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Yim SH, Sunwoo JS, Kim D, Chu MK, Yun CH, Yang KI. Fatigue or excessive daytime sleepiness: which is more closely related to depression? Sleep Breath 2024; 28:989-997. [PMID: 38095767 DOI: 10.1007/s11325-023-02964-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 05/31/2024]
Abstract
OBJECTIVE/BACKGROUND This study investigated fatigue and excessive daytime sleepiness to determine which was more closely related to depression in the general population. PATIENTS/METHODS Participants were investigated across 15 South Korean districts. Excessive daytime sleepiness, fatigue, and depression were evaluated using the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Patient Health Questionnaire-9 (PHQ-9), respectively. Depression was defined as PHQ-9 ≥ 10. The authors classified the combination of excessive daytime sleepiness and fatigue as excessive daytime sleepiness with fatigue (E+F+, ESS ≥ 11, FSS ≥ 36), fatigue without excessive daytime sleepiness (E-F+, ESS < 11, FSS ≥ 36), excessive daytime sleepiness without fatigue (E+F-, ESS ≥ 11, FSS < 36), and no fatigue and excessive daytime sleepiness (E-F-, ESS < 11, FSS < 36). RESULTS Among 2,493 participants (1,257 women), mean age was 47.9 ± 0.3 years. The prevalence of depression, fatigue, and excessive daytime sleepiness was 8.4% (n = 210), 30.8% (n = 767), and 15.3% (n = 382), respectively. The frequency of the four categories with depression (vs. controls) was as follows.: E+F+ (n = 67, 31.9% vs. 7.3%) (P < 0.001), E-F+ (n = 71, 33.8% vs. 20.3%) (P < 0.001), E+F-( n = 16, 7.6% vs. 5.8%) (P = 0.294), and E-F- (n = 56, 26.7% vs. 66.6%) (P < 0.001). After adjusting for covariates, depression was associated with E+F+ (odds ratio, OR 8.804, 95% confidence interval (CI) 5.818-13.132), E-F+ (OR 3.942, 95% CI 2.704-5.747), E+F- (OR 2.812, 95% CI 1.542-5.131), and E-F- (reference). Additionally, we performed logistic regression according to two categories. There was no significant difference in the association of depression between E+F- (reference) and E-F+ (OR 1.399, 95% CI 0.760-2.575). CONCLUSION Although fatigue and excessive daytime sleepiness were associated with depression regardless of the presence of each other, we could not clarify which was more closely related to depression.
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Affiliation(s)
- Soo Hwan Yim
- Department of Neurology, Ulsan University, College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, College of Medicine, Severance Hospital, Yonsei University, Seoul, Republic of Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
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Seferoğlu M, Aksoy MK, Tunç A. Hand Grip Strength as a Predictive Tool for Upper Extremity Functionality, Balance, and Quality of Life in People With Multiple Sclerosis. Int J MS Care 2024; 26:134-139. [PMID: 38872997 PMCID: PMC11168298 DOI: 10.7224/1537-2073.2022-030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND Upper extremity strength and function are rarely assessed in routine multiple sclerosis (MS) care. This study aimed to evaluate hand muscle strength and functionality in individuals with MS and investigate correlations with upper extremity function, cognitive status, health-related quality of life (HRQOL), and balance. METHODS A cross-sectional study was conducted with 45 consecutive individuals with MS between the ages of 18 and 65. Upper limb motor strength was evaluated using a hand grip strength dynamometer. Upper limb functional capacity was assessed using the Nine-Hole Peg Test (9HPT) and the Duruoz Hand Index (DHI). Balance, coordination, and falls were measured with the Berg Balance Scale (BBS), Falls Efficacy Scale (FES), and the 30-Second Chair Stand Test (30CST). Cognitive function was evaluated using the Montreal Cognitive Assessment instrument and the Symbol Digit Modalities Test. Level of HRQOL was assessed using the self-reported 54-item MS Quality of Life-54 questionnaire. RESULTS Out of the 45 participants (80% women, mean age 36.6 ± 8.6 years), higher hand grip dynamometer measures were strongly correlated with better DHI, 9HPT, BBS, FES, and 30CST scores. In the regression analysis, a 1-unit increase in dynamometer measures led to a 0.383 increase in overall HRQOL score. CONCLUSIONS This study demonstrates that increased hand grip strength (HGS) is associated with better hand functionality, balance, and HRQOL in individuals with MS. It provides evidence to support more systematic measurement of HGS in the care of people with MS.
