1
|
Helminen J, Jehkonen M. Relationship between neuropsychiatric symptoms and cognition in multiple sclerosis: A systematic review. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-16. [PMID: 39325074 DOI: 10.1080/23279095.2024.2403764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
The results of previous research on the relationship between neuropsychiatric symptoms and cognition in multiple sclerosis (MS) have been mixed. The aim of this systematic review was to examine the evidence on the relationship between neuropsychiatric symptoms and different cognitive domains in adult (≥18 years) MS patients. A literature search was conducted in the Ovid Medline, PsycInfo, Scopus, and Web of Science databases. A total of 4,216 nonduplicate records were identified, and after screening, 37 studies met the inclusion criteria and were included in the systematic review. Higher levels of depressive symptoms were related to deficits in processing speed, verbal memory, executive functions, visuospatial functions, and attention in MS patients. Symptoms of anxiety were not consistently related to any of the cognitive functions, but the relationship to deficits in visual memory received a minimal amount of support. Higher levels of apathy were most clearly associated with impairment in executive functions, but the association with deficits in visuospatial functions, visual memory, working memory, and processing speed was also supported. The results indicate that more neuropsychiatric symptoms, especially depressive symptoms and apathy, are associated with cognitive dysfunction in MS patients. These results can be utilized in the clinical examination and treatment planning of MS patients.
Collapse
Affiliation(s)
- Johanna Helminen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mervi Jehkonen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
2
|
Maggi G, Altieri M, Risi M, Rippa V, Borgo RM, Sacco R, Buonanno D, D'Ambrosio A, Bisecco A, Santangelo G, Gallo A. Vocabulary knowledge as a reliable proxy of cognitive reserve in multiple sclerosis: a validation study. Neurol Sci 2024; 45:3931-3938. [PMID: 38418663 PMCID: PMC11254959 DOI: 10.1007/s10072-024-07388-w] [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: 11/23/2023] [Accepted: 02/04/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The present study aimed to explore the suitability of the vocabulary knowledge (VOC) test as an accurate and reliable proxy of cognitive reserve (CR) by evaluating its psychometric properties and discrimination accuracy compared with other CR measures in multiple sclerosis (MS). METHODS Sixty-eight consecutive people with multiple sclerosis (pwMS), followed at our MS outpatient clinic, completed a clinical evaluation and neuropsychological assessment including: VOC, Brief Repeatable Battery of Neuropsychological Tests (BRB-N), Cognitive Reserve Index Questionnaire (CRIq), Beck Depression Inventory-II, and State-Trait Anxiety Inventory. Reliability, convergent and divergent validity, and discrimination accuracy of the VOC were assessed using educational level as reference standard. The possible effects of sociodemographic and clinical factors on VOC and their role in predicting global cognitive status were also explored. RESULTS VOC demonstrated good internal consistency (Cronbach's α = 0.894) and adequate construct validity. It showed an acceptable level of discrimination between pwMS with high and low CR, comparable to the CRIq score. Education strongly affected VOC scores, which in turn were independent of MS features. VOC emerged as an independent predictor of global cognitive status together with MS-related disability. CONCLUSION We demonstrated the validity of VOC as a reliable CR measure in pwMS. Thus, CR may also be estimated using fixed objective measures, independent of brain pathology and clinical features. Early CR estimation may help clinicians identify pwMS at a higher risk of cognitive decline and plan strict neuropsychological monitoring and cognitive interventions.
Collapse
Affiliation(s)
- Gianpaolo Maggi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Manuela Altieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Mario Risi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valentina Rippa
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Riccardo Maria Borgo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosaria Sacco
- Department of Neurology, Neurocenter of Southern Switzerland (NSI), Regional Hospital of Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Daniela Buonanno
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro D'Ambrosio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
3
|
Shafiee A, Soltani H, Teymouri Athar MM, Jafarabady K, Mardi P. The prevalence of depression and anxiety among Iranian people with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2023; 78:104922. [PMID: 37597350 DOI: 10.1016/j.msard.2023.104922] [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: 04/19/2023] [Revised: 06/21/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND There is significant inconsistency regarding the prevalence rate of depression and anxiety among people with multiple sclerosis (MS) in Iran. We sought to conduct this comprehensive meta-analysis to assess the prevalence of depression and anxiety in Iranian multiple sclerosis patients. METHODS A systematic search was conducted on 14 March 2023 in PubMed/MEDLINE, Web of Science, Scopus, Embase, and Iranian national databases. All studies assessing the prevalence of depression and anxiety among Iranian people with MS were included. We used the NEWCASTLE-OTTAWA tool for quality assessment. We pooled the prevalence of individual studies using the random effect model. RESULTS Our systematic search showed 23 articles that meet the eligibility criteria. Most of the included studies were cross-sectional. The most used questionnaire to assess depression and anxiety were Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS), respectively. The overall prevalence of depression and anxiety among Iranian people with MS was 47% (95%CI: 39%-55%%, I2 =94%) and 51% (95%CI: 36%-66%%, I2 =97%), respectively. The results of subgroup and meta-regression analyses showed assessment scale used and the province was significantly associated with the prevalence of the outcomes. Tehran had the most studies published on this topic. The prevalence of depression and anxiety was highest in Kermanshah province. The funnel plot and Egger's regression test did not show a significant source of funnel plot asymmetry for depression (p-value = 0.8138), and anxiety (p-value = 0.8259). CONCLUSION Our study indicates that a significant proportion of people with MS in Iran are affected by depression and anxiety.
