems turned out to be the most important aspect when identifying disease-related mental health symptoms in MS.
Collapse
Affiliation(s)
- Melanie Filser
- COGITO Center for Applied Neurocognition and Neuropsychological Research, Life Science Centre, Merowingerplatz 1, 40225 Düsseldorf, Germany; Department of Experimental Psychology, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Sharon Jean Baetge
- COGITO Center for Applied Neurocognition and Neuropsychological Research, Life Science Centre, Merowingerplatz 1, 40225 Düsseldorf, Germany
| | - Carolin Balloff
- Institute of Clinical Neuroscience and Medical Psychology, Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Axel Buchner
- Department of Experimental Psychology, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Straße, 52425 Jülich, Germany
| | - Markus Heibel
- Sauerlandklinik Hachen, MS-Spezialambulanz, Siepenstr. 44, 59846 Sundern‑Hachen, Germany
| | - Uwe Meier
- Neuro Centrum, Neurological practice, Am Ziegelkamp 1f, 41515 Grevenbroich, Germany
| | - Daniela Rau
- Nervenfachärztliche Gemeinschaftspraxis, Pfauengasse 8, 89073 Ulm, Germany
| | - Alina Renner
- COGITO Center for Applied Neurocognition and Neuropsychological Research, Life Science Centre, Merowingerplatz 1, 40225 Düsseldorf, Germany
| | - Herbert Schreiber
- Nervenfachärztliche Gemeinschaftspraxis, Pfauengasse 8, 89073 Ulm, Germany
| | - Sebastian Ullrich
- punkt05 Statistikberatung, Life Science Centre, Merowingerplatz 1, 40225 Düsseldorf, Germany
| | - Iris-Katharina Penner
- COGITO Center for Applied Neurocognition and Neuropsychological Research, Life Science Centre, Merowingerplatz 1, 40225 Düsseldorf, Germany; Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany.
| |
Collapse
|
44
|
Estimating the relative contribution of comorbidities in predicting health-related quality of life of people with multiple sclerosis. J Neurol 2020; 268:569-581. [PMID: 32880072 DOI: 10.1007/s00415-020-10195-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the relative contribution of comorbidities in predicting the health-related quality of life (HRQoL) of people with Multiple Sclerosis (PwMS). OBJECTIVE To determine the associations between the number of and individual comorbidities and HRQoL and estimate the relative contribution of different comorbidities on HRQoL. METHODS Cross-sectional analysis of data on self-reported presence of 30 comorbidities and HRQoL from the Australian MS Longitudinal Study (AMSLS) participants (n = 902). HRQoL was measured using the Assessment of Quality of Life-8 Dimensions (AQoL-8D). Linear regression and general dominance analysis were used. RESULTS Higher number of comorbidities was associated with lower HRQoL (p trend p < 0.01). Comorbidities accounted for 18.1% of the variance in HRQoL. Mental health and musculoskeletal disorders were the strongest contributors to lower HRQoL. Of individual comorbidities, systemic lupus erythematosus (SLE) [β = - 0.16 (- 0.27, - 0.05)] and depression [β = - 0.15(- 0.18, - 0.13)] were most strongly associated with overall HRQoL, depression [β = - 0.14(- 0.16, - 0.11)] and anxiety [β = - 0.10 (- 0.13, - 0.07)] with psychosocial HRQoL, and SLE [β = - 0.18 (- 0.29, - 0.07)], rheumatoid arthritis [β = - 0.11 (- 0.19, - 0.02)] and hyperthyroidism [β = - 0.11 (- 0.19, - 0.03)) with physical HRQoL. CONCLUSION Comorbidities potentially make important contributions to HRQoL in PwMS. Our findings highlight groups of and individual comorbidities that could provide the largest benefits for the HRQoL of PwMS if they were targeted for prevention, early detection, and optimal treatment.
Collapse
|
45
|
Midaglia L, Otero S, Baró F, Montalban X, Tintoré M. Menopause and multiple sclerosis: Influence on prognosis and role of disease-modifying drugs and hormonal replacement therapy. Mult Scler 2020; 28:173-182. [DOI: 10.1177/1352458520952022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background:Sex hormones play a role in both the risk and the prognosis of multiple sclerosis (MS). Considering all stages of women’s reproductive life, data regarding the influence of menopause on MS and vice versa are scarce.Objective:The aim of this study was to review the evidence addressing the relationship between menopause and MS.Methods:A literature search through PubMed was conducted, selecting studies that assessed (1) the influence of menopause in the MS course, (2) the influence of MS and disease-modifying drugs (DMD) on the development of menopause and (3) the effect of hormone replacement therapy (HRT) on symptoms of menopausal MS patients.Results:(1) Most studies suggest menopause may transitorily aggravate MS symptoms. Two studies found an inflexion point on the Expanding Disability Status Scale (EDSS) with clinical worsening during the menopausal transition. Another study considering full EDSS trajectories from clinically isolated syndrome to postmenopause did not find such an EDSS inflection; (2) MS and DMD do not seem to alter the age of menopause onset; and (3) HRT in menopausal MS patients has not shown consistent benefits.Conclusion:Menopause seems to be associated with transient symptom worsening, but the existence of an inflection in disability progression is still controversial. Properly designed studies are necessary to achieve conclusive results.