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Affiliation(s)
- Meral Seferoğlu
- From the Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | | | - Abdulkadir Tunç
- Department of Neurology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Le HH, Ken-Opurum J, LaPrade A, Maculaitis MC, Sheehan JJ. Exploring humanistic burden of fatigue in adults with multiple sclerosis: an analysis of US National Health and Wellness Survey data. BMC Neurol 2024; 24:51. [PMID: 38297247 PMCID: PMC10832085 DOI: 10.1186/s12883-023-03423-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND This retrospective study examined the humanistic burden of fatigue in patients with relapsing-remitting multiple sclerosis (RRMS), compared with adults without MS, using data from the 2017 and 2019 US National Health and Wellness Survey. METHODS The 5-item Modified Fatigue Impact Scale (MFIS-5) was used to assess level of fatigue (MFIS-5 score <15: low fatigue [LF]; MFIS-5 score ≥15: high fatigue [HF]) in patients with RRMS. Health-related quality of life (HRQoL) measures (Short Form 36-Item Health Survey version 2, Euroqol-5 Dimensions-5 Levels [EQ-5D-5L], Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7], Perceived Deficits Questionnaire-5) and treatment-related characteristics were assessed. RESULTS In total, 498 respondents were identified as RRMS (n=375 RRMS+LF, n=123 RRMS+HF) and compared with 1,494 matched non-MS controls. RRMS+LF and RRMS+HF had significantly lower Short Form 6 Dimensions health utility, Mental and Physical Component Summary, and EQ-5D-5L scores and higher PHQ-9 and GAD-7 scores, compared with matched non-MS controls (all p<0.001); scores were worse for RRMS+HF than RRMS+LF across all measures (all p<0.001). A higher proportion of RRMS+HF reported moderate-to-severe depression and moderate-to-severe anxiety, compared with RRMS+LF and matched non-MS controls (both p<0.001). Fatigue was a significant predictor of poor HRQoL across all measures (all p<0.001). CONCLUSIONS Patients with RRMS experienced lower HRQoL with higher levels of fatigue, highlighting an unmet need. Results may help to inform physician-patient communication and shared decision-making to address fatigue and its associated impact on patients' HRQoL.
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Affiliation(s)
- Hoa H Le
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
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Marrie RA, Bernstein CN, Dolovich C, Bolton JM, Graff LA, Hitchon CA, Lix LM, Marriott JJ, Fisk JD. Within-person fluctuations over three years in depression, anxiety, fatigue, and health-related quality of life in multiple sclerosis. Mult Scler 2023; 29:1503-1513. [PMID: 37537962 PMCID: PMC10580669 DOI: 10.1177/13524585231190771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Longitudinal studies of health-related quality of life (HRQoL) in multiple sclerosis (MS) are limited. Most have examined average changes within the population, rather than dynamic changes within individuals. OBJECTIVE To assess the between- and within-individual association between depression, anxiety, fatigue, cognition, physical functioning, and physical comorbidities and HRQoL. METHODS Adults with MS underwent physical and cognitive assessments and reported symptoms of fatigue (Daily Fatigue Impact Scale), depression and anxiety (Hospital Anxiety and Depression Scale (HADS)), and HRQoL (RAND-36) annually (n = 4 visits). We evaluated associations of elevated symptoms of anxiety (HADS-A) and depression (HADS-D), fatigue, physical function (timed-walk and nine-hole peg test), cognitive function and comorbidity count with physical (PCS-36) and mental (MCS-36) HRQoL using multivariable linear models-estimating between-person and within-person effects. RESULTS Of 255 participants with MS enrolled, 81.6% were women. After adjustment, within-person increases in depression and fatigue were associated with decreases in physical HRQoL. Increases in depression, anxiety, and comorbidity count were associated with decreases in mental HRQoL. CONCLUSIONS Within-person increases in symptoms of depression, anxiety and fatigue, and comorbidity count are associated with HRQoL decreases among adults with MS, highlighting the potential magnitude of individual benefit of intervention for these symptoms.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Casandra Dolovich
