1
|
Jellinger KA. Behavioral disorders in multiple sclerosis: a comprehensive review. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02816-9. [PMID: 39231817 DOI: 10.1007/s00702-024-02816-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/28/2024] [Indexed: 09/06/2024]
Abstract
Multiple sclerosis (MS) is a heterogenous autoimmune-mediated disease of the central nervous system (CNS) characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of neuropsychiatric symptoms, behavioral changes are common, even from the early stages of the disease, while they are associated with cognitive deficits in advanced MS. According to DSM-5, behavioral disorders include attention deficits, oppositional, defiant and conduct disorders, anxiety, panic, obsessive-compulsive disorders (OCD), disruptive and emotional disorders, while others include also irritability, agitation, aggression and executive dysfunctions. Approximately 30 to 80% of individuals with MS demonstrate behavioral changes associated with disease progression. They are often combined with depression and other neuropsychiatric disorders, but usually not correlated with motor deficits, suggesting different pathomechanisms. These and other alterations contribute to disability in MS. While no specific neuropathological data for behavioral changes in MS are available, those in demyelination animal models share similarities with white matter and neuroinflammatory abnormalities in humans. Neuroimaging revealed prefrontal cortical atrophy, interhemispheric inhibition and disruption of fronto-striato-thalamic and frontoparietal networks. This indicates multi-regional patterns of cerebral disturbances within the MS pathology although their pathogenic mechanisms await further elucidation. Benefits of social, psychological, behavioral interventions and exercise were reported. Based on systematical analysis of PubMed, Google Scholar and Cochrane library, current epidemiological, clinical, neuroimaging and pathogenetic evidence are reviewed that may aid early identification of behavioral symptoms in MS, and promote new therapeutic targets and strategies.
Collapse
Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
| |
Collapse
|
2
|
Wasem J, Heer Y, Karamasioti E, Muros-Le Rouzic E, Marcelli G, Di Maio D, Braune S, Kobelt G, Dillon P. Cost and Quality of Life of Disability Progression in Multiple Sclerosis Beyond EDSS: Impact of Cognition, Fatigue, and Limb Impairment. PHARMACOECONOMICS - OPEN 2024; 8:665-678. [PMID: 38949748 PMCID: PMC11362420 DOI: 10.1007/s41669-024-00501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Understanding the socioeconomic burden of multiple sclerosis (MS) is essential to inform policymakers and payers. Real-world studies have associated increasing costs and worsening quality of life (QoL) with disability progression. This study aims to further evaluate the impact of cognition, fatigue, upper and lower limb function (ULF, LLF) impairments, and disease progression per Expanded Disability Status Scale (EDSS) level, on costs and QoL. METHODS This was a cross-sectional cohort study including 20,988 patients from the German NeuroTransData MS registry from 2009 to 2019. QoL analyses were based on EQ-5D-5L. Cost analyses included indirect/direct medical and non-medical costs. Eight subgroups, ranging from 439 to 1812 patients were created based on presence of measures for disease progression (EDSS), cognition (Symbol Digit Modalities Test [SDMT]), fatigue (Modified Fatigue Impact 5-Item Scale [MFIS-5]), ULF (Nine-Hole Peg Test [9HPT]), and LLF (Timed 25-Foot Walk [T25FW]). Multivariable linear regression assessed the independent effect of each test's score on QoL and costs, while adjusting for EDSS and 12 other confounders. RESULTS Lower QoL was associated with decreasing cognition (p < 0.001), worsening ULF (p = 0.025), and increasing fatigue (p < 0.0001); however, the negative impact of LLF worsening on QoL was not statistically significant (p = 0.54). Higher costs were associated with decreasing cognition (p < 0.001), worsening of ULF (p = 0.0058) and LLF (p = 0.049), and increasing fatigue (p < 0.0001). Each 1-scale-step worsening function of SDMT, MFIS-5, 9HPT, and T25FW scores resulted in €170, €790, €330, and €520 higher costs, respectively. Modeling disability progression based on SDMT, MFIS-5, 9HPT, and T25FW scores as an interaction with EDSS strata found associations with lower QoL and higher costs at variable EDSS ranges. CONCLUSIONS Disease progression in MS measured by 9HPT, SDMT, and MFIS-5 had a significant negative impact on QoL and broad socioeconomic costs independent of EDSS. T25FW had a significant negative association with costs. Cognition, fatigue, ULF, and LLF have stronger impact on costs and QoL in patients with higher EDSS scores. Additional determinants of MS disability status, including SDMT, MFIS-5, 9HPT, and T25FW, should be considered for assessing cost effectiveness of novel therapeutics for MS.
