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Kinkel RP, Laforet G, You X. Disease-related determinants of quality of life 10 years after clinically isolated syndrome. Int J MS Care 2015; 17:26-34. [PMID: 25741224 DOI: 10.7224/1537-2073.2013-041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The main clinical determinants of quality of life (QOL) 5 years after clinically isolated syndrome (CIS) are Expanded Disability Status Scale (EDSS) score and conversion to clinically definite multiple sclerosis (CDMS). The aim of this study was to determine the demographic, clinical, and magnetic resonance imaging (MRI) factors associated with QOL 10 years after CIS. METHODS Controlled High Risk Avonex® Multiple Sclerosis Prevention Study in Ongoing Neurologic Surveillance (CHAMPIONS) 10-year patients were assessed for CDMS, EDSS score, MRI T2 activity, brain parenchymal fraction, and patient-reported QOL. Associations were evaluated using analysis of variance models. RESULTS A second clinical event consistent with CDMS and higher EDSS scores at years 5 and 10 were associated with lower 36-item Short Form Health Status Survey (SF-36) Physical Component Summary scores at year 10 (P < .01). Patients with earlier onset of CDMS had worse patient-reported Physical Component Summary, SF-36 Mental Component Summary, fatigue, and pain scores at year 10 than patients with later or no onset of CDMS. Neither initial randomization group nor any MRI metrics assessed at baseline or during follow-up were associated with QOL at 10 years. CONCLUSIONS These results support the development of therapies for patients with CIS that significantly reduce the risk of conversion to CDMS and the progression of physical disability to milestones as low as EDSS scores of 2.0.
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Affiliation(s)
- R Philip Kinkel
- Multiple Sclerosis Program, Department of Neurosciences, University of California San Diego, San Diego, CA, USA (RPK); and Biogen Idec Inc, Cambridge, MA, USA (GL, XY). Dr. Laforet is now with Genzyme, Cambridge, MA, USA
| | - Genevieve Laforet
- Multiple Sclerosis Program, Department of Neurosciences, University of California San Diego, San Diego, CA, USA (RPK); and Biogen Idec Inc, Cambridge, MA, USA (GL, XY). Dr. Laforet is now with Genzyme, Cambridge, MA, USA
| | - Xiaojun You
- Multiple Sclerosis Program, Department of Neurosciences, University of California San Diego, San Diego, CA, USA (RPK); and Biogen Idec Inc, Cambridge, MA, USA (GL, XY). Dr. Laforet is now with Genzyme, Cambridge, MA, USA
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Baumstarck K, Pelletier J, Boucekine M, Auquier P. Predictors of quality of life in patients with relapsing-remitting multiple sclerosis: A 2-year longitudinal study. Rev Neurol (Paris) 2015; 171:173-80. [DOI: 10.1016/j.neurol.2014.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/04/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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Piacentini V, Mauri I, Cattaneo D, Gilardone M, Montesano A, Schindler A. Relationship Between Quality of Life and Dysarthria in Patients With Multiple Sclerosis. Arch Phys Med Rehabil 2014; 95:2047-54. [DOI: 10.1016/j.apmr.2014.04.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
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Bueno AM, Sayao AL, Yousefi M, Devonshire V, Traboulsee A, Tremlett H. Health-related quality of life in patients with longstanding 'benign multiple sclerosis'. Mult Scler Relat Disord 2014; 4:31-8. [PMID: 25787050 DOI: 10.1016/j.msard.2014.09.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 09/26/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND We explored health-related quality of life (HRQoL) and psychosocial aspects in a cohort of patients with a history of longstanding benign MS (BMS). METHODS Patients with BMS (EDSS≤3 after 20 years disease duration) were re-assessed 25-30 years post-MS symptom onset for: EDSS, HRQoL (MSQoL-54), depression (Beck Depression Inventory-II), and fatigue (Modified Fatigue Impact Scale). Associations between these measures and patient characteristics (age, disease duration, 'benign status' [remained benign (EDSS≤3) vs no longer benign (EDSS>3)]) were examined. RESULTS Of the 61 patients included, 36 (49%) remained benign and 25 (41%) progressed (EDSS>3). Overall, physical and mental HRQoL scores were positively associated with each other (r=0.63; p<0.0001) and both negatively correlated with fatigue (r=-0.76 and -0.44, respectively; p<0.0005) and depression (r=-0.55 and -0.77; p<0.0001). Patients who remained benign reported better physical HRQoL vs those no longer benign (mean (SD)=67.3±18.1 vs 50.7±19.9, p=0.001), but not mental health (mean (SD)=67.4±19.3 vs 65.0±20.6, p=0.639). Generally, neither age nor disease duration was strongly associated with HRQoL (r<0.35). CONCLUSION Lower self-reported physical or mental HRQoL was associated with worsening fatigue and depression. However, EDSS progression was associated with the physical, but not mental aspects of HRQoL. Patient-reported HRQoL in 'benign MS' provides insight on the impact of MS beyond EDSS alone.