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J Marriott
- Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
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Ahvenjärvi H, Niiranen M, Simula S, Hämäläinen P, Surcel HM, Remes AM, Ryytty M, Krüger J. Fatigue and health-related quality of life depend on the disability status and clinical course in RRMS. Mult Scler Relat Disord 2023; 77:104861. [PMID: 37442075 DOI: 10.1016/j.msard.2023.104861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/01/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Fatigue is a prominent and disabling symptom of multiple sclerosis (MS), impairing quality of life. The disease course of relapsing remitting MS (RRMS) is individual. OBJECTIVES We aimed to study the effects of demographic and clinical characteristics, as well as lifestyle risk factors on experienced fatigue and health-related quality of life (HRQoL) among RRMS patients, comparing benign and severe disease types. METHODS Altogether 198 Finnish RRMS patients were recruited for this real-life cross-sectional study. Self-reported questionnaires were used to evaluate fatigue and HRQoL by using Fatigue Scale for Motor and Cognitive Functions and 15D health-related quality of life questionnaires. Patients were categorized into subgroups based on the current disability status measured by the Expanded Disability Status Scale (EDSS) cut-off value of 4.5, and by retrospective clinical course divided into benign and aggressive RRMS. RESULTS All in all, 73% of the RRMS patients suffered from fatigue. Lower HRQoL had a strong correlation with more prominent fatigue (r = -0.719). Higher EDSS was associated with more prominent fatigue and lower HRQoL in the whole RRMS cohort. Older age at the disease onset was associated with more prominent fatigue and decreased HRQoL in the groups of aggressive RRMS and EDSS > 4.5. In the groups of EDSS ≤ 4.5 and benign RRMS, a higher number of used disease-modifying treatments (DMTs) was associated with more pronounced fatigue and reduced HRQoL. In addition, higher BMI was associated with lower HRQoL in patients with benign RRMS. Side effects (45 %) and lack of efficacy (26 %) were the most common reasons for discontinuing a DMT. Cessation due to side effects was the only reason that was significantly associated with more prominent fatigue and lower HRQoL. Use of nicotine products, gender, or disease duration were not associated with fatigue or HRQoL. CONCLUSIONS Individuals with severe RRMS and higher EDSS scores are more prone to experience fatigue and lower HRQoL. In addition, fatigue and lower HRQoL are more commonly observed among RRMS patients with older age at disease onset and in those with multiple DMT switches.
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Affiliation(s)
- Henrik Ahvenjärvi
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland
| | - Marja Niiranen
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. Box 100, FI-70029 Kuopio, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sakari Simula
- Southern Savo Hospital District, Department of Neurology, Porrassalmenkatu 35-37, FI-50100 Mikkeli, Finland
| | - Päivi Hämäläinen
- Masku Neurological Rehabilitation Centre, Vaihemäentie 10, FI-21250 Masku, Finland; Department of Psychology, FI-20014 University of Turku, Finland
| | - Heljä-Marja Surcel
- Faculty of Medicine, University of Oulu, P.O. Box 8000, FI-90014 University of Oulu, Finland; Biobank Borealis of Northern Finland, Northern Ostrobothnia Hospital District, P.O. Box 10, FI-90029 Oulu University Hospital, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Clinical Neurosciences, P.O. Box 4, Yliopistonkatu 3, FI-00014 University of Helsinki, Finland
| | - Mervi Ryytty
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland.