Collapse
Affiliation(s)
- Jürgen Wasem
- Faculty of Economics, University of Duisburg-Essen, Essen, Germany
| | - Yanic Heer
- PricewaterhouseCoopers (PwC), Zurich, Switzerland
| | | | | | | | | | | | - Gisela Kobelt
- EHE International, St Moritz, Switzerland
- European Health Economics, Mulhouse, France
| | - Paul Dillon
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| |
Collapse
|
3
|
Jellinger KA. Depression and anxiety in multiple sclerosis. Review of a fatal combination. J Neural Transm (Vienna) 2024; 131:847-869. [PMID: 38869643 DOI: 10.1007/s00702-024-02792-0] [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: 04/03/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024]
Abstract
Depression and anxiety are the most frequent neuropsychiatric symptoms of multiple sclerosis (MS), an autoimmune-mediated demyelinating neurodegenerative disease. Their prevalence is 25-65% and 20-54%, respectively, often associated with chronic fatigue and cognitive impairment, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. Both disorders often arise before MS diagnosis, lead to faster disability and impair the quality of life. Risk factors are (young) age, genetic and family history burden. While no specific neuropathological data for depression (and anxiety) in MS are available, modern neuroimaging studies showed bilateral fronto-temporal, subcortical and limbic atrophies, microstructural white matter lesions and disruption of frontoparietal, limbic and neuroendocrine networks. The pathogenesis of both depression and anxiety in MS is related to shared mechanisms including oxidative stress, mitochondrial dysfunction, neuroinflammation and neuroendocrine mechanisms inducing complex functional and structural brain lesions, but they are also influenced by social and other factors. Unfortunately, MS patients with anxiety, major depression or suicidal thoughts are often underassessed and undertreated. Current treatment, in addition to antidepressant therapy include transcranial magnetic stimulation, cognitive, relaxation, dietary and other healthcare measures that must be individualized. The present state-of- the-art review is based on systematic analysis of PubMed, Google Scholar and Cochrane Library until May 2024, with focus on the prevalence, clinical manifestation, neuroimaging data, immune mechanisms and treatment options. Depression and anxiety in MS, like in many other neuroimmune disorders, are related, among others, to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate management to improve the quality of life in this disabling disease.
Collapse
Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
| |
Collapse
|
4
|
Probst Y, Kinnane E. Quality of reporting health behaviors for multiple sclerosis (QuoRH-MS): A scoping review to inform intervention planning and improve consistency of reporting. Brain Behav 2024; 14:e3635. [PMID: 39148370 PMCID: PMC11327400 DOI: 10.1002/brb3.3635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/26/2024] [Accepted: 07/03/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurological condition that necessitates a multidisciplinary approach to aid those living with MS in managing their disease. Health behavior, or lifestyle modification, is an emerging approach to MS self-management. MS researchers utilize measurement tools to ensure that interventions are best suited to the outcomes, thereby potentially influencing practice. The aim of this study was to investigate which tools are being used for health behavior management studies in people living with MS and develop an aid for tool selection. METHODS A scoping review guided by the PRISMA-Sc checklist and the JBI manual for evidence synthesis was employed with a systematic search strategy executed across four scientific databases: Medline, PubMed, CINAHL, and Cochrane Libraries. The types of assessment tools used were extracted from the included studies. Each tool was categorized into the health behavior intervention discipline (nutrition, exercise, and psychology) and then subcategorized by the tool's purpose. The frequency of use was determined for each tool. Reporting of validation of the assessment tools were collated to inform a tool selection checklist. RESULTS The review identified a total of 248 tools (12 nutrition, 55 exercise, and 119 psychology unique reports) from 166 studies. Seventy-seven multidimensional tools were identified including measures of quality of life, fatigue, and functional scales. Only 88 studies (53%) referred to the validity of the tools. The most commonly reported tools were the dietary habits questionnaire (n = 4, nutrition), 6-minute walk test (n = 17, exercise), Symbol Digits and Modalities Test, and Hospital Anxiety and Depression Scale (n = 15 each, psychology) with the Expanded Disability Status Scale reported 43 times. CONCLUSION Evidence from interventions may inform practice for health professionals. This review provides insights into the range of tools reported across health behavior intervention studies for MS and offers a guide toward more consistent reporting of study methods.