Collapse
Affiliation(s)
- Arman Shafiee
- Department of Psychiatry and Mental Health, Alborz University of Medical Sciences, Karaj, Iran; Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
| | - Hedieh Soltani
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Kyana Jafarabady
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Parham Mardi
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| |
Collapse
|
4
|
Brasanac J, Chien C. A review on multiple sclerosis prognostic findings from imaging, inflammation, and mental health studies. Front Hum Neurosci 2023; 17:1151531. [PMID: 37250694 PMCID: PMC10213782 DOI: 10.3389/fnhum.2023.1151531] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) of the brain is commonly used to detect where chronic and active lesions are in multiple sclerosis (MS). MRI is also extensively used as a tool to calculate and extrapolate brain health by way of volumetric analysis or advanced imaging techniques. In MS patients, psychiatric symptoms are common comorbidities, with depression being the main one. Even though these symptoms are a major determinant of quality of life in MS, they are often overlooked and undertreated. There has been evidence of bidirectional interactions between the course of MS and comorbid psychiatric symptoms. In order to mitigate disability progression in MS, treating psychiatric comorbidities should be investigated and optimized. New research for the prediction of disease states or phenotypes of disability have advanced, primarily due to new technologies and a better understanding of the aging brain.
Collapse
Affiliation(s)
- Jelena Brasanac
- Charité – Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Medizinische Klinik m.S. Psychosomatik, Berlin, Germany
| | - Claudia Chien
- Charité – Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Medizinische Klinik m.S. Psychosomatik, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Neuroscience Clinical Research Center, Berlin, Germany
| |
Collapse
|
5
|
Lago S, Bevilacqua F, Stabile MR, Scarpazza C, Bambini V, Arcara G. Case report: Pragmatic impairment in multiple sclerosis after worsening of clinical symptoms. Front Psychol 2022; 13:1028814. [PMID: 36506966 PMCID: PMC9731094 DOI: 10.3389/fpsyg.2022.1028814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Pragmatics, defined as the ability to integrate language and context to communicate effectively, may be impaired in Multiple Sclerosis (MS). We present the case of a patient with active secondary progressive MS who, after a first neuropsychological assessment that evidenced only a slight pragmatic impairment, suffered a sudden worsening of her clinical conditions, treated with corticosteroids. After this clinical worsening, her pragmatic abilities declined markedly, both in comprehension and production. This worsening was accompanied by a decline only in one attention task, in the context of an overall stable cognitive functioning. We conclude that pragmatics may be a domain particularly susceptible to cognitive worsening, highlighting the importance of its assessment in clinical practice.
Collapse
Affiliation(s)
- Sara Lago
- IRCCS San Camillo Hospital, Venice, Italy,Department of Neuroscience, Padova Neuroscience Centre, University of Padova, Padua, Italy,*Correspondence: Sara Lago,
| | | | | | - Cristina Scarpazza
- IRCCS San Camillo Hospital, Venice, Italy,Department of General Psychology, University of Padova, Padua, Italy
| | - Valentina Bambini
- Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy
| | | |
Collapse
|
6
|
Takeda A, Minatani S, Ishii A, Matsuo T, Tanaka M, Yoshikawa T, Itoh Y. Impact of depression on mental fatigue and attention in patients with multiple sclerosis. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
7
|
Hoffmeister J, Basso MR, Reynolds B, Whiteside D, Mulligan R, Arnett PA, Combs DR. Effects of diminished positive mood and depressed mood upon verbal learning and memory among people with multiple sclerosis. J Clin Exp Neuropsychol 2021; 43:117-128. [PMID: 33622171 DOI: 10.1080/13803395.2020.1853066] [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: 12/21/2022]
Abstract
Objective: Cognitive impairment affects as many as 65% of people with multiple sclerosis (PWMS), and memory impairment confers greater severity of disability and functional impairment. Depression is also common among PWMS, and lifetime prevalence rates are as high as 50%. Research has yet to clearly define the relationship between memory dysfunction and depression among PWMS, and may reflect incomplete assessment of depressive symptoms. The present study examined different aspects of depressive symptoms including anhedonia (i.e., diminished positive mood) and their relationships with verbal learning and memory among PWMS.Method: Participants were 48 healthy individuals and 96 PWMS. They were primarily Caucasian (90.3%) and female (75.0%). Participants completed the California Verbal Learning Test-2 (CVLT-2) to assess verbal learning and memory and the Chicago Multiscale Depression inventory to assess depressed mood (CMDI-Mood) and diminished positive mood (CMDI-DPM).Results: Linear regression revealed that the main effect of CMDI-DPM and the interaction of CMDI-DPM and CMDI-Mood significantly explained variance across learning, recall, and recognition CVLT-2 indices. Follow-up analyses indicated that CMDI-DPM was only significant in the absence of high CMDI-Mood scores. CMDI-Mood explained variance in only CVLT-2 Trial B.Conclusions: Depressed mood had little direct effect upon memory performance in PWMS. In the absence of severe depressed mood, higher levels of positive mood corresponded to better memory performance. However, the impact of diminished positive mood was rendered null among those endorsing high levels of depressed mood. These data may imply that anhedonia corresponds with poorer memory function among PWMS, and suggests that investigators and clinicians should assess multiple mood dimensions among PWMS.
Collapse
Affiliation(s)
| | | | - Bradley Reynolds
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Ryan Mulligan
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Peter A Arnett
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Dennis R Combs
- Department of Psychology, University of Texas at Tyler, Tyler, TX, USA
| |
Collapse
|
8
|
Raimo S, Santangelo G, Trojano L. The emotional disorders associated with multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:197-220. [PMID: 34389118 DOI: 10.1016/b978-0-12-822290-4.00009-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is associated with a high prevalence of emotional and mood disorders. Emotional disorders may worsen during illness progression and affect the quality of life of patients and their families. MS is often associated with depression, with an increased risk of suicide, poor adherence to treatment, decreased functional status, and quality of life. The diagnosis and treatment of emotional and mood disorders in these patients is often challenging since several symptoms of these disorders overlap with those of MS. Other prevalent emotional disorders in MS include bipolar disorder, anxiety disorders, emotional blunting (apathy), and pseudobulbar affect. Early recognition and treatment of these comorbidities could contribute to the reduction of disability and even to decreased mortality. The aim of this chapter is to provide an up-to-date review of mood and emotional disorders that are often associated with MS, focusing on their epidemiology, clinical features, pathogenesis, assessment, and treatment. The interplay between the psychosocial impact of the chronic disability and the demyelinating structural lesions of the brain in precipitating emotional and mood disorders is discussed, as well as its implications for diagnosis and treatment.