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Tanguay P, Décary S, Lemaire-Paquette S, Léonard G, Piché A, Dubois MF, Kairy D, Bravo G, Corriveau H, Marquis N, Tousignant M, Chassé M, Carvalho LP. Trajectories of health-related quality of life and their predictors in adult COVID-19 survivors: A longitudinal analysis of the Biobanque Québécoise de la COVID-19 (BQC-19). Qual Life Res 2023:10.1007/s11136-023-03406-0. [PMID: 37004627 PMCID: PMC10066943 DOI: 10.1007/s11136-023-03406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE A significant number of people will experience prolonged symptoms after COVID-19 infection that will greatly impact functional capacity and quality of life. The aim of this study was to identify trajectories of health-related quality of life (HRQOL) and their predictors among adults diagnosed with COVID-19. METHODS This is a retrospective analysis of an ongoing prospective cohort study (BQC-19) including adults (≥18y) recruited from April 2020 to March 2022. Our primary outcome is HRQOL using the EQ-5D-5L scale. Sociodemographic, acute disease severity, vaccination status, fatigue, and functional status at onset of the disease were considered as potential predictors. The latent class mixed model was used to identify the trajectories over an 18-month period in the cohort as a whole, as well as in the inpatient and outpatient subgroups. Multivariable and univariable regressions models were undertaken to detect predictors of decline. RESULTS 2163 participants were included. Thirteen percent of the outpatient subgroup (2 classes) and 28% in the inpatient subgroup (3 classes) experienced a more significant decline in HRQOL over time than the rest of the participants. Among all patients, age, sex, disease severity and fatigue, measured on the first assessment visit or on the first day after hospital admission (multivariable models), were identified as the most important predictors of HRQOL decline. Each unit increase in the SARC-F and CFS scores increase the likelihood of belonging to the declining trajectory (univariable models). CONCLUSION Although to different degrees, similar factors explain the decline in HRQOL over time among the overall population, people who have been hospitalized or not. Clinical functional capacity scales could help to determine the risk of HRQOL decline.
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Affiliation(s)
- Pamela Tanguay
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Simon Décary
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | | | - Guillaume Léonard
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - Alain Piché
- Département de Microbiologie et d'Infectiologie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-France Dubois
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
- Département Des Sciences de la Santé Communautaire, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Dahlia Kairy
- École de Réadaptation, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Université de Montréal, Montreal, Canada
| | - Gina Bravo
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
- Département Des Sciences de la Santé Communautaire, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Hélène Corriveau
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - Nicole Marquis
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Michel Tousignant
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - Michaël Chassé
- Centre de Recherche du Centre Hospitalier, Université de Montréal, Montreal, Canada
| | - Livia Pinheiro Carvalho
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada.
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada.
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Marchesi O, Vizzino C, Filippi M, Rocca MA. Current perspectives on the diagnosis and management of fatigue in multiple sclerosis. Expert Rev Neurother 2022; 22:681-693. [PMID: 35881416 DOI: 10.1080/14737175.2022.2106854] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Fatigue is a common and debilitating symptom among multiple sclerosis (MS) patients with a prevalence up to 81% and with a considerable impact on quality of life. However, its subjective nature makes it difficult to define and quantify in clinical practice. Research aimed at a more precise definition and knowledge of this construct is thus continuously growing. AREAS COVERED This review summarizes the most relevant updates available on PubMed up to July 1st 2022 regarding: the assessment methods that aim to measure the concept of fatigue (as opposed to fatigability), the possible treatment pathways currently available to clinicians, interconnection with the pathophysiological substrates and with the common comorbidities of MS, such as depression and mood disorders. EXPERT OPINION The in-depth study of fatigue can help to better understand its actual impact on MS patients and can stimulate clinicians towards a more valid approach, through a targeted analysis of this symptom. Considering fatigue from a multidimensional perspective allows the use of patient-tailored methods for its identification and subsequent treatment by different professional figures. Better identification of methods and treatment pathways would reduce the extremely negative impact of fatigue on MS patients' quality of life.