Collapse
Affiliation(s)
- Yasmine Probst
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Emily Kinnane
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
5
|
Simpson AC, Hu C, Mowry EM, Naismith RT, Fitzgerald KC, Nourbakhsh B. Structural MRI measures are associated with fatigue severity and persistence in a large, real-world cohort of people with multiple sclerosis. Mult Scler 2024; 30:738-746. [PMID: 38525561 DOI: 10.1177/13524585241239473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Results of research on radiological hallmarks of multiple sclerosis (MS) fatigue have been conflicting. OBJECTIVE To investigate the associations of lesion and brain compartment volumes with fatigue severity and persistence in people with multiple sclerosis (PwMS). METHODS The Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) network collects standardized data during routine care of PwMS from 10 healthcare institutions. Magnetic resonance imaging (MRI) predictors included baseline brain parenchymal (BPF) and gray matter fractions (GMF) and T2 lesion volume (T2LV). The Quality of Life in Neurological Disorders (Neuro-QOL) fatigue subscore was analyzed linearly and categorically using T-score cutpoints, with a period of elevated symptoms defined as T-score ⩾ mean + 0.5 SD over follow-up. RESULTS At baseline, of 4012 participants (average age: 45.6 ± 11.8 years; 73% female; 31% progressive MS), 2058 (51%) had no fatigue, 629 (16%) had mild fatigue, and 1325 (33%) had moderate-to-severe fatigue. One SD greater baseline BPF and GMF were associated with 0.83 (p < 0.001) and 0.38 (p = 0.02) lower values in the baseline Neuro-QOL fatigue T-score. A 1 SD lower log of total T2LV was associated with a 0.49 (p < 0.001) lower baseline fatigue T-score. Higher BPF and lower T2LV at baseline were associated with lower odds of subsequent periods of elevated fatigue. CONCLUSION Baseline lesion burden and lower generalized whole-brain volumes were associated with MS fatigue in cross-sectional and longitudinal analyses in a large, real-world cohort of PwMS.
Collapse
Affiliation(s)
- Alexandra C Simpson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chen Hu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA/ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert T Naismith
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA/ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Elkhooly M, Bao F, Bernitsas E. Impact of Disease Modifying Therapy on MS-Related Fatigue: A Narrative Review. Brain Sci 2023; 14:4. [PMID: 38275509 PMCID: PMC10813476 DOI: 10.3390/brainsci14010004] [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: 11/26/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system by causing inflammation, demyelination and neurodegeneration. Fatigue is the most prevalent and one of the most disabling symptoms among people with MS (pwMS). Due to its complexity and subjective character, fatigue is still little understood despite its frequent occurrence and severe impact. The potential causes, effects, and treatments of fatigue associated with MS have been extensively studied in recent years. Though the benefits of such a variety of contributions are obvious, there have not been many attempts to evaluate the effect of disease modifying therapies (DMTs) on MS-related fatigue. In this review, we summarize clinical trials and research studies, and we discuss the effect of different DMTs on MS-related fatigue.
Collapse
Affiliation(s)
- Mahmoud Elkhooly
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL 62702, USA;
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Department of Neurology and Psychiatry, Minia University, Minia 61519, Egypt
| | - Fen Bao
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| |
Collapse
|
7
|
Kołtuniuk A, Pawlak B, Krówczyńska D, Chojdak-Łukasiewicz J. The quality of life in patients with multiple sclerosis - Association with depressive symptoms and physical disability: A prospective and observational study. Front Psychol 2023; 13:1068421. [PMID: 36687950 PMCID: PMC9853525 DOI: 10.3389/fpsyg.2022.1068421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
Background Patients with multiple sclerosis (MS) experience disabilities which significantly affect their quality of life (QOL) and mental health. Mood disorders and depressive symptoms are one of the most common psychiatric conditions in MS patients. This study aimed to evaluate the level of QOL in MS patients and to assess the influence of depressive symptoms and physical disability on QOL. Methods This prospective and observational study was conducted among 100 MS patients (mean age of 36.23 ± 11.77) recruited from the Lower Silesian Unit of the Polish Association for Multiple Sclerosis. This study used a questionnaire designed by the authors, which contained questions about sociodemographic and clinical data, as well as the following standardized questionnaires: the Activities of Daily Living questionnaire (ADL), the Instrumental Activities of Daily Living questionnaire (IADL), the Expanded Disability Status Scale (EDSS), the Beck Depression Inventory (BDI) and Multiple Sclerosis International Quality of Life Questionnaire (MusiQOL). Results The average EDSS score among patients was 3.13 ± 2.38 points. More than half of the respondents (68%) suffered from depression of varying severity. The univariate linear regression models showed that the independent (p < 0.05) QOL predictors (total MusiQOL) were as follows: the number of complaints, IADL results, BDI results, EDSS score, higher education, and material status >2000 PLN. In addition, the multiple linear regression model showed that the BDI result was a significant predictor of QOL (p < 0.005). Conclusion Depressive symptoms significantly affect the QOL of MS patients.