Collapse
Affiliation(s)
- Simona Raimo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| |
Collapse
|
9
|
Artemiadis A, Bakirtzis C, Ifantopoulou P, Zis P, Bargiotas P, Grigoriadis N, Hadjigeorgiou G. The role of cognitive reserve in multiple sclerosis: A cross-sectional study in 526 patients. Mult Scler Relat Disord 2020; 41:102047. [DOI: 10.1016/j.msard.2020.102047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 11/17/2022]
|
10
|
Khader HA, Emran B, Sulaimi MA, Abdulhadi DA, Obaidli KA, Deai AA, Albatineh AN. Estimating the prevalence of cognition and mental health among multiple sclerosis patients: A population-based cross-sectional study. Mult Scler Relat Disord 2019; 36:101391. [PMID: 31557677 DOI: 10.1016/j.msard.2019.101391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 08/09/2019] [Accepted: 09/07/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurological disease, considered most common autoimmune disorder of the central nervous system with dramatic impact on patient's emotional/mental well-being. Cognitive decline is acknowledged as debilitating symptom of MS. This paper aims to estimate the prevalence of cognition and mental health impairment among MS patients in Kuwait and test their association with socio-economic factors. METHODS Data were collected from 224 MS patients. As scales of MS quality of life inventory (MSQOLI), mental health inventory (MHI) and perceived deficit questionnaire (PDQ) were used to estimate scores for mental health and cognition, respectively. Tertiles were used to estimate prevalence and associations were tested accordingly. RESULTS The prevalence of cognition and mental health impairment were approximately 23.3% and 14.1%, respectively. When stratified by gender, significant difference exists in mental health impairment. When stratified by nationality, there is significant difference between Kuwaiti and Non-Kuwaiti Arabs in cognition. Poorest patients had median cognition score worse than all other income categories. CONCLUSION MS in Kuwait seems to have an earlier age at onset. There is significant gender difference in mental health impairment among patients. Future interventions should be directed toward women, low-income, and non-Kuwaiti-Arabs. The estimated prevalence is based on self-reported data, tertiles as cut-off points, and hence should be interpreted with caution. PDQ and MHI are MSQOLI scales used as screening tools that don't correlate well with an objective test and shouldn't replace objective measures of physical and cognitive function tests including expanded disability status scale or magnetic resonance imaging.
Collapse
Affiliation(s)
- Hamad Al Khader
- Faculty of Medicine, Department of Community Medicine and Behavioral Sciences, Kuwait University, P.O Box 24924, Safat 13110, Kuwait
| | - Basel Emran
- Faculty of Medicine, Department of Community Medicine and Behavioral Sciences, Kuwait University, P.O Box 24924, Safat 13110, Kuwait
| | - Mariam Al Sulaimi
- Faculty of Medicine, Department of Community Medicine and Behavioral Sciences, Kuwait University, P.O Box 24924, Safat 13110, Kuwait
| | - Dalal Al Abdulhadi
- Faculty of Medicine, Department of Community Medicine and Behavioral Sciences, Kuwait University, P.O Box 24924, Safat 13110, Kuwait
| | - Khaled Al Obaidli
- Faculty of Medicine, Department of Community Medicine and Behavioral Sciences, Kuwait University, P.O Box 24924, Safat 13110, Kuwait
| | - Aisha Al Deai
- Faculty of Medicine, Department of Community Medicine and Behavioral Sciences, Kuwait University, P.O Box 24924, Safat 13110, Kuwait
| | - Ahmed N Albatineh
- Faculty of Medicine, Department of Community Medicine and Behavioral Sciences, Kuwait University, P.O Box 24924, Safat 13110, Kuwait.
| |
Collapse
|
11
|
Panda SP, Das RC, Srivastava K, Ratnam A, Sharma N. Psychiatric comorbidity in multiple sclerosis. Neurol Neurochir Pol 2018; 52:704-709. [PMID: 30274945 DOI: 10.1016/j.pjnns.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/19/2018] [Accepted: 09/09/2018] [Indexed: 11/19/2022]
Abstract
AIM To study the prevalence of psychiatric comorbidities in patients of multiple sclerosis and their association to the degree of disability. METHOD Psychiatric symptoms were assessed in 90 patients of multiple sclerosis using GHQ-12, MMSE, HADS, Beck Depression Inventory and AUDIT. Neurological disability was assessed using Expanded Disability Status Scale. Correlations were determined between EDSS scores and psychiatric scale scores. RESULT 61% of patients had significant psychological distress. Depression was most common (38.8%) which was followed by anxiety symptoms (27.8%). Cognitive functioning was relatively intact in patients with mild to moderate neurological disability. Alcohol abuse was mostly restricted to male gender. CONCLUSION Psychiatric illness is highly prevalent in patients of multiple sclerosis leading to poor quality of life and significant distress. Psychiatric disability was higher in patients who had greater deterioration in neurological function. All cases of MS should be assessed for psychiatric morbidities as can be alleviated by appropriate intervention.
Collapse
Affiliation(s)
- S P Panda
- Department of Psychiatry, Armed Forces Medical College (AFMC), Sholapur Road, Pune 411040, Maharashtra, India.