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Affiliation(s)
- Anna-Marie Bueno
- Department of Medicine (Division of Neurology), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ana-Luiza Sayao
- Department of Medicine (Division of Neurology), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Masoud Yousefi
- Department of Medicine (Division of Neurology), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Virginia Devonshire
- Department of Medicine (Division of Neurology), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Anthony Traboulsee
- Department of Medicine (Division of Neurology), Faculty of Medicine, University of British Columbia, Vancouver, Canada; Brain Research Centre, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Helen Tremlett
- Department of Medicine (Division of Neurology), Faculty of Medicine, University of British Columbia, Vancouver, Canada; Brain Research Centre, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Abstract
Objective:To compare neurologist and patient perceptions of multiple sclerosis (MS)-related health status.Methods:MS patients (n=99) were recruited from six sites in Canada. Following a consultation with their neurologist, patients estimated their relapse frequency, rated their general health and quality of life (QoL), reviewed descriptions of eight health domains and selected the three most important, and completed a utility assessment using the standard gamble (SG). Concurrently, neurologists independently used the same instruments to rate their patients' health status. Assessments were compared on the basis of paired mean values of both groups and the degree of exact agreement quantified by intraclass coefficient (ICC) and kappa analyses, which yield values of 1.0 with 100% agreement.Results:There were significant differences (p<0.001) between patient and neurologist ratings for relapses in the last year (0.86 vs. 0.4, respectively), QoL (61.2 vs. 69.7 (maximum score = 100) and utility (0.864 vs. 0.971); ICC analysis revealed moderate to poor levels of agreement (0.56 for QoL to 0.03 for SG). There was little concordance in identification of important health domain and the only significant associations were in bodily pain and social functioning (kappa statistic = 0.24, p = 0.026 for both). Neurologists identified physical functioning domains as important, while patients placed more emphasis on mental health domains.Conclusions:Discrepancies between neurologist and patient perceptions of MS were observed. The study identifies a need to educate neurologists on the recognition of MS health domains that are important in the definition of patient QoL.
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Validity of maximal exercise testing in people with multiple sclerosis and low to moderate levels of disability. Phys Ther 2014; 94:1168-75. [PMID: 24677255 DOI: 10.2522/ptj.20130418] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cardiopulmonary exercise testing can be considered the gold standard for assessing cardiorespiratory fitness. Little is known about the criteria for maximal exercise testing in people with multiple sclerosis (MS) and how these criteria behave across different levels of neurological disability. OBJECTIVE The study objectives were to determine the criteria for maximal exercise testing across various levels of disability and to assess concomitant subgroup differences in measures related to the participant, disease, and function. DESIGN This was a cross-sectional study. METHODS Cardiopulmonary exercise testing was conducted with a sample of 56 participants with MS. Analysis of variance was used to assess the criteria in participants with MS and low, mild, and moderate levels of disability. RESULTS Mean peak oxygen consumption (V̇o2peak) was 21.4 (SD=7.1) mL·kg(-1)·min(-1). An oxygen consumption (V̇o2) plateau was seen in 37.5% of participants. A respiratory exchange ratio of 1.10 or greater was achieved by 69.6% of the participants, a maximal heart rate within 90% of their age-predicted maximal heart rate was achieved by 48.2% of the participants, and 23.2% of the participants perceived their exertion to be 18 or greater on the Borg Scale of Perceived Exertion (scores of 6-20). The values for achieved heart rate and incidence of a V̇o2 plateau were significantly lower in participants with moderate levels of disability than in those with mild levels of disability. LIMITATIONS The primary limitations of this study were its cross-sectional nature and relatively small sample of participants with moderate levels of disability. CONCLUSION The findings suggest that the outcome of cardiopulmonary exercise testing in people with MS and low to mild levels of disability (Expanded Disability Status Scale scores of ≤4.0) is a valid measure of cardiorespiratory fitness, whereas the outcome in people with moderate levels of disability (Expanded Disability Status Scale scores of >4.0) is most likely symptom limited.