Collapse
Affiliation(s)
- Aleksandra Kołtuniuk
- Division of Internal Medicine Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Pawlak
- Division of Internal Medicine Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Krówczyńska
- Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
- Department of Nursing and Obstetrics Collegium Mazovia, Siedlce, Poland
| | | |
Collapse
|
8
|
Kasindi A, Fuchs DT, Koronyo Y, Rentsendorj A, Black KL, Koronyo-Hamaoui M. Glatiramer Acetate Immunomodulation: Evidence of Neuroprotection and Cognitive Preservation. Cells 2022; 11:cells11091578. [PMID: 35563884 PMCID: PMC9099707 DOI: 10.3390/cells11091578] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Novel, neuroprotective uses of Copaxone (generic name: glatiramer acetate—GA) are being examined, primarily in neurological conditions involving cognitive decline. GA is a well-studied synthetic copolymer that is FDA-approved for immune-based treatment of relapsing remitting multiple sclerosis (RRMS). Clinical studies have explored the potential mechanism of action (MOA) and outcomes of GA immunization in patients. Furthermore, results from these and animal studies suggest that GA has a direct immunomodulatory effect on adaptive and innate immune cell phenotypes and responses. These MOAs have been postulated to have a common neuroprotective impact in several neuroinflammatory and neurodegenerative diseases. Notably, several clinical studies report that the use of GA mitigated MS-associated cognitive decline. Its propensity to ameliorate neuro-proinflammatory and degenerative processes ignites increased interest in potential alternate uses such as in age-related macular degeneration (AMD), amyotrophic lateral sclerosis (ALS), and Alzheimer’s disease (AD). Preclinical studies are exploring less frequent subcutaneous administration of GA, such as once weekly or monthly or a single dosing regimen. Indeed, cognitive functions were found to be either preserved, reversed, or improved after the less frequent treatment regimens with GA in animal models of AD. In this systematic review, we examine the potential novel uses of GA across clinical and pre-clinical studies, with evidence for its beneficial impact on cognition. Future investigation in large-size, double-blind clinical trials is warranted to establish the impact of GA immunomodulation on neuroprotection and cognitive preservation in various neurological conditions.
Collapse
Affiliation(s)
- Arielle Kasindi
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.K.); (D.-T.F.); (Y.K.); (A.R.); (K.L.B.)
| | - Dieu-Trang Fuchs
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.K.); (D.-T.F.); (Y.K.); (A.R.); (K.L.B.)
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.K.); (D.-T.F.); (Y.K.); (A.R.); (K.L.B.)
| | - Altan Rentsendorj
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.K.); (D.-T.F.); (Y.K.); (A.R.); (K.L.B.)
| | - Keith L. Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.K.); (D.-T.F.); (Y.K.); (A.R.); (K.L.B.)
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.K.); (D.-T.F.); (Y.K.); (A.R.); (K.L.B.)
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Correspondence:
| |
Collapse
|
9
|
Dymecka J, Gerymski R, Tataruch R, Bidzan M. Fatigue, Physical Disability and Self-Efficacy as Predictors of the Acceptance of Illness and Health-Related Quality of Life in Patients with Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413237. [PMID: 34948845 PMCID: PMC8703876 DOI: 10.3390/ijerph182413237] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system that leads to permanent disability and many neurological symptoms, making everyday functioning difficult. The predictors of the acceptance of illness and the health-related quality of life in people with MS include the degree of disability, neurological symptoms and psychosocial factors, such as personal resources. The aim of our study is to determine the relationships among disability, fatigue, self-efficacy, acceptance of illness and quality of life. The study group consisted of 137 people diagnosed with multiple sclerosis-73 women and 64 men. EDSS, GNDS, LSES, AIS and MSIS-29 were used in the present study. The results show that all tested variables were significantly correlated with each other. Disability and fatigue were significant predictors of both the physical and psychological aspects of patients' quality of life. Self-efficacy was a significant predictor of both the acceptance of illness and the psychological aspect of patients' quality of life. Based on the current research study, it can be concluded that factors of a biomedical nature explain other aspects of struggling with the disease, rather than psychological resources.