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Affiliation(s)
- Olga Marchesi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit and IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Sainz de la Maza S, Maurino J, Borges M, Martín-Martínez J, Sotoca J, Alonso A, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco MR, García-Soto JD, Campo-Amigo MD, Navarro-Cantó L, Agüera E, Garcés M, Carmona O, Gabaldón-Torres L, Forero L, Hervás M, de Alda LR, Gómez-Ballesteros R, Castillo-Triviño T. Measuring productivity loss in early relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 58:103398. [PMID: 35216781 DOI: 10.1016/j.msard.2021.103398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiple sclerosis is one of the most common causes of neurological disability in young adults with major consequences for their autonomy and capacity to maintain employment. OBJECTIVE The aim of this study was to assess the impact on work productivity in early-stage relapsing-remitting multiple sclerosis (RRMS). METHODS A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. Absenteeism, presenteeism, and unpaid work loss due to RRMS were measured using the Valuation of Lost Productivity (VOLP) questionnaire. The EDSS, SymptoMScreen, 5-item Modified Fatigue Impact Scale, Hospital Anxiety and Depression Scale, Symbol Digit Modalities Test, and Multiple Sclerosis Work Difficulties Questionnaire were used to gather information on disability, patients' perception of symptom severity, fatigue, mood/anxiety, cognition, and problems in the workplace, respectively. Associations between the VOLP and clinical and work outcomes were analyzed using Spearman's rank correlations. RESULTS A total of 189 patients were included. Mean age (SD) was 36.1 ± 9.4 years and 71.4% were female. Mean disease duration was 1.2 ± 0.8 years. Median EDSS score was 1.0 (IQR 0, 2.0). One hundred thirty patients (68.8%) were working for pay or self-employed. Fifty-three patients (40.8%) reported absence from work in the past 3 months with an average of 14.3 absent workdays. Their health problems resulted in the loss of 3.4% of their actual work time in the past 7 days. Thirty patients got help (11.8 h) with their unpaid work activities in the past 7 days. Absenteeism was significantly correlated with anxiety and depression (rho=0.298 and 0.291, p<0.001), fatigue (rho=0.214, p = 0.014), and symptom severity (rho=0.213, p = 0.015). Presenteeism was significantly correlated with fatigue (rho=0.375, p<0.001), symptom severity (rho=0.373, p<0.001), depression (rho=0.263, p = 0.008), and disability (rho=0.215, p = 0.031). CONCLUSIONS Productivity loss even in a RRMS population with short disease duration stresses the need for more efficient treatment control of disease activity from earlier stages.
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Affiliation(s)
| | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Ana Alonso
- Department of Neurology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Maria R Blasco
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - María Del Campo-Amigo
- Department of Neurology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de Elche, Elche, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Moisés Garcés
- Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervás
- Department of Neurology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
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Yalachkov Y, Anschuetz V, Jakob J, Schaller-Paule MA, Schaefer JH, Reilaender A, Friedauer L, Behrens M, Foerch C. C-Reactive Protein Levels and Gadolinium-Enhancing Lesions Are Associated With the Degree of Depressive Symptoms in Newly Diagnosed Multiple Sclerosis. Front Neurol 2021; 12:719088. [PMID: 34764926 PMCID: PMC8575739 DOI: 10.3389/fneur.2021.719088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Inflammation is essential for the pathogenesis of multiple sclerosis (MS). While the immune system contribution to the development of neurological symptoms has been intensively studied, inflammatory biomarkers for mental symptoms such as depression are poorly understood in the context of MS. Here, we test if depression correlates with peripheral and central inflammation markers in MS patients as soon as the diagnosis is established. Methods: Forty-four patients were newly diagnosed with relapsing-remitting MS, primary progressive MS or clinically isolated syndrome. Age, gender, EDSS, C-reactive protein (CRP), albumin, white blood cells count in cerebrospinal fluid (CSF WBC), presence of gadolinium enhanced lesions (GE) on T1-weighted images and total number of typical MS lesion locations were included in linear regression models to predict Beck Depression Inventory (BDI) score and the depression dimension of the Symptoms Checklist 90-Revised (SCL90RD). Results: CRP elevation and GE predicted significantly BDI (CRP: p = 0.007; GE: p = 0.019) and SCL90RD (CRP: p = 0.004; GE: p = 0.049). The combination of both factors resulted in more pronounced depressive symptoms (p = 0.04). CSF WBC and EDSS as well as the other variables were not correlated with depressive symptoms. Conclusions: CRP elevation and GE are associated with depressive symptoms in newly diagnosed MS patients. These markers can be used to identify MS patients exhibiting a high risk for the development of depressive symptoms in early phases of the disease.