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Williet N, Sandborn WJ, Peyrin-Biroulet L. Patient-reported outcomes as primary end points in clinical trials of inflammatory bowel disease. Clin Gastroenterol Hepatol 2014; 12:1246-56.e6. [PMID: 24534550 DOI: 10.1016/j.cgh.2014.02.016] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/29/2013] [Accepted: 02/06/2014] [Indexed: 02/07/2023]
Abstract
The Food and Drug Administration (FDA) is moving from the Crohn's Disease Activity Index to patient-reported outcomes (PROs) and objective measures of disease, such as findings from endoscopy. PROs will become an important aspect of assessing activity of inflammatory bowel disease (IBD) and for labeling specific drugs for this disease. PROs always have been considered in the management of patients with rheumatoid arthritis or multiple sclerosis, and have included measurements of quality of life, disability, or fatigue. Several disease-specific scales have been developed to assess these PROs and commonly are used in clinical trials. Outcomes reported by patients in clinical trials of IBD initially focused on quality of life, measured by the Short-Form 36 questionnaire or disease-specific scales such as the Inflammatory Bowel Disease Questionnaire or its shorter version. Recently considered factors include fatigue, depression and anxiety, and work productivity, as measured by the Functional Assessment Chronic Illness Therapy-Fatigue, the Hospital Anxiety Depression, and the Work Productivity Activity Impairment Questionnaire, respectively. However, few data are available on how treatment affects these factors in patients with IBD. Although disability generally is recognized in patients with IBD, it is not measured. The international IBD disability index currently is being validated. None of the PROs currently used in IBD were developed according to FDA guidance for PRO development. PROs will be a major primary end point of future trials. FDA guidance is needed to develop additional PROs for IBD that can be incorporated into trials, to better compare patients' experience with different therapies.
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Affiliation(s)
- Nicolas Williet
- Inserm, U954 et Service d'Hepato-Gastroenterologie, Hôpital Universitaire de Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, France
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Laurent Peyrin-Biroulet
- Inserm, U954 et Service d'Hepato-Gastroenterologie, Hôpital Universitaire de Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, France.
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Pierzchala K, Adamczyk-Sowa M, Dobrakowski P, Kubicka-Baczyk K, Niedziela N, Sowa P. Demographic characteristics of MS patients in Poland's upper Silesia region. Int J Neurosci 2014; 125:344-51. [DOI: 10.3109/00207454.2014.937002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Klevan G, Jacobsen CO, Aarseth JH, Myhr KM, Nyland H, Glad S, Lode K, Figved N, Larsen JP, Farbu E. Health related quality of life in patients recently diagnosed with multiple sclerosis. Acta Neurol Scand 2014; 129:21-6. [PMID: 23772958 DOI: 10.1111/ane.12142] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe a representative population of patients recently diagnosed with MS in terms of both motor and non-motor disability. In particular we wanted to examine the HRQoL in this population to get a better understanding of what impact various clinical features have on the patients' experience of distress in the early phase of the disease. METHODS Ninety three patients diagnosed with MS in Hordaland and Rogaland county in 1998-2000 and 96 healthy controls were examined through questionnaires on HRQoL (SF-36), depression (Beck's depression inventory), fatigue (fatigue severity scale) and apathy (Starkstein's apathy scale). The patients also underwent neurological examination including the expanded disability status scale and the Multiple Sclerosis Functional Composite, as well as the symbol digit memory test and the selective reminder test. RESULTS Patients with MS reported a lower HRQoL than the controls with a mean physical health summary score of 57.3 compared to 84.5 (P < 0.001), and a mental health summary score of 66.4 vs 79.2 (P < 0.001). The controls scored significantly higher on all SF-36 sub scores except for bodily pain. The incidence of fatigue was 71% in patients compared to 27% in controls (P < 0.001), whereas 46% of patients vs 18% of controls reported depression (P < 0.001). The mean score for apathy was significantly higher among patients. CONCLUSIONS Patients with recently diagnosed MS reported significantly lower on both physical and mental aspects of HRQoL compared with controls. Depression, fatigue and apathy were more common and more severe in MS. We found no correlation between cognitive decline and HRQoL scores.