Collapse
Affiliation(s)
- Joanna Dymecka
- Department of Health Psychology and Quality of Life, Institute of Psychology, Opole University, 45-040 Opole, Poland;
| | - Rafał Gerymski
- Department of Health Psychology and Quality of Life, Institute of Psychology, Opole University, 45-040 Opole, Poland;
- Correspondence:
| | - Rafał Tataruch
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland;
| | - Mariola Bidzan
- Department of Clinical and Health Psychology, Institute of Psychology, University of Gdansk, 80-309 Gdansk, Poland;
| |
Collapse
|
10
|
Connection between microstructural alterations detected by diffusion MRI and cognitive dysfunction in MS: A model-free analysis approach. Mult Scler Relat Disord 2021; 57:103442. [PMID: 34896877 DOI: 10.1016/j.msard.2021.103442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cognitive decline is a prominent symptom of MS. Clear connection between cognitive status and white matter microstructural changes has not been unequivocally observed to date. OBJECTIVE To characterise the relationship between white matter microstructure and cognitive performance a partial least squares (PLS) approach was used. METHODS 53 RR MS patients' T1 and DTI images and BICAMS subtests were used in our analysis. Standard FSL pipeline was used to obtain diffusion parameters. A PLS approach was applied to reveal the diffusion parameter patterns responsible for the cognitive dysfunction. RESULTS The first latent variable (LV) was mainly associated with demyelination, while the second and third explained axonal damage. While the first two LV represented mainly Brief Visuospatial Memory Test (BVMT) and Single Digit Modality Test (SDMT), the third LV depicted diffusion alterations mainly the verbal subtest. The first LVs spatial map showed demyelination in the corpus callosum. The second LVs spatial map showed the diffusion alterations in the thalamus. The third LV depicted diffusion alterations in the putative left superior longitudinal fascicle. CONCLUSION Visual memory demanding tasks versus language functions depend on distinct patterns of diffusion parameters and the spatial organisation. Axial diffusivity alterations, a putative marker of irreversible axonal loss explained around 20% of variability in the cognitive functions.
Collapse
|
11
|
Oliva Ramirez A, Keenan A, Kalau O, Worthington E, Cohen L, Singh S. Prevalence and burden of multiple sclerosis-related fatigue: a systematic literature review. BMC Neurol 2021; 21:468. [PMID: 34856949 PMCID: PMC8638268 DOI: 10.1186/s12883-021-02396-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system that results in progressive and irreversible disability. Fatigue is one of the most common MS-related symptoms and is characterized by a persistent lack of energy that impairs daily functioning. The burden of MS-related fatigue is complex and multidimensional, and to our knowledge, no systematic literature review has been conducted on this subject. The purpose of this study was to conduct a systematic literature review on the epidemiology and burden of fatigue in people with multiple sclerosis (pwMS). METHODS Systematic searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews to identify relevant studies of fatigue in pwMS. English-language records published from 2010 to January 2020 that met predefined eligibility criteria were included. We initially selected studies that reported quality of life (QoL) and economic outcomes according to categories of fatigue (e.g., fatigued vs non-fatigued). Studies assessing associations between economic outcomes and fatigue as a continuous measure were later included to supplement the available data. RESULTS The search identified 8147 unique records, 54 of which met the inclusion criteria. Of these, 39 reported epidemiological outcomes, 11 reported QoL, and 9 reported economic outcomes. The supplementary screen for economic studies with fatigue as a continuous measure included an additional 20 records. Fatigue prevalence in pwMS ranged from 36.5 to 78.0%. MS-related fatigue was consistently associated with significantly lower QoL. Results on the economic impact of fatigue were heterogeneous, but most studies reported a significant association between presence or severity of fatigue and employment status, capacity to work, and sick leave. There was a gap in evidence regarding the direct costs of MS-related fatigue and the burden experienced by caregivers of pwMS. CONCLUSION Fatigue is a prevalent symptom in pwMS and is associated with considerable QoL and economic burden. There are gaps in the evidence related to the direct costs of MS-related fatigue and the burden of fatigue on caregivers. Addressing fatigue over the clinical course of the disease may improve health and economic outcomes for patients with MS.