| | - R C Das
- Department of Psychiatry, Armed Forces Medical College (AFMC), Sholapur Road, Pune 411040, Maharashtra, India
| | - Kalpana Srivastava
- Department of Psychiatry, Armed Forces Medical College (AFMC), Sholapur Road, Pune 411040, Maharashtra, India
| | - Ashutosh Ratnam
- Department of Psychiatry, Armed Forces Medical College (AFMC), Sholapur Road, Pune 411040, Maharashtra, India
| | - Neha Sharma
- Department of Psychiatry, Armed Forces Medical College (AFMC), Sholapur Road, Pune 411040, Maharashtra, India
| |
Collapse
|
12
|
Musella A, Gentile A, Rizzo FR, De Vito F, Fresegna D, Bullitta S, Vanni V, Guadalupi L, Stampanoni Bassi M, Buttari F, Centonze D, Mandolesi G. Interplay Between Age and Neuroinflammation in Multiple Sclerosis: Effects on Motor and Cognitive Functions. Front Aging Neurosci 2018; 10:238. [PMID: 30135651 PMCID: PMC6092506 DOI: 10.3389/fnagi.2018.00238] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/20/2018] [Indexed: 01/09/2023] Open
Abstract
Aging is one of the main risk factors for the development of many neurodegenerative diseases. Emerging evidence has acknowledged neuroinflammation as potential trigger of the functional changes occurring during normal and pathological aging. Two main determinants have been recognized to cogently contribute to neuroinflammation in the aging brain, i.e., the systemic chronic low-grade inflammation and the decline in the regulation of adaptive and innate immune systems (immunosenescence, ISC). The persistence of the inflammatory status in the brain in turn may cause synaptopathy and synaptic plasticity impairments that underlie both motor and cognitive dysfunctions. Interestingly, such inflammation-dependent synaptic dysfunctions have been recently involved in the pathophysiology of multiple sclerosis (MS). MS is an autoimmune neurodegenerative disease, typically affecting young adults that cause an early and progressive deterioration of both cognitive and motor functions. Of note, recent controlled studies have clearly shown that age at onset modifies prognosis and exerts a significant effect on presenting phenotype, suggesting that aging is a significant factor associated to the clinical course of MS. Moreover, some lines of evidence point to the different impact of age on motor disability and cognitive deficits, being the former most affected than the latter. The precise contribution of aging-related factors to MS neurological disability and the underlying molecular and cellular mechanisms are still unclear. In the present review article, we first emphasize the importance of the neuroinflammatory dependent mechanisms, such as synaptopathy and synaptic plasticity impairments, suggesting their potential exacerbation or acceleration with advancing age in the MS disease. Lastly, we provide an overview of clinical and experimental studies highlighting the different impact of age on motor disability and cognitive decline in MS, raising challenging questions on the putative age-related mechanisms involved.
Collapse
Affiliation(s)
- Alessandra Musella
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele University of Rome, Rome, Italy
| | - Antonietta Gentile
- Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Unit of Neurology, Istituto Neurologico Mediterraneo (IRCCS Neuromed), Pozzilli, Italy
| | - Francesca Romana Rizzo
- Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesca De Vito
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Diego Fresegna
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Bullitta
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Vanni
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Livia Guadalupi
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Fabio Buttari
- Unit of Neurology, Istituto Neurologico Mediterraneo (IRCCS Neuromed), Pozzilli, Italy
| | - Diego Centonze
- Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Unit of Neurology, Istituto Neurologico Mediterraneo (IRCCS Neuromed), Pozzilli, Italy
| | - Georgia Mandolesi
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele University of Rome, Rome, Italy
| |
Collapse
|
13
|
Vitkova M, Gdovinova Z, Rosenberger J, Szilasiova J, Mikula P, Stewart RE, Groothoff JW, van Dijk JP. Is Poor Sleep Quality Associated With Greater Disability in Patients With Multiple Sclerosis? Behav Sleep Med 2018; 16:106-116. [PMID: 27191379 DOI: 10.1080/15402002.2016.1173555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Poor sleep is a serious burden for patients with multiple sclerosis (MS). The aim of this study is to assess whether the association between sleep quality and disability in MS patients is direct or mediated by depression, pain, and fatigue. We collected data from 152 patients with MS who filled out the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Inventory and one item of the Short Form-36 regarding pain. The relationship between poor sleep and disability was found to be indirect, mediated by depression (p < 0.05), pain (p < 0.001) and physical fatigue (p < 0.01). Treatment of sleep disturbances may have beneficial effects beyond improving sleep. It may reduce depression, pain, and physical fatigue, which in turn may lessen disability.
Collapse
Affiliation(s)
- Marianna Vitkova
- a Department of Neurology, Faculty of Medicine , Safarik University , Kosice , Slovakia.,b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia
| | - Zuzana Gdovinova
- a Department of Neurology, Faculty of Medicine , Safarik University , Kosice , Slovakia
| | - Jaroslav Rosenberger
- b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia
| | - Jarmila Szilasiova
- a Department of Neurology, Faculty of Medicine , Safarik University , Kosice , Slovakia
| | - Pavol Mikula
- b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia
| | - Roy E Stewart
- c Department of Community & Occupational Health , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| | - Johan W Groothoff
- c Department of Community & Occupational Health , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| | - Jitse P van Dijk
- b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia.,c Department of Community & Occupational Health , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| |
Collapse
|
14
|
Abstract
Depressive disorders are common in patients with multiple sclerosis, influencing their quality of life and adherence to treatments, as well as becoming more frequent with the progression of the disease and in the secondary progressive form of multiple sclerosis. Patients with multiple sclerosis often experience a typical cluster of symptoms in association with depression, such as fatigue, pain and cognitive impairment. However, the pathogenesis of multiple sclerosis-related depression remains partially unclear, even though genetic, immune-inflammatory and psychosocial factors might be seen to play a role, in addition to the brain structural alterations documented by magnetic resonance imaging studies. The high incidence and burden of depression in people affected with multiple sclerosis are matters of crucial importance. Despite such importance, the efficacy of pharmacologic treatments has been poorly studied and, for the most part, the access to non-pharmacological treatments is partially dependent on the local health system availability. It has been determined that interferon-beta and glatiramer acetate do not cause depressive symptoms; however, no definitive data in this regard are avaible for the newer disease-modifyng medications. In this review, we discuss the diagnosis, prevalence, pathogenesis, clinical aspects, magnetic resonance imaging findings and treatments available in patients experiencing multiple sclerosis-related depression.