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Affiliation(s)
- G. Klevan
- Department of Neurology; Stavanger University Hospital; Stavanger Norway
- Norwegian Centre of Movement Disorders; Stavanger University Hospital; Stavanger Norway
| | - C. O. Jacobsen
- Department of Neurology; Stavanger University Hospital; Stavanger Norway
- Norwegian Centre of Movement Disorders; Stavanger University Hospital; Stavanger Norway
| | - J. H. Aarseth
- Department of Neurology Norwegian; Multiple Sclerosis Competence Centre; Haukeland University Hospital; Bergen Norway
| | - K.-M. Myhr
- Department of Neurology Norwegian; Multiple Sclerosis Competence Centre; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; KG Jebsen MS-research Centre; Haukeland University Hospital; Bergen Norway
- Clinical Institute 1; University of Bergen; Bergen Norway
| | - H. Nyland
- Department of Neurology Norwegian; Multiple Sclerosis Competence Centre; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; KG Jebsen MS-research Centre; Haukeland University Hospital; Bergen Norway
- Clinical Institute 1; University of Bergen; Bergen Norway
| | - S. Glad
- Department of Neurology Norwegian; Multiple Sclerosis Competence Centre; Haukeland University Hospital; Bergen Norway
| | - K. Lode
- Norwegian Centre of Movement Disorders; Stavanger University Hospital; Stavanger Norway
| | - N. Figved
- Department of Geriatric Psychiatry; Stavanger University Hospital; Stavanger Norway
| | - J. P. Larsen
- Norwegian Centre of Movement Disorders; Stavanger University Hospital; Stavanger Norway
- Clinical Institute 1; University of Bergen; Bergen Norway
| | - E. Farbu
- Department of Neurology; Stavanger University Hospital; Stavanger Norway
- Norwegian Centre of Movement Disorders; Stavanger University Hospital; Stavanger Norway
- Clinical Institute 1; University of Bergen; Bergen Norway
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Wickström A, Dahle C, Vrethem M, Svenningsson A. Reduced sick leave in multiple sclerosis after one year of natalizumab treatment. A prospective ad hoc analysis of the TYNERGY trial. Mult Scler 2013; 20:1095-101. [DOI: 10.1177/1352458513517590] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 11/29/2013] [Indexed: 11/15/2022]
Abstract
Background: In a retrospective study, we have previously shown that work ability was improved after the initiation of natalizumab treatment in relapsing–remitting multiple sclerosis (RRMS). In another prospective trial (TYNERGY) the effect on MS-related fatigue was evaluated after 12 months of treatment with natalizumab. A comprehensive Capacity for Work Questionnaire (CWQ) was used to collect data regarding number of working hours and sickness absence. The predefined intention-to-treat analysis regarding work ability did not, however, show significant results. Objectives: The objective of this paper is to assess the amount of sick leave in RRMS before and after one year of natalizumab treatment and correlate it to fatigue and walking ability. Methods: This is a post-hoc analysis of the complete data from the CWQ used in the TYNERGY trial. Results: MS patients receiving sickness benefit before start of treatment reduced their sickness benefit by an absolute change of 33% after one year of natalizumab treatment. Younger age and improvement of walking ability correlated significantly with reduction of sick leave. Conclusions: This ad-hoc analysis of prospectively collected data supported our previous retrospective study and thus indicates a positive relationship between natalizumab treatment and improvement in work ability.