Collapse
Affiliation(s)
| | - Alexander Keenan
- Health Economics and Market Access, Janssen Research & Development, LLC, Titusville, NJ, USA.
| | | | | | | | | |
Collapse
|
12
|
Mackay L, Johnson AM, Moodie ST, Rosehart H, Morrow SA. Predictors of cognitive fatigue and fatigability in multiple sclerosis. Mult Scler Relat Disord 2021; 56:103316. [PMID: 34638096 DOI: 10.1016/j.msard.2021.103316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (PwMS) commonly experience cognitive fatigue (CF), defined as a decrease in cognitive performance with sustained activity, yet CF remains understudied. Further, the relationship between subjective CF and objective CF, or cognitive fatiguability, has not been fully elucidated in previous studies. Understanding the predictors of cognitive fatigue may scaffold the development of interventions that target this symptom. The objective of this prospective study was to evaluate the extent to which depression, anxiety, information processing speed, and sleep quality predict subjective and objective CF. METHODS PwMS were recruited from one academic MS clinic in London (ON) Canada. Objective CF was measured by the Paced Auditory Serial Addition Test (PASAT), where performance on the last third of the PASAT is compared to performance on the 1st third, a validated measurement of objective CF. Subjective CF was measured by the cognitive component of the Modified Fatigue Impact Scale (MFIS). Additionally, depression, anxiety, information processing speed, and sleep quality data was collected. All assessments took place on the same day. Pearson's r was calculated to examine the relationship among all continuous outcome measures while linear regression analyses were used to examine predictors of subjective and objective CF. RESULTS The sample consisted of 53 subjects who were mostly female (37; 69.8%) with a mean age of 44.2 years; the majority (47; 88.7%) had relapsing MS. Objective CF and subjective CF were not significantly related (r = - 0.16). Further, there was no statistically significant predictors of objective CF noted. In contrast, subjective CF demonstrated a statistically significant relationship with the Symbol Digit Modalities Test (SDMT; r = - 0.29, p = .05), Hospital Anxiety and Depression Scale (HADS), depression subscale (r = 0.61, p < .001), HADS anxiety subscale (r = 0.54, p < .001), and sleep quality (r = 0.33, p = .02). Additionally, all variables predicted subjective CF, R2adj = 0.384 [F (6, 40) = 5.783, p = .0002]. In particular, anxiety significantly predicted subjective CF when controlling for depression, information speed, and sleep quality. CONCLUSION This study demonstrated that subjective CF is significantly predicted by anxiety, and strongly influenced by information processing impairment and depression. Addressing underlying affective factors, such as anxiety or depression, may help alleviate perceived or subjective CF among PwMS, thus improving their function and quality of life. Further studies with a larger sample size or longitudinal follow up may help define predictors of objective CF.
Collapse
Affiliation(s)
- Leila Mackay
- Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario N6A 5Q5, Canada
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, London, Ontario, Canada
| | - Sheila T Moodie
- School of Communication Sciences and Disorders, The University of Western Ontario, London, Ontario, Canada
| | - Heather Rosehart
- Clinical Neurological Sciences, University Hospital-London Health Sciences Center, 339 Windermere Road, London, Ontario, Canada
| | - Sarah A Morrow
- Clinical Neurological Sciences, University Hospital-London Health Sciences Center, 339 Windermere Road, London, Ontario, Canada.
| |
Collapse
|
13
|
Tanaka M, Vécsei L. Monitoring the Redox Status in Multiple Sclerosis. Biomedicines 2020; 8:E406. [PMID: 33053739 PMCID: PMC7599550 DOI: 10.3390/biomedicines8100406] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023] Open
Abstract
Worldwide, over 2.2 million people suffer from multiple sclerosis (MS), a multifactorial demyelinating disease of the central nervous system. MS is characterized by a wide range of motor, autonomic, and psychobehavioral symptoms, including depression, anxiety, and dementia. The blood, cerebrospinal fluid, and postmortem brain samples of MS patients provide evidence on the disturbance of reduction-oxidation (redox) homeostasis, such as the alterations of oxidative and antioxidative enzyme activities and the presence of degradation products. This review article discusses the components of redox homeostasis, including reactive chemical species, oxidative enzymes, antioxidative enzymes, and degradation products. The reactive chemical species cover frequently discussed reactive oxygen/nitrogen species, infrequently featured reactive chemicals such as sulfur, carbonyl, halogen, selenium, and nucleophilic species that potentially act as reductive, as well as pro-oxidative stressors. The antioxidative enzyme systems cover the nuclear factor erythroid-2-related factor 2 (NRF2)-Kelch-like ECH-associated protein 1 (KEAP1) signaling pathway. The NRF2 and other transcriptional factors potentially become a biomarker sensitive to the initial phase of oxidative stress. Altered components of the redox homeostasis in MS were discussed in search of a diagnostic, prognostic, predictive, and/or therapeutic biomarker. Finally, monitoring the battery of reactive chemical species, oxidative enzymes, antioxidative enzymes, and degradation products helps to evaluate the redox status of MS patients to expedite the building of personalized treatment plans for the sake of a better quality of life.