Collapse
|
15
|
Ruano L, Branco M, Portaccio E, Goretti B, Niccolai C, Patti F, Chisari C, Gallo P, Grossi P, Ghezzi A, Roscio M, Mattioli F, Stampatori C, Simone M, Viterbo RG, Amato MP. Patients with paediatric-onset multiple sclerosis are at higher risk of cognitive impairment in adulthood: An Italian collaborative study. Mult Scler 2017; 24:1234-1242. [DOI: 10.1177/1352458517717341] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Patients with paediatric-onset multiple sclerosis (POMS) could be at an increased risk for cognitive impairment (CI), given the potential harmful effects of disease activity in neurodevelopment. However, there is scarce information on their long-term cognitive outcomes. Objective: To compare the prevalence and profile of CI between adults with a history of POMS and those with classic, adult-onset multiple sclerosis (AOMS). Methods: Cognitive performance was assessed through the Brief Repeatable Battery (BRB) and the Stroop Test in consecutive patients referred to six Italian MS centres. CI was defined as impairment in ⩾2 cognitive domains. Results: In all, 119 patients with POMS and 712 with AOMS were included in this analysis. The prevalence of CI was 48.0% in AOMS, 44.5% in POMS; with similar neuropsychological profile between the two groups. However, when adjusting for current age, we found a significantly increased risk for CI (odds ratio (OR) = 1.71; p = 0.02) and for impairment in information processing speed (OR = 1.86; p < 0.01) in patients with POMS. A higher Expanded Disability Status Scale (EDSS) was also identified in POMS ( p = 0.03) compared with AOMS patients. Conclusion: Patients with a history of POMS appear to be at higher risk of physical and cognitive disability than AOMS patients, after correcting for age effects, with particular involvement of information processing speed.
Collapse
Affiliation(s)
- Luis Ruano
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal/Departamento de Epidemiologia Clinica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina, Universidade do Porto, Porto, Portugal/Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Mariana Branco
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | | | - Benedetta Goretti
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Claudia Niccolai
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | - Marta Simone
- Child and Adolescence Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| |
Collapse
|
16
|
The Relationship between Psychosocial Factors and Cognition in Multiple Sclerosis. Behav Neurol 2017; 2017:6847070. [PMID: 28584406 PMCID: PMC5451874 DOI: 10.1155/2017/6847070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a common disorder in some regions of the world, with over 2.3 million people diagnosed worldwide. Cognitive impairment is one of the earliest symptoms to present in the course of the disease and can cause significant morbidity. We proposed a study to explore the psychosocial predictors of cognitive impairment in MS patients in Saudi Arabia, a previously unexplored patient population. METHODS Demographic data, depression scale (PHQ9), symptom burden (PHQ15), anxiety (GAD7), disease duration, and Montreal Cognitive Assessment (MOCA) scores were collected from 195 patients in a neurology clinic in Ryiadh, Saudi Arabia. Univariate and multiple regression analyses were conducted to identify variables that are significantly associated with cognitive impairment. RESULTS Variables that were identified to be significantly associated with cognition, p < 0.05, were education level, disease duration, and family history. DISCUSSION Both education level and disease duration were variables identified in previous studies. We showed family history to be a significant variable, and no association was found with depression or anxiety, which is unique to our study population. CONCLUSIONS We identified several psychosocial predictors that are associated with cognition in our patient population. It was also noted that a difference exists between patient populations, highlighting the need for further studies in specific geographical regions.
Collapse
|
17
|
Oliveira SR, Kallaur AP, Lopes J, Colado Simão AN, Reiche EM, de Almeida ERD, Morimoto HK, de Carvalho Jennings de Pereira WL, Alfieri DF, Flauzino T, de Meleck Proença C, Gomes AM, Kaimen-Maciel DR, Maes M. Insulin resistance, atherogenicity, and iron metabolism in multiple sclerosis with and without depression: Associations with inflammatory and oxidative stress biomarkers and uric acid. Psychiatry Res 2017; 250:113-120. [PMID: 28152396 DOI: 10.1016/j.psychres.2016.12.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/03/2016] [Accepted: 12/26/2016] [Indexed: 12/17/2022]
Abstract
Depression is accompanied by metabolic disorders in iron metabolism, lipoproteins, and insulin resistance. We measured plasma levels of ferritin, iron, lipids, insulin, and glucose and computed the homeostasis model assessment (HOMA2IR) and atherogenic index of plasma (AIP) in MS patients with and without depression and healthy controls. Explanatory variables were serum uric acid, interleukin (IL)-6, lipid hydroperoxides (CL-LOOH), albumin, and C-reactive protein (CRP). Depression was assessed using the Hospital Anxiety and Depression Scale (HADS), neurological disability using the Expanded Disability Status Scale (EDSS), and disease progression using ∆EDSS over five years earlier. HOMA2IR and insulin were predicted by diagnosis (increased in MS), age and body mass index (BMI); AIP by diagnosis, sex, BMI, CRP, and uric acid; triglycerides by diagnosis (higher in MS without depression), age, BMI and uric acid; ferritin by diagnosis (higher in MS), sex, CRP, and albumin; and iron by albumin. The HADS score was significantly predicted by ∆EDSS, gastro-intestinal symptoms, iron (inverse), and age. MS is characterized by significantly increased insulin resistance, which is determined by increased insulin levels; and increased ferritin, a biomarker of inflammation. Depression in MS is not associated with increased insulin resistance and atherogenicity but with lowered iron.
Collapse
Affiliation(s)
- Sayonara Rangel Oliveira
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Ana Paula Kallaur
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Josiane Lopes
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Andrea Name Colado Simão
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Edna Maria Reiche
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Elaine Regina Delicato de Almeida
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Helena Kaminami Morimoto
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Wildea Lice de Carvalho Jennings de Pereira
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil; Outpatient Clinic for Multiple Sclerosis, University Hospital, State University of Londrina, Londrina, Paraná, Brazil
| | - Daniela Frizon Alfieri
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Tamires Flauzino
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Caio de Meleck Proença
- Medicine School, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Anna Maria Gomes
- Outpatient Clinic for Multiple Sclerosis, University Hospital, State University of Londrina, Londrina, Paraná, Brazil; Department of Clinical Medicine, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Damacio Ramón Kaimen-Maciel
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Michael Maes
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil; Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand; Impact Strategic Research Center, Deakin University, Geelong, Australia; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; Revitalis, Waalre, The Netherlands.