Collapse
Affiliation(s)
- Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Otero
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Baró
- Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
46
|
Alphonsus KB, D'Arcy C. Factors Associated With Medication Use Among Individuals Living With Multiple Sclerosis. J Evid Based Integr Med 2020; 25:2515690X20936978. [PMID: 32618199 PMCID: PMC7491223 DOI: 10.1177/2515690x20936978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system causing neurological deterioration over time. The objective of this study was to examine the predictors associated with MS medication use. The categories that were investigated were various alternative treatments such as complementary/alternative medications (CAMs), rehabilitation therapy and psychotherapy services as well as comorbid health conditions. The Survey on Living with Neurological Conditions in Canada (SLNCC) 2011-2012 was used (N = 73 347) to carry out a logistic regression model. Individuals who did not take CAMs were more (OR = 5.44, 95% CI 1.37-9.29) likely to use medications for MS. Having a mood disorder was associated with greater use of MS medications (OR = 5.39, 95% CI 1.60-18.17) while back problems were associated with lower odds of medication use (OR = 0.38, 95% CI 0.15-0.98). These factors need to be taken into consideration when creating effective medication adherence interventions.
Collapse
Affiliation(s)
| | - Carl D'Arcy
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
47
|
Thrue C, Riemenschneider M, Hvid LG, Stenager E, Dalgas U. Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains. Mult Scler 2020; 27:1477-1485. [DOI: 10.1177/1352458520936231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the “time matters”-perspective has become a focal point when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible.
Collapse
Affiliation(s)
- C Thrue
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - M Riemenschneider
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - LG Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - E Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/Department of Neurology, MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Sønderborg, Denmark
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
48
|
Guilleux A, Roux J, Travers D, Leray E. Prevalence of mental disorders is higher in patients with multiple sclerosis than in the general population or in patients with rheumatoid arthritis in France. Mult Scler J Exp Transl Clin 2020; 6:2055217320941540. [PMID: 32922830 PMCID: PMC7457671 DOI: 10.1177/2055217320941540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Mental disorders (MDs) in multiple sclerosis (MS) patients decreases
treatment adherence and quality of life, and increases the risk of
disability progression and care consumption. Objective This study was to assess the prevalence of MDs in MS patients compared with
healthy controls (HC) of the French general population and rheumatoid
arthritis (RA) patients. Methods The 2015 prevalence of MDs for MS patients, RA patients and general
population was estimated using a random population-based data sample from
‘National Inter-Scheme Information System on Health Insurance’ in the
2011–2015 period. Two control groups (1:5 ratio for the HC and 1:1 for the
RA group) were matched to the MS group for year of birth, gender, area of
residence and health insurance scheme. Results A total of 1145 MS patients were identified (sex ratio of 2.5 (F/M); median
age 50 years). The prevalence of MDs was higher in the population of
patients with MS (37.3%) than in the French general population (13.6%), and
to a lesser extent in the RA group (21.1%) leading to the prevalence ratios
of 2.8 (95% confidence intervals (CIs) 2.5–3.0) and 1.9 (95% CI 1.7–2.3),
respectively. Conclusions This study confirmed that MS patients are at a higher risk of MDs than the
French general population or RA patients.
Collapse
Affiliation(s)
- Alice Guilleux
- EHESP, REPERES, University of Rennes, France
- Centre d’Investigation Clinique de Rennes, University of Rennes, France
| | - Jonathan Roux
- EHESP, REPERES, University of Rennes, France
- EHESP, REPERES, University of Rennes, France
- Centre d’Investigation Clinique de Rennes, University of Rennes, France
| | - David Travers
- Department of Psychiatry, University Hospital CHU Pontchaillou, France
- EHESP, REPERES, University of Rennes, France
- Centre d’Investigation Clinique de Rennes, University of Rennes, France
| | - Emmanuelle Leray
- EHESP, REPERES, University of Rennes, France
- Centre d’Investigation Clinique de Rennes, University of Rennes, France
| |
Collapse
|
49
|
Machine-learning models for depression and anxiety in individuals with immune-mediated inflammatory disease. J Psychosom Res 2020; 134:110126. [PMID: 32387817 DOI: 10.1016/j.jpsychores.2020.110126] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/29/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Individuals with immune-mediated inflammatory disease (IMID) have a higher prevalence of psychiatric disorders than the general population. We utilized machine-learning to identify patient-reported outcome measures (PROMs) that accurately predict major depressive disorder (MDD) and anxiety disorder in an IMID population. METHODS Participants with IMID were enrolled in a cohort study and completed a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), and multiple PROMs. PROM items were ranked separately for MDD and anxiety disorder by the standardized mean difference between individuals with and without psychiatric disorders. Items were added sequentially to logistic regression (LR), neural network (NN), and random forest (RF) models. Discriminative performance was assessed with area under the receiver operator curve (AUC) and calibration was assessed with Brier scores. Ten-fold cross-validation was used. RESULTS Of 637 participants, 75% were female and average age was 51 years. AUC and Brier scores respectively ranged from 0.87-0.91 and 0.07 (i.e., no variation) for MDD models, and from 0.79-0.83 and 0.09-0.11 for anxiety disorder models. In LR and NN, few PROM items were required to obtain optimal discriminatory performance. RF did not perform as well as LR and NN when few PROM items were included. CONCLUSIONS Predictive model performance was respectable and revealed insight into PROM items that are predictive of MDD and anxiety disorder. Models that included only the items 'I felt depressed' and 'I felt like I needed help for my anxiety' performed similarly to models that included all items from multiple PROMs.
Collapse
|
50
|
Predictors of hospitalization in a Canadian MS population: A matched cohort study. Mult Scler Relat Disord 2020; 41:102028. [DOI: 10.1016/j.msard.2020.102028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
|