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Affiliation(s)
- Anne Wickström
- Department of Pharmacology and Clinical Neuroscience, Section of Neuroscience, Umeå University, Sweden
| | - Charlotte Dahle
- Department of Clinical and Experimental Medicine, Clinical Immunology, Faculty of Health Sciences, Linköping University, Sweden
- Clinical Immunology and Transfusion Medicine, County Council of Östergötland, Sweden
| | - Magnus Vrethem
- Department of Clinical and Experimental Medicine, Neurology and Clinical Neurophysiology, Faculty of Health Sciences, Linköping University, Sweden
- Department of Neurology and Neurophysiology, County Council of Östergötland, Sweden
| | - Anders Svenningsson
- Department of Pharmacology and Clinical Neuroscience, Section of Neuroscience, Umeå University, Sweden
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Schairer LC, Foley FW, Zemon V, Tyry T, Campagnolo D, Marrie RA, Gromisch ES, Schairer D. The impact of sexual dysfunction on health-related quality of life in people with multiple sclerosis. Mult Scler 2013; 20:610-6. [DOI: 10.1177/1352458513503598] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Sexual dysfunction is a prevalent symptom in multiple sclerosis (MS) that may affect patients’ health-related quality of life (HrQoL). Objective: The objective of this paper is to examine the impact of sexual dysfunction on HrQoL in a large national sample using The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Methods: Participants were recruited from a large MS registry, the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants self-reported demographic information and completed the Patient Determined Disease Steps (PDDS), MSISQ-19, and the Short Form-12 (SF-12). Results: The study population included 6183 persons (mean age: 50.6, SD = 9.6; 74.7% female, 42.3% currently employed). Using multivariate hierarchical regression analyses, all variables excluding gender predicted both the physical component summary (PCS-12) and the mental component summary (MCS-12) of the SF-12. Scores on the MSISQ-19 uniquely accounted for 3% of the variance in PCS-12 scores while disability level, as measured by PDDS, accounted for 31% of the variance. Conversely, MSISQ-19 scores uniquely accounted for 13% of the variance in MCS-12 scores, whereas disability level accounted for less than 1% of the variance. Conclusion: In patients with MS, sexual dysfunction has a much larger detrimental impact on the mental health aspects of HrQoL than severity of physical disability.
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Affiliation(s)
| | - Frederick W Foley
- Ferkauf Graduate School of Psychology, Yeshiva University, USA
- Holy Name Medical Center, Multiple Sclerosis Center, USA
| | - Vance Zemon
- Ferkauf Graduate School of Psychology, Yeshiva University, USA
| | | | | | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Canada
| | | | - David Schairer
- Albert Einstein College of Medicine, Yeshiva University, USA
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Borghi M, Cavallo M, Carletto S, Ostacoli L, Zuffranieri M, Picci RL, Scavelli F, Johnston H, Furlan PM, Bertolotto A, Malucchi S. Presence and significant determinants of cognitive impairment in a large sample of patients with multiple sclerosis. PLoS One 2013; 8:e69820. [PMID: 23922813 PMCID: PMC3726772 DOI: 10.1371/journal.pone.0069820] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/12/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives To investigate the presence and the nature of cognitive impairment in a large sample of patients with Multiple Sclerosis (MS), and to identify clinical and demographic determinants of cognitive impairment in MS. Methods 303 patients with MS and 279 healthy controls were administered the Brief Repeatable Battery of Neuropsychological tests (BRB-N); measures of pre-morbid verbal competence and neuropsychiatric measures were also administered. Results Patients and healthy controls were matched for age, gender, education and pre-morbid verbal Intelligence Quotient. Patients presenting with cognitive impairment were 108/303 (35.6%). In the overall group of participants, the significant predictors of the most sensitive BRB-N scores were: presence of MS, age, education, and Vocabulary. The significant predictors when considering MS patients only were: course of MS, age, education, vocabulary, and depression. Using logistic regression analyses, significant determinants of the presence of cognitive impairment in relapsing-remitting MS patients were: duration of illness (OR = 1.053, 95% CI = 1.010–1.097, p = 0.015), Expanded Disability Status Scale score (OR = 1.247, 95% CI = 1.024–1.517, p = 0.028), and vocabulary (OR = 0.960, 95% CI = 0.936–0.984, p = 0.001), while in the smaller group of progressive MS patients these predictors did not play a significant role in determining the cognitive outcome. Conclusions Our results corroborate the evidence about the presence and the nature of cognitive impairment in a large sample of patients with MS. Furthermore, our findings identify significant clinical and demographic determinants of cognitive impairment in a large sample of MS patients for the first time. Implications for further research and clinical practice were discussed.