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Affiliation(s)
- Yavor Yalachkov
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Victoria Anschuetz
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jasmin Jakob
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany.,Department of Neurology, Universitätsmedizin Mainz, Mainz, Germany
| | | | | | | | - Lucie Friedauer
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marion Behrens
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
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10
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Smyth P, Watson KE, Tsuyuki RT. Measuring the effects of nurse practitioner (NP)-led care on depression and anxiety levels in people with multiple sclerosis: a study protocol for a randomized controlled trial. Trials 2021; 22:785. [PMID: 34749784 PMCID: PMC8577034 DOI: 10.1186/s13063-021-05726-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022] Open
Abstract
Background Canada has one of the highest rates of multiple sclerosis (MS) in the world. Treatments and supports for people with MS (PwMS) have become increasingly complex, requiring individualized and adaptive care. Specialized NPs provide advanced skills to those with complex medical conditions, with potential to enhance the health, functioning, and quality of life for PwMS. This study aims to determine the effect of a Nurse Practitioner (NP) on depression and anxiety levels in PwMS. Methods We will perform a parallel randomized controlled trial. PwMS who are followed by general private-practice neurologists will be randomly assigned to the intervention group (NP-led care) or the ‘usual care’ control group (general neurologist or family physician and registered nurse support). In the intervention group, the NP will assess and provide care to the MS patient and their caregiver at a baseline visit, with 3-month and 6-month follow-up visits. PwMS in the control group will receive usual care provided by their community neurologists or family physicians with the standard assistance provided by registered nurses experienced in MS care. The primary outcome will be the difference in change in the patient’s anxiety and depression scores as measured by the validated Hospital Anxiety and Depression Scale (HADS) questionnaire at 3 months. Secondary outcomes will include difference in change in HADS at 6 months; Modified Fatigue Impact Scale scores (MSIF) at 3 and 6 months; EQ-5D scores at 3 and 6 months; caregiver health-related quality of life in MS measures (CAREQOL-MS) at 3 and 6 months; number of visits and phone calls to healthcare professionals recorded by patient, and satisfaction with NP-led care vs usual care measured by the validated Consultant Satisfaction Questionnaire. Discussion Findings from this study will contribute to exploring benefits of advanced nursing practitioner interventions for PwMS followed by general neurologists and family physicians in a community setting. It will provide evidence of the benefits of NP-led care for PwMS and offer an alternative healthcare resource for management of MS. Trial registration ClinicalTrials.govPro00069595. Retrospectively registered on June 26, 2020. Protocol version: January 2017, version 1. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05726-3.
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Affiliation(s)
- Penelope Smyth
- Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada.
| | - Kaitlyn E Watson
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ross T Tsuyuki
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Pharmacology, University of Alberta, Edmonton, AB, Canada
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11
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Sauder T, Hansen S, Bauswein C, Müller R, Jaruszowic S, Keune J, Schenk T, Oschmann P, Keune PM. Mindfulness training during brief periods of hospitalization in multiple sclerosis (MS): beneficial alterations in fatigue and the mediating role of depression. BMC Neurol 2021; 21:390. [PMID: 34625058 PMCID: PMC8499486 DOI: 10.1186/s12883-021-02390-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Persons with MS (PwMS) are frequently affected by fatigue and depression. Mindfulness-based interventions may reduce these symptoms in PwMS and consequently their application has been extended to various settings. Only few efforts have been made to explore effects of short-term mindfulness training during brief periods of hospitalization. In the current study, the feasibility and potential effects of short-term mindfulness training on depression, fatigue, rumination and cognition were explored in PwMS in an acute-care hospital setting. Based on previous work, it was further examined whether the relation between trait mindfulness and fatigue prior to and following the intervention was mediated by depression and whether a mediation effect was also observable throughout the intervention. METHODS A short-term mindfulness training protocol was developed, tailored to the requirements of the acute-care setting. Subsequently, 30 PwMS were recruited sequentially and received mindfulness training during the routine clinical process (median duration in hospital: eight days, number of sessions: four). Participants completed relevant self-report measures (depression, fatigue, rumination) and a neuropsychological assessment before and after training. RESULTS Participants reported significantly increased trait mindfulness and decreased depression and fatigue following the intervention. Respective change scores were highly correlated so that increased trait mindfulness was associated with decreased symptoms. In the rumination domain, patients reported a tendency for an increased adaptive ability to engage in distractive behavior during arising negative mood. Other measures of trait rumination and cognition remained relatively stable. Results of the mediation analyses indicated that depression mediated the negative relationship between trait mindfulness and fatigue symptoms at pre and post assessments. With regards to the change scores, an association between mindfulness and cognitive fatigue ceased to be significant when depression was controlled, albeit in this case, the mediation effect did not reach significance. CONCLUSION Results of the current study indicate that short-term mindfulness training during brief periods of hospitalization may be beneficial for PwMS. They further complement previous work by identifying depression as a potential mediator of the antagonistic relationship between mindfulness and fatigue. Based on the current exploratory study, future trials are warranted to address this mechanism of mindfulness training in more detail.