| |
Collapse
|
18
|
Messmer Uccelli M, Traversa S, Ponzio M. A survey study comparing young adults with MS and healthy controls on self-esteem, self-efficacy, mood and quality of life. J Neurol Sci 2016; 368:369-73. [PMID: 27538666 DOI: 10.1016/j.jns.2016.07.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Studies have shown that people with multiple sclerosis (MS) report low levels of self-efficacy and self-esteem, high levels of anxiety and depression and reduced quality of life. The study aims to assess self-esteem, self-efficacy, mood and quality of life in young adults with MS and to compare them to a healthy control group. METHODS The age range for inclusion in the study was between 18 and 35years of age for both groups. Subjects with MS were recruited through the Italian MS Society. Healthy controls were recruited through social media and from a university undergraduate program. Subjects completed an anonymous online questionnaire combining various scales. Group differences on demographic data were assessed using parametric and non-parametric tests. Analyses of covariance (ANCOVA) were performed to evaluate differences between the two groups on scales of self-perception, mood and quality of life, adjusting for potentially confounding factors. RESULTS Eighty-nine subjects with MS and 109 HC were included in the analysis. ANCOVA failed to demonstrate statistically significant differences between groups on self-esteem (F=0.11, p=0.743), self-efficacy (F=2.22, p=0.138), mood (anxiety F=0.03, p=0.855; depression F=0.06, p=0.812) and quality of life (F=0.08, p=0.772). CONCLUSIONS This study demonstrated that young adults with MS and healthy controls have similar levels of self-esteem and self-efficacy and that they do not differ significantly on measures of mood and quality of life, as previously reported.
Collapse
Affiliation(s)
| | - Silvia Traversa
- Italian Multiple Sclerosis Society & Research Foundation, Via Operai 40, Genoa, Italy.
| | - Michela Ponzio
- Italian Multiple Sclerosis Society & Research Foundation, Via Operai 40, Genoa, Italy.
| |
Collapse
|
19
|
Kallaur AP, Lopes J, Oliveira SR, Simão ANC, Reiche EMV, de Almeida ERD, Morimoto HK, de Pereira WLCJ, Alfieri DF, Borelli SD, Kaimen-Maciel DR, Maes M. Immune-Inflammatory and Oxidative and Nitrosative Stress Biomarkers of Depression Symptoms in Subjects with Multiple Sclerosis: Increased Peripheral Inflammation but Less Acute Neuroinflammation. Mol Neurobiol 2015; 53:5191-202. [DOI: 10.1007/s12035-015-9443-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/11/2015] [Indexed: 01/02/2023]
|
20
|
Impact of depression, fatigue, and global measure of cortical volume on cognitive impairment in multiple sclerosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:519785. [PMID: 25861633 PMCID: PMC4377448 DOI: 10.1155/2015/519785] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 11/25/2022]
Abstract
Objective. To investigate the influence of demographic and clinical variables, such as depression, fatigue, and quantitative MRI marker on cognitive performances in a sample of patients affected by multiple sclerosis (MS). Methods. 60 MS patients (52 relapsing remitting and 8 primary progressive) underwent neuropsychological assessments using Rao's Brief Repeatable Battery of Neuropsychological Tests (BRB-N), the Beck Depression Inventory-second edition (BDI-II), and the Fatigue Severity Scale (FSS). We performed magnetic resonance imaging to all subjects using a 3 T scanner and obtained tissue-specific volumes (normalized brain volume and cortical brain volume). We used Student's t-test to compare depressed and nondepressed MS patients. Finally, we performed a multivariate regression analysis in order to assess possible predictors of patients' cognitive outcome among demographic and clinical variables. Results. 27.12% of the sample (16/59) was cognitively impaired, especially in tasks requiring attention and information processing speed. From between group comparison, we find that depressed patients had worse performances on BRB-N score, greater disability and disease duration, and brain volume decrease. According to multiple regression analysis, the BDI-II score was a significant predictor for most of the neuropsychological tests. Conclusions. Our findings suggest that the presence of depressive symptoms is an important determinant of cognitive performance in MS patients.
Collapse
|
21
|
Marrie RA, Cohen J, Stuve O, Trojano M, Sørensen PS, Reingold S, Cutter G, Reider N. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler 2015; 21:263-81. [PMID: 25623244 PMCID: PMC4361468 DOI: 10.1177/1352458514564491] [Citation(s) in RCA: 248] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Comorbidity is an area of increasing interest in multiple sclerosis (MS). Objective: The objective of this review is to estimate the incidence and prevalence of comorbidity in people with MS and assess the quality of included studies. Methods: We searched the PubMed, SCOPUS, EMBASE and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles. Two reviewers independently screened abstracts. One reviewer abstracted data using a standardized form and the abstraction was verified by a second reviewer. We assessed study quality using a standardized approach. We quantitatively assessed population-based studies using the I2 statistic, and conducted random-effects meta-analyses. Results: We included 249 articles. Study designs were variable with respect to source populations, case definitions, methods of ascertainment and approaches to reporting findings. Prevalence was reported more frequently than incidence; estimates for prevalence and incidence varied substantially for all conditions. Heterogeneity was high. Conclusion: This review highlights substantial gaps in the epidemiological knowledge of comorbidity in MS worldwide. Little is known about comorbidity in Central or South America, Asia or Africa. Findings in North America and Europe are inconsistent. Future studies should report age-, sex- and ethnicity-specific estimates of incidence and prevalence, and standardize findings to a common population.