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Affiliation(s)
- Martina Borghi
- Department of Mental Health, “San Luigi Gonzaga” Hospital Medical School, University of Turin, ASL TO3, Orbassano, Italy
| | - Marco Cavallo
- Department of Mental Health, “San Luigi Gonzaga” Hospital Medical School, University of Turin, ASL TO3, Orbassano, Italy
- Department of Translational Medicine, “Amedeo Avogadro” University of Eastern Piedmont, Novara, Italy
- * E-mail:
| | - Sara Carletto
- Department of Mental Health, “San Luigi Gonzaga” Hospital Medical School, University of Turin, ASL TO3, Orbassano, Italy
| | - Luca Ostacoli
- Department of Mental Health, “San Luigi Gonzaga” Hospital Medical School, University of Turin, ASL TO3, Orbassano, Italy
| | - Marco Zuffranieri
- Department of Mental Health, “San Luigi Gonzaga” Hospital Medical School, University of Turin, ASL TO3, Orbassano, Italy
| | - Rocco Luigi Picci
- Department of Mental Health, “San Luigi Gonzaga” Hospital Medical School, University of Turin, ASL TO3, Orbassano, Italy
| | - Francesco Scavelli
- Department of Mental Health, “San Luigi Gonzaga” Hospital Medical School, University of Turin, ASL TO3, Orbassano, Italy
| | - Harriet Johnston
- School of Psychology, University of St Andrews, St Andrews, Scotland, United Kingdom
| | - Pier Maria Furlan
- Department of Mental Health, “San Luigi Gonzaga” Hospital Medical School, University of Turin, ASL TO3, Orbassano, Italy
| | - Antonio Bertolotto
- Neurologia 2 – CRESM (Regional Reference Centre for Multiple Sclerosis), “San Luigi Gonzaga” Hospital Medical School, Orbassano, Italy
| | - Simona Malucchi
- Neurologia 2 – CRESM (Regional Reference Centre for Multiple Sclerosis), “San Luigi Gonzaga” Hospital Medical School, Orbassano, Italy
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Use of the PRIMUS scale to assess quality of life in a Spanish population of multiple sclerosis patients. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2012.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Evaluación de la calidad de vida mediante cuestionario PRIMUS en población española de pacientes con esclerosis múltiple. Neurologia 2013; 28:340-7. [DOI: 10.1016/j.nrl.2012.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 06/25/2012] [Indexed: 11/18/2022] Open
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Bove R, Chitnis T. Sexual disparities in the incidence and course of MS. Clin Immunol 2013; 149:201-10. [PMID: 23608496 DOI: 10.1016/j.clim.2013.03.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/06/2013] [Accepted: 03/11/2013] [Indexed: 11/18/2022]
Abstract
Multiple sclerosis (MS) affects three times more women than men and this ratio appears to be increasing. However male patients experience increased disease progression, brain atrophy, and cognitive impairment. Gonadal hormones may modulate these sex differences. For example, female puberty heralds an increased risk of MS, and during pregnancy disease activity is milder, with an increased risk of postpartum relapses. Gonadal hormones likely have complex and inflammatory and neuroprotective effects, and may interact with other disease modulators, such as vitamin D. Sex differences in the heritability of disease susceptibility genes implicate a role for epigenetic modification. Many questions remain, including the impact of sex on treatment response and epigenetic changes, and the modulatory potential of hormonal treatments. This article summarizes what is known about sexual dimorphism in MS onset and course, as well as potential interactions between sex and other factors influencing MS pathogenesis, incidence and severity.
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Affiliation(s)
- Riley Bove
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Measuring the quality of life in patients with multiple sclerosis in clinical practice: a necessary challenge. Mult Scler Int 2013; 2013:524894. [PMID: 23533758 PMCID: PMC3603557 DOI: 10.1155/2013/524894] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/07/2013] [Accepted: 02/05/2013] [Indexed: 11/18/2022] Open
Abstract
While the physical disability aspect of multiple sclerosis (MS) is of great importance, quality of life (QoL) measurements are being considered increasingly important with regard to evaluating disease progression, treatment, and the management of care provided to MS patients. Despite the acknowledged need to consider QoL issues, QoL assessment remains underutilized in clinical practice. These issues should be explored and understood to promote the use of measuring QoL in MS clinical practice. We explore the difficulties for clinicians: choosing and determining the most appropriate QoL measure and how to best integrate QoL measurements into clinical practice. This paper discusses several avenues to provide to clinicians arguments of the clinical relevance and accuracy of QoL instruments and ultimately to enhance the use of QoL measures in clinical practice for MS patients.