Collapse
Affiliation(s)
- Masaru Tanaka
- MTA-SZTE, Neuroscience Research Group, Semmelweis u. 6, H-6725 Szeged, Hungary;
- Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - László Vécsei
- MTA-SZTE, Neuroscience Research Group, Semmelweis u. 6, H-6725 Szeged, Hungary;
- Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| |
Collapse
|
14
|
Pérez de Heredia-Torres M, Huertas-Hoyas E, Sánchez-Camarero C, Máximo-Bocanegra N, Alegre-Ayala J, Sánchez-Herrera-Baeza P, Martínez-Piédrola RM, García-Bravo C, Mayoral-Martín A, Serrada-Tejeda S. Occupational performance in multiple sclerosis and its relationship with quality of life and fatigue. Eur J Phys Rehabil Med 2020; 56:148-154. [DOI: 10.23736/s1973-9087.20.05914-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
15
|
Tóth E, Faragó P, Király A, Szabó N, Veréb D, Kocsis K, Kincses B, Sandi D, Bencsik K, Vécsei L, Kincses ZT. The Contribution of Various MRI Parameters to Clinical and Cognitive Disability in Multiple Sclerosis. Front Neurol 2019; 9:1172. [PMID: 30728801 PMCID: PMC6351478 DOI: 10.3389/fneur.2018.01172] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
Next to the disseminated clinical symptoms, cognitive dysfunctions are common features of multiple sclerosis (MS). Over the recent years several different MRI measures became available representing the various features of the pathology, but the contribution to various clinical and cognitive functions is not yet fully understood. In this multiparametric MRI study we set out to identify the set of parameters that best predict the clinical and cognitive disability in MS. High resolution T1 weighted structural and high angular resolution diffusion MRI images were measured in 53 patients with relapsing remitting MS and 53 healthy controls. Clinical disability was inflicted by EDSS and cognitive functions were evaluated with the BICAMS tests. The contribution of lesion load, partial brain, white matter, gray matter and subcortical volumes as well as the diffusion parameters in the area of the lesions and the normal appearing white matter were examined by model free, partial least square (PLS) approach. Significance of the predictors was tested with Variable Importance in the Projection (VIP) score and 1 was used for threshold of significance. The PLS analysis indicated that the axial diffusivity of the NAWM contributed the most to the clinical disability (VIP score: 1.979). For the visuo-spatial working memory the most critical contributor was the size of the bilateral hippocampi (VIP scores: 1.183 and 1.2 left and right respectively). For the verbal memory the best predictors were the size of the right hippocampus (VIP score: 1.972), lesion load (VIP score: 1.274) and the partial brain volume (VIP score: 1.119). In case of the information processing speed the most significant contribution was from the diffusion parameters (fractional anisotropy, mean and radial diffusivity, VIP scores: 1.615, 1.321 respectively) of the normal appearing white matter. Our results indicate that various MRI measurable factors of MS pathology contribute differently to clinical and cognitive disability. These results point out the importance of the volumetry of the subcortical structures and the diffusion measures of the white matter in understanding the disability progression.
Collapse
Affiliation(s)
- Eszter Tóth
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Péter Faragó
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - András Király
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Veréb
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.,MTA-SZTE Neuroscience Research Group, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.,Department of Radiology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| |
Collapse
|
16
|
Fernández-Muñoz JJ, Cigarán-Méndez M, Navarro-Pardo E, Pérez-de-Heredia-Torres M, Parás-Bravo P, Fernández-de-las-Peñas C. Is the association between health-related quality of life and fatigue mediated by depression in patients with multiple sclerosis? A Spanish cross-sectional study. BMJ Open 2018; 8:e016297. [PMID: 29362245 PMCID: PMC5786117 DOI: 10.1136/bmjopen-2017-016297] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine the mediating effects of depression on health-related quality of life and fatigue in individuals with multiple sclerosis (MS). DESIGN A cross-sectional study. SETTING Tertiary urban hospital. PARTICIPANTS One hundred and eight patients (54% women) with MS participated in this study. OUTCOME MEASURES Demographic and clinical data (weight, height, medication and neurological impairment), fatigue (Fatigue Impact Scale), depression (Beck Depression Inventory-II) and health-related quality of life (Short-Form Health Survey 36) were collected. RESULTS Fatigue was significantly associated with bodily pain, physical function, mental health and depression. Depression was associated with bodily pain and mental health. The path analysis found direct effects from physical function, bodily pain and depression to fatigue (all, P<0.01). The path model analysis revealed that depression exerted a mediator effect from bodily pain to fatigue (B=-0.04, P<0.01), and from mental health to fatigue (B=-0.16, P<0.01). The amount of fatigue explained by all predictors in the path model was 37%. CONCLUSIONS This study found that depression mediates the relationship between some health-related quality of life domains and fatigue in people with MS. Future longitudinal studies focusing on proper management of depressive symptoms in individuals with MS will help determine the clinical implications of these findings.