Collapse
Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Health Sciences Center, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Canada
| |
Collapse
|
22
|
Mattioli F, Stampatori C, Bellomi F, Danni M, Compagnucci L, Uccelli A, Pardini M, Santuccio G, Fregonese G, Pattini M, Allegri B, Clerici R, Lattuada A, Montomoli C, Corso B, Capra R. A RCT Comparing Specific Intensive Cognitive Training to Aspecific Psychological Intervention in RRMS: The SMICT Study. Front Neurol 2015; 5:278. [PMID: 25628596 PMCID: PMC4292447 DOI: 10.3389/fneur.2014.00278] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 12/08/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Specific cognitive rehabilitation in multiple sclerosis (MS) resulted to be effective compared to no treatment. So far the possible role of an aspecific psychological intervention on cognition has not been investigated. OBJECTIVE The aim of the SMICT RCT was to compare the efficacy of a specific cognitive training with an aspecific psychological intervention in relapsing-remitting MS patients. METHODS From a sample of 150 patients, with the same disability and immunomodulatory therapy, submitted to neuropsychological examination, 45 impaired in at least one test were included and 41 randomized to have either a specific cognitive training for the impaired function (22) or to an aspecific psychological intervention (19) for 4 months, starting after baseline examination. Neuropsychological tests and functional scales were administered at baseline and 1 year later. RESULTS After 1 year, the mean number of pathological tests was significantly lower in the specific treatment group, compared to the aspecific group. Memory and attention/speeded information processing functions were mostly improved. Depression and quality of life were not different between groups at follow up. CONCLUSION Our study demonstrates that an intensive and domain specific cognitive approach results to be more effective than aspecific psychological intervention in patients with MS.
Collapse
Affiliation(s)
- Flavia Mattioli
- Neuropsychology Unit, Spedali Civili di Brescia , Brescia , Italy
| | | | - Fabio Bellomi
- Neuropsychology Unit, Spedali Civili di Brescia , Brescia , Italy
| | - Maura Danni
- Clinica Neurologica, University of Ancona , Ancona , Italy
| | | | - Antonio Uccelli
- Clinica Neurologica, MS Center, University of Genoa , Genoa , Italy
| | - Matteo Pardini
- Clinica Neurologica, MS Center, University of Genoa , Genoa , Italy
| | - Giuseppe Santuccio
- Neurology Unit, Azienda Ospedaliera Valtellina Valchiavenna , Sondrio , Italy
| | - Giuditta Fregonese
- Neurology Unit, Azienda Ospedaliera Valtellina Valchiavenna , Sondrio , Italy
| | | | | | | | | | - Cristina Montomoli
- Biostatistics Unit, Department of Public Health, Experimental and Forensic Medicine, Pavia University , Pavia , Italy
| | - Barbara Corso
- Biostatistics Unit, Department of Public Health, Experimental and Forensic Medicine, Pavia University , Pavia , Italy
| | - Ruggero Capra
- MS Center, Spedali Civili di Brescia , Brescia , Italy
| |
Collapse
|
23
|
Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, Cutter G, Reider N. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler 2015; 21:305-17. [PMID: 25583845 PMCID: PMC4429164 DOI: 10.1177/1352458514564487] [Citation(s) in RCA: 316] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychiatric comorbidity is associated with lower quality of life, more fatigue, and reduced adherence to disease-modifying therapy in multiple sclerosis (MS). OBJECTIVES The objectives of this review are to estimate the incidence and prevalence of selected comorbid psychiatric disorders in MS and evaluate the quality of included studies. METHODS We searched the PubMed, PsychInfo, SCOPUS, and Web of Knowledge databases and reference lists of retrieved articles. Abstracts were screened for relevance by two independent reviewers, followed by full-text review. Data were abstracted by one reviewer, and verified by a second reviewer. Study quality was evaluated using a standardized tool. For population-based studies we assessed heterogeneity quantitatively using the I² statistic, and conducted meta-analyses. RESULTS We included 118 studies in this review. Among population-based studies, the prevalence of anxiety was 21.9% (95% CI: 8.76%-35.0%), while it was 14.8% for alcohol abuse, 5.83% for bipolar disorder, 23.7% (95% CI: 17.4%-30.0%) for depression, 2.5% for substance abuse, and 4.3% (95% CI: 0%-10.3%) for psychosis. CONCLUSION This review confirms that psychiatric comorbidity, particularly depression and anxiety, is common in MS. However, the incidence of psychiatric comorbidity remains understudied. Future comparisons across studies would be enhanced by developing a consistent approach to measuring psychiatric comorbidity, and reporting of age-, sex-, and ethnicity-specific estimates.
Collapse
Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Canada
| | | | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Community Health Sciences, University of Manitoba, Canada
| |
Collapse
|
24
|
Hartoonian N, Terrill AL, Beier ML, Turner AP, Day MA, Alschuler KN. Predictors of anxiety in multiple sclerosis. Rehabil Psychol 2014; 60:91-8. [PMID: 25496434 DOI: 10.1037/rep0000019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVES The aims of this study were to (1) identify the predictors of symptoms of anxiety, and (2) evaluate the differential association of somatic and nonsomatic symptoms of depression on anxiety over time in persons with multiple sclerosis (MS). METHOD/DESIGN Participants were 513 persons with MS who previously enrolled in a study exploring the experience of living with MS and completed a 4-month follow-up survey. The main outcome measure used was the Hospital Anxiety and Depression Scale-Anxiety. Demographic, disease-associated variables (time since onset of MS, Expanded Disability Status Scale Mobility, pain, and fatigue), and Time 1 psychological variables were entered into a hierarchical regression model to examine predictors at baseline for anxiety symptoms at Time 2. RESULTS A large portion of the sample was White (92%), female (82%), and had relapsing-remitting MS (57%). After adjusting for demographic and disease related variables, anxiety (β <.001), employment (β = .07), and nonsomatic depressive symptoms (β = .10) at baseline significantly predicted anxiety at Time 2, ps < .05. Interactions revealed significant effects for time since onset of MS and somatic symptoms as well as time since onset and nonsomatic symptoms, ps < .05. Nonsomatic symptoms were more linked to anxiety early in the disease and somatic symptoms were more prominently linked to anxiety later in the disease. CONCLUSIONS Findings suggest that nonsomatic symptoms of depression and employment predict anxiety in MS. The relationship between different aspects of depression and anxiety may change over the course of the disease.