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Boucekine M, Loundou A, Baumstarck K, Minaya-Flores P, Pelletier J, Ghattas B, Auquier P. Using the random forest method to detect a response shift in the quality of life of multiple sclerosis patients: a cohort study. BMC Med Res Methodol 2013; 13:20. [PMID: 23414459 PMCID: PMC3626785 DOI: 10.1186/1471-2288-13-20] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/13/2013] [Indexed: 11/10/2022] Open
Abstract
Background Multiple sclerosis (MS), a common neurodegenerative disease, has well-described associations with quality of life (QoL) impairment. QoL changes found in longitudinal studies are difficult to interpret due to the potential response shift (RS) corresponding to respondents’ changing standards, values, and conceptualization of QoL. This study proposes to test the capacity of Random Forest (RF) for detecting RS reprioritization as the relative importance of QoL domains’ changes over time. Methods This was a longitudinal observational study. The main inclusion criteria were patients 18 years old or more with relapsing-remitting multiple sclerosis. Every 6 months up to month 24, QoL was recorded using generic and MS-specific questionnaires (MusiQoL and SF-36). At 24 months, individuals were divided into two ‘disability change’ groups: worsened and not-worsened patients. The RF method was performed based on Breiman’s description. Analyses were performed to determine which QoL scores of SF-36 predicted the MusiQoL index. The average variable importance (AVI) was estimated. Results A total of 417 (79.6%) patients were defined as not-worsened and 107 (20.4%) as worsened. A clear RS was identified in worsened patients. While the mental score AVI was almost one third higher than the physical score AVI at 12 months, it was 1.5 times lower at 24 months. Conclusion This work confirms that the RF method offers a useful statistical approach for RS detection. How to integrate the RS in the interpretation of QoL scores remains a challenge for future research. Trial registration ClinicalTrials.gov identifier:
NCT00702065
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Affiliation(s)
- Mohamed Boucekine
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Université de la Méditerranée, Marseille cedex 05, France.
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70
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Kikuchi H, Mifune N, Niino M, Kira JI, Kohriyama T, Ota K, Tanaka M, Ochi H, Nakane S, Kikuchi S. Structural equation modeling of factors contributing to quality of life in Japanese patients with multiple sclerosis. BMC Neurol 2013; 13:10. [PMID: 23339479 PMCID: PMC3560116 DOI: 10.1186/1471-2377-13-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/15/2013] [Indexed: 11/24/2022] Open
Abstract
Background To improve quality of life (QOL) in patients with multiple sclerosis (MS), it is important to decrease disability and prevent relapse. The aim of this study was to examine the causal and mutual relationships contributing to QOL in Japanese patients with MS, develop path diagrams, and explore interventions with the potential to improve patient QOL. Methods Data of 163 Japanese MS patients were obtained using the Functional Assessment of MS (FAMS) and Nottingham Adjustment Scale-Japanese version (NAS-J) tests, as well as four additional factors that affect QOL (employment status, change of income, availability of disease information, and communication with medical staff). Data were then used in structural equation modeling to develop path diagrams for factors contributing to QOL. Results The Expanded Disability Status Scale (EDSS) score had a significant effect on the total FAMS score. Although EDSS negatively affected the FAMS symptom score, NAS-J subscale scores of anxiety/depression and acceptance were positively related to the FAMS symptom score. Changes in employment status after MS onset negatively affected all NAS-J scores. Knowledge of disease information improved the total NAS-J score, which in turn improved many FAMS subscale scores. Communication with doctors and nurses directly and positively affected some FAMS subscale scores. Conclusions Disability and change in employment status decrease patient QOL. However, the present findings suggest that other factors, such as acquiring information on MS and communicating with medical staff, can compensate for the worsening of QOL.