Collapse
Affiliation(s)
| | | | - Esperanza Navarro-Pardo
- Departamento de Psicología Evolutiva y de la Educación, Universitat de Valencia, Valencia, Comunitat Valenciana, Spain
| | - Marta Pérez-de-Heredia-Torres
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Paula Parás-Bravo
- Department of Nursing, Universidad de Cantabria, Santander, Cantabria, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| |
Collapse
|
17
|
Péntek M, Kobelt G, Berg J, Capsa D, Dalén J, Bíró Z, Mátyás K, Komoly S. New insights into the burden and costs of multiple sclerosis in Europe: Results for Hungary. Mult Scler 2017. [DOI: 10.1177/1352458517708142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: To estimate the value of interventions in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with costs. This requires that cost data be regularly updated. Objectives and methods: This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption, work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of disability, from the societal perspective, in HUF 2015. Results: A total of 521 patients (mean age 47 years) participated; 85% were below retirement age, and of these, 47% were employed. Employment was related to disability and MS affected productivity at work for 82% of those working. Overall, 94% and 66% of patients experienced fatigue and cognitive difficulties as a problem, respectively. The mean utility and annual costs were 0.691 and 3,432,000HUF at Expanded Disability Status Scale (EDSS) 0–3, 0.491 and 5,262,000HUF at EDSS 4–6.5 and 0.076 and 6,235,000HUF at EDSS 7–9, respectively. The average cost of a relapse was estimated at 240,500HUF. Conclusion: This study illustrates the burden of MS on Hungarian patients and provides current data that are important for the development of health policies.
Collapse
Affiliation(s)
- Márta Péntek
- Corvinus University of Budapest, Budapest, Hungary
| | | | | | | | | | - Zita Bíró
- Flór Ferenc County Hospital, Kistarcsa, Hungary
| | | | | | | |
Collapse
|
18
|
Câmara NAAC, Gondim APS. Factors associated with adherence to immunomodulator treatment in people with multiple sclerosis. BRAZ J PHARM SCI 2017. [DOI: 10.1590/s2175-97902017000116132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
19
|
Nejati S, Rajezi Esfahani S, Rahmani S, Afrookhteh G, Hoveida S. The Effect of Group Mindfulness-based Stress Reduction and Consciousness Yoga Program on Quality of Life and Fatigue Severity in Patients with MS. J Caring Sci 2016; 5:325-335. [PMID: 28032077 PMCID: PMC5187553 DOI: 10.15171/jcs.2016.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 05/27/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction: The chronic nature of Multiple Sclerosis (MS),
have can leave devastating effects on quality of life and fatigue. The present research
aimed to study the effect of group Mindfulness-based Stress Reduction (MBSR) and conscious
yoga program on the quality of life and fatigue severity among patients with MS. Methods: This study was quasi-experimental with intervention
and control groups. The statistical population included all members to MS Society of
Tehran Province, 24 of whom diagnosed with MS were selected as the sample based on the
inclusion criteria. The subjects were randomly assigned into the test group (12 patients)
and the control group (12 patients). MS Quality of Life-54 (MSQOL-54) and Fatigue Severity
Scale (FSS) were used for data collection. Subjects in the test group underwent a MBSR and
conscious yoga program in 8 two-hour sessions. The data were analyzed using the SPSS
ver.13 software. Results: The study findings showed that there was a
significant difference between subjects in the experimental and control groups in terms of
mean score of some subscales of quality of life including physical health, role
limitations due to physical and emotional problems, energy, emotional well-being, health
distress, health perception, and satisfaction with sexual function, overall quality of
life, and fatigue severity. Conclusion: The results show that the program is effective
in reduction of fatigue severity and improving some subscales of quality of life in MS
patients. Hence, this supportive method can be used as an effective way for improving
quality of life and relieving fatigue in MS patients.
Collapse
Affiliation(s)
- Somayeh Nejati
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Rajezi Esfahani
- Clinical Psychology, Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Rahmani
- Department of Psychology and Educational Science, Semnan University, Semnan, Iran
| | - Gita Afrookhteh
- Psychological Counseling and Guidance, Azad University of Science and Research, Tehran, Iran
| | - Shahrzad Hoveida
- Health Psychology, Azad University of Science and Research, Alborz, Iran
| |
Collapse
|