Collapse
Affiliation(s)
| | | | | | | | - Melissa A Day
- School of Psychology, Australian Catholic University
| | - Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| |
Collapse
|
25
|
Gray V, Arnett P. Aging with multiple sclerosis: cognitive, emotional and neuropathological considerations. Neurodegener Dis Manag 2014; 4:187-94. [DOI: 10.2217/nmt.14.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Although individuals aging with multiple sclerosis (MS) can experience a compounding of their symptoms, in some circumstances they become more adept at coping with aging-related changes. Fortunately, individuals aging with MS often adjust well to aging, particularly if they have sufficient social support. They also do not appear to show accelerated rates of cognitive decline, and rates of some neuropathological changes have been shown to normalize compared with those seen in normal aging. Results are mixed as to whether older MS patients have higher rates of depression.
Collapse
|
26
|
Does fatigue complaint reflect memory impairment in multiple sclerosis? Mult Scler Int 2014; 2014:692468. [PMID: 24724029 PMCID: PMC3958802 DOI: 10.1155/2014/692468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/23/2014] [Accepted: 01/23/2014] [Indexed: 01/21/2023] Open
Abstract
Background and Purpose. Fatigue and memory impairment are common symptoms in multiple sclerosis (MS) and both may interact with cognition. This can contribute to making a complaint misrepresentative of the objective disorder. We sought to determine whether fatigue complaint in MS reflects memory impairment and investigated whether patients' subjective fatigue is associated with memory complaint. Methods. Fifty MS patients complaining of fatigue underwent subjective assessment of fatigue and memory complaint measured using self-assessment scales. Cognitive functions were assessed using a battery of neuropsychological tests, including a test of verbal episodic memory, the selective reminding test (SRT). Correlations were studied between subjective fatigue, memory complaint, and performance in verbal episodic memory. Results. Depression score, psychotropic and/or antiepileptic drug use, Expanded Disability Status Scale (EDSS) score, and MS form were confounding factors. After adjusting for these confounding factors, neither fatigue complaint nor memory complaint was correlated with SRT performance. Subjective fatigue was significantly associated with memory complaint. Conclusion. Although complaint of fatigue in MS was correlated with memory complaint, subjective fatigue was not the expression of memory impairment.
Collapse
|
27
|
Fragoso YD, Adoni T, Anacleto A, da Gama PD, Goncalves MVM, Matta APDC, Parolin MFK. Recommendations on diagnosis and treatment of depression in patients with multiple sclerosis. Pract Neurol 2014; 14:206-9. [DOI: 10.1136/practneurol-2013-000735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
28
|
Seyed Saadat SM, Hosseininezhad M, Bakhshayesh B, Seyed Saadat SN, Nabizadeh SP. Prevalence and predictors of depression in Iranian patients with multiple sclerosis: a population-based study. Neurol Sci 2013; 35:735-40. [PMID: 24322949 DOI: 10.1007/s10072-013-1593-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
Depression is a frequent symptom in multiple sclerosis (MS) which has a negative impact on quality of life and cognitive status. The purpose of this study was to determine the prevalence and associated factors of depression, and status of antidepressant use in Iranian MS patients. One-hundred and sixty patients with definite MS were included. Demographic and clinical characteristics were recorded. Fatigue and depression were evaluated using the fatigue severity scale and Beck depression inventory-II. Cognitive performance and disability were examined by mini-mental status examination and expanded disability status scale. Multiple logistic regressions were used to determine the associated factors of depression and antidepressant use. The prevalence of depression and severe depression was 59.4 and 18.1 %, respectively. However, only 21.1 % of patients were on antidepressant treatment, while the prevalence of unrecognized/untreated depression was found to be as high as 44.1 %. Multivariable analysis showed that fatigue (P < 0.0001, OR = 5.98, 95 % CI = 2.9-12.3) and older age (P = 0.027, OR = 2.24, 95 % CI = 1.09-4.6) were associated with depression in MS patient. A significant association was found between fatigue and antidepressant use (P = 0.001, OR = 6.81, 95 % CI = 2.26-20.48). Our findings demonstrate that depression is significantly associated with fatigue and older age, regardless of other factors. Moreover, despite the high prevalence of depression in MS, most patients do not receive adequate treatment.
Collapse
|
29
|
Sarısoy G, Terzi M, Gümüş K, Pazvantoğlu O. Psychiatric symptoms in patients with multiple sclerosis. Gen Hosp Psychiatry 2013; 35:134-40. [PMID: 23260339 DOI: 10.1016/j.genhosppsych.2012.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 10/08/2012] [Accepted: 10/17/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study was intended to identify general psychiatric symptoms in multiple sclerosis (MS) patients and to determine the distribution of these psychiatric symptoms by type of MS and degree of disability. METHODS One hundred fifty-two volunteers, 76 MS patients and 76 healthy controls, matched in terms of age, gender, marital status, years spent in education and income, were included. Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, Padua Inventory, Rosenberg Self-Esteem Scale and Eating Attitude Test. Degree of disability was determined using the Expanded Disability Status Scale (EDSS). In addition to being compared between the patient and control groups, scale scores were also compared between groups established on the basis of relapsing-remitting or progressive forms of MS, neurological disability and ambulatory ability. Correlations were determined between EDSS scores and psychiatric scale scores. RESULTS In addition to symptoms of depression, anxiety and sleep impairment in MS patients, we also determined that less studied symptoms such as somatization, obsession, compulsion, interpersonal sensitivity, anger-hostility, phobic anxiety, paranoid ideation, psychoticism, low self-esteem and distorted eating attitudes were also more frequent compared to the healthy controls. Some symptoms were also more prevalent in progressive MS patients compared to relapsing-remitting subjects. Symptoms increase as degree of disability rises and ambulatory capacity declines. CONCLUSION Depressive, anxious and sleep impairment symptoms are not the only ones seen in MS patients; other psychiatric symptoms are also common. Further studies are needed to investigate the frequency and causes of these little-investigated symptoms. As seen in patients with a progressive course and greater neurological disability, more psychiatric symptoms develop in patients with more severe disease.
Collapse
Affiliation(s)
- Gökhan Sarısoy
- Ondokuz Mayis University School of Medicine Samsun/Turkey.
| | | | | | | |
Collapse
|