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Affiliation(s)
- Torsten Sauder
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Carina Bauswein
- Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Roy Müller
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Sonja Jaruszowic
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Jana Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Thomas Schenk
- Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Patrick Oschmann
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany. .,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
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12
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Gaudioso C, Oo S, Mar S, Hendricks-Ferguson VL, Newland P, Varni JW. PedsQL Multiple Sclerosis Module Domain and Item Development: Qualitative Methods. J Child Neurol 2021; 36:901-910. [PMID: 34048290 DOI: 10.1177/08830738211015016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this qualitative methods study was to develop the domains and items to support the content validity for the Pediatric Quality of Life Inventory (PedsQL) Multiple Sclerosis Module for youth with pediatric-onset multiple sclerosis. METHODS A literature review of multiple sclerosis-specific questionnaires and clinical research was conducted to generate domains. An expert panel composed of 12 neurologists who were pediatric-onset multiple sclerosis specialists provided feedback on the conceptual framework. Focus interviews with 9 youth with pediatric-onset multiple sclerosis and 6 parents were conducted to develop the relevant domains and item content from the patient and parent perspective. In the cognitive interviews phase, 9 youth with pediatric-onset multiple sclerosis and 6 parents provided feedback on item content, relevance, importance, and understandability of the pediatric-onset multiple sclerosis-specific domains and items. The final interview phase with 5 youth with pediatric-onset multiple sclerosis and 5 parents comprised a pilot testing of the new PedsQL MS Module. RESULTS Eighteen domains were derived from the qualitative methods with item content saturation achieved at 100 items based on 40 interviews with 23 youth with pediatric-onset multiple sclerosis aged 10-21 years and 17 parents. The domains derived include general fatigue, sleep/rest fatigue, cognitive functioning, tingling sensations, numbness sensations, physical weakness, pain, speech, balance, fine motor, vision, urination, constipation, bowel incontinence, worry, communication, treatment, and medicines. CONCLUSIONS Qualitative methods involving 23 youth with pediatric-onset multiple sclerosis and 17 parents in the domain and item development process support the content validity for the new PedsQL MS Module. Future plans include a national field test of the PedsQL MS Module scales and items.
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Affiliation(s)
- Cristina Gaudioso
- Department of Neurology, Division of Pediatric Neurology, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Samuel Oo
- Department of Neurology, Division of Pediatric Neurology, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Soe Mar
- Department of Neurology, Division of Pediatric Neurology, 12275Washington University School of Medicine, St Louis, MO, USA
| | | | - Pamela Newland
- 499763Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO, USA
| | - James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, 14736Texas A&M University, College Station, TX, USA
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13
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Ferorelli P, Antonelli F, Shevchenko A, Mischiati C, Doepp M, Lenzi S, Borromeo I, Feriotto G, Beninati S. Reduction in Fatigue Symptoms Following the Administration of Nutritional Supplements in Patients with Multiple Sclerosis. Med Sci (Basel) 2021; 9:52. [PMID: 34287336 PMCID: PMC8293375 DOI: 10.3390/medsci9030052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Despite recent advances in immune-modulatory drugs, pharmacological therapies have been proven ineffective in severe presentations of multiple sclerosis (MS), including secondary progressive MS. At present, therapeutic interventions' performance is primarily focused on ameliorating symptoms to improve the patient's quality of life (QOL). Among complementary treatments, nutrition has been considered a decisive factor to control symptoms and enhance the wellness of MS patients. Although no special diets are associated with MS, the impact of diet and dietary supplements on the course of progressive forms of the disease has been studied during the last few years. Fatigue is among the most common and disabling symptoms reported by MS patients. Fatigue has been defined in the Multiple Sclerosis Council for Clinical Practice Guidelines (MSCCPG, 1998) as a "subjective lack of physical and/or mental energy that the individual perceives as an interference with habitual and desired activities". This study aimed to compare the psychometric functioning of the "Fatigue Severity Scale" (FSS) and the "Modified Fatigue Impact Scale" (MFIS) in our sample of people with MS. Specifically, during chronic treatment, the change in these two parameters with two vitamin-rich dietary supplements (Citozym® and Ergozym®) was evaluated. The impact of these nutritional supplements revealed differences in antioxidant and anti-inflammatory parameters among the volunteers in the treatment group, with a subsequent improvement in fatigue. In conclusion, the results obtained have confirmed the effectiveness of complementary nutritional therapies, evaluated essentially based on hematological biomarkers, through which it is possible to act on disability to improve the QOL of MS patients.
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Affiliation(s)
| | | | - Anna Shevchenko
- Department of Pharmacology, Kabardine University, 101000 Nalchik, Russia;
| | - Carlo Mischiati
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44100 Ferrara, Italy;
| | - Manfred Doepp
- Department of Psychology and Sports Science, Giessen Justus, Liebig University Gießen, 35398 Gießen, Germany;
| | - Stefano Lenzi
- Department of Health Engineering, Université Européenne de Bruxelles Jean Monnet, Schaerbeek, 1030 Brussels, Belgium;
| | - Ilaria Borromeo
- Department of Physics, University of Tor Vergata, 00100 Rome, Italy;
| | - Giordana Feriotto
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, 44100 Ferrara, Italy;
| | - Simone Beninati
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00100 Rome, Italy
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14
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Crouch TA, Reas HE, Quach CM, Erickson TM. Does depression in multiple sclerosis mediate effects of cognitive functioning on quality of life? Qual Life Res 2021; 31:497-506. [PMID: 34228241 DOI: 10.1007/s11136-021-02927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Patients with multiple sclerosis (MS) are at significant risk for decreased quality of life (QoL), in part due to factors such as cognitive impairment and depression. However, objective versus subjective assessments of cognitive functioning may differentially predict QoL, and it remains unknown whether they each impact QoL through levels of depression. The aims of the present study included (1) testing the effects of cognitive impairment on MS-related QoL via depression symptoms and (2) examining whether perceived and objective cognitive functioning differentially predict QoL through depression. METHODS Patients formally diagnosed with MS (N = 128) participated in cognitive assessment (Brief International Cognitive Assessment for Multiple Sclerosis) and completed self-report measures of perceived cognitive functioning (perceived deficits questionnaire), depression (Hospital Anxiety and Depression Scale), and MS-related QoL (functional assessment of multiple sclerosis). RESULTS Mediational hypotheses were tested by regression and structural equation modeling. As hypothesized, both perceived and objective cognitive functioning independently predicted lower QoL controlling for the effects of depression (p < 0.001). Consistent with hypotheses, depression mediated effects of both perceived (95% CI [0.31, 0.68]) and objective cognitive functioning (95% CI [0.09, 6.96]) on QoL when tested in separate models. However, when both predictors were modeled simultaneously, depression only mediated the effects of perceived (not objective) cognitive functioning (95% CI for standardized effect [0.10, 0.61]). CONCLUSIONS This study, thus, suggests the need to conceptualize different pathways by which objective and subjective cognitive impairment may shape QoL in the lives of individuals with MS.
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Affiliation(s)
- Tara A Crouch
- Sleep Medicine, Puget Sound VA Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
| | - Hannah E Reas
- Sleep Medicine, Puget Sound VA Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Christina M Quach
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA, 98119, USA
| | - Thane M Erickson
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA, 98119, USA.
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15
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The Effect of Depression on Health-Related Quality of Life Is Mediated by Fatigue in Persons with Multiple Sclerosis. Brain Sci 2021; 11:brainsci11060751. [PMID: 34198920 PMCID: PMC8227168 DOI: 10.3390/brainsci11060751] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
The interrelations between fatigue, depression and health-related quality of life (HRQoL) in persons with multiple sclerosis (PwMS) are complex, and the directionality of the effects is unclear. To address this gap, the current study used a longitudinal design to assess direct and indirect effects of fatigue and depression on HRQoL in a one-year follow-up survey. A sample of 210 PwMS from the nationwide Swiss MS Registry was used. HRQoL was assessed using the European Quality of Life 5-Dimension 5-Level questionnaire. Path analysis on HRQoL, with fatigue and depression as predictors, was applied. Fatigue was measured by the