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Affiliation(s)
- Hiromi Kikuchi
- College of Nursing, Sapporo City University, Sapporo, Japan
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71
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Grytten N, Aarseth JH, Espeset K, Berg Johnsen G, Wehus R, Lund C, Riise T, Haugstad R. Health-related quality of life and disease-modifying treatment behaviour in relapsing-remitting multiple sclerosis--a multicentre cohort study. Acta Neurol Scand 2012:51-7. [PMID: 23278657 DOI: 10.1111/ane.12033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To assess the overall health-related quality of life (HRQoL) in a population-based cohort of patients recently diagnosed with multiple sclerosis (MS) compared with the general Norwegian population, to compare HRQoL among MS patients continuing, switching, stopping or not starting disease-modifying treatment (DMT) and to assess the motivation for DMT according to HRQoL. MATERIALS AND METHODS A multicentre retrospective survey completed by patients recently diagnosed with relapsing-remitting MS (relapsing-remitting multiple sclerosis, RRMS) during 2001-2007 at four university clinics in Norway was performed. HRQoL was measured by the SF-36 version 2 Health Survey and standardized according to the general population with a mean of 50 and a standard deviation of 10. Motivation for DMT was assessed using Visual Analogue Scale (VAS). RESULTS The mean age at diagnosis was 37 years. Patients had reduced mean scores for all eight dimensions of the SF-36 with lowest scores on social functioning (mean = 31.1), mental health (mean = 32.7), general health (mean = 39.7) and vitality (mean = 40.9) compared with the general population. Continuers scored higher on mental summary scale (mean = 37.9) and lower on physical summary scale (mean = 43.8) compared with non-starters. Non-starters scored highest on physical summary scale (mean = 45.2, P = 0.007) and lowest on mental summary scale (36.1, P = 0.01) compared with continuers, stoppers and switchers. Patients with high SF-36 physical health summary score and low SF-36 mental health summary score were less motivated for using DMT. CONCLUSION The association of HRQoL and motivation to DMT emphasizes the need for health care personnel to inform and motivate patients to DMT, especially among patients with low mental health and otherwise high physical health and functioning.
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Affiliation(s)
- N. Grytten
- Norwegian Multiple Sclerosis Competence Centre; Department of Neurology; Haukeland University Hospital; Bergen; Norway
| | - J. H. Aarseth
- Norwegian Multiple Sclerosis Registry and Biobank; Department of Neurology; Haukeland University Hospital
| | - K. Espeset
- Department of Neurology; St Olav's Hospital; Trondheim University Hospital; Trondheim; Norway
| | | | - R. Wehus
- Department of Neurology; Oslo University Hospital; Rikshospitalet; Oslo; Norway
| | - C. Lund
- Department of Neurology; Oslo University Hospital; Rikshospitalet; Oslo; Norway
| | | | - R. Haugstad
- Norwegian Multiple Sclerosis Competence Centre; Department of Neurology; Haukeland University Hospital; Bergen; Norway
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Fernández O, Fernández V, Baumstarck-Barrau K, Muñoz L, Gonzalez Alvarez MDM, Arrabal JC, León A, Alonso A, López-Madrona JC, Bustamante R, Luque G, Guerrero M, di Cantogno EV, Auquier P. Validation of the spanish version of the Multiple Sclerosis International Quality of Life (Musiqol) questionnaire. BMC Neurol 2011; 11:127. [PMID: 22013975 PMCID: PMC3206836 DOI: 10.1186/1471-2377-11-127] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 10/18/2011] [Indexed: 11/23/2022] Open
Abstract
Background The Multiple Sclerosis International Quality Of Life (MusiQoL) questionnaire, a 31-item, multidimensional, self-administrated questionnaire that is available in 14 languages including Spanish, has been validated using a large international sample. We investigated the validity and reliability of the Spanish version of MusiQoL in Spain. Methods Consecutive patients with different types and severities of multiple sclerosis (MS) were recruited from 22 centres across Spain. All patients completed the MusiQoL questionnaire, the 36-Item Short Form (SF-36) health survey, and a symptoms checklist at baseline and 21 days later. External validity, internal consistency, reliability and reproducibility were tested. Results A total of 224 Spanish patients were evaluated. Dimensions of MusiQoL generally demonstrated a high internal consistency (Cronbach's alpha: 0.70-0.92 for all but two MusiQoL domain scores). External validity testing revealed that the MusiQoL index score correlated significantly with all SF-36 dimension scores (Pearson's correlation: 0.46-0.76), reproducibility was satisfactory (intraclass correlation coefficient: 0.60-0.91), acceptability was high, and the time taken to complete the 31-item questionnaire was reasonable (mean [standard deviation]: 9.8 [11.8] minutes). Conclusions The Spanish version of the MusiQoL questionnaire appears to be a valid and reliable instrument for measuring quality of life in patients with MS in Spain and constitutes a useful instrument to measure health-related quality of life in the clinical setting.
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Affiliation(s)
- Oscar Fernández
- Institute of Clinical Neurosciences, Service of Neurology, Hospital Regional Universitario Carlos Haya, Avda, Carlos Haya s/n, 29010 Málaga, Spain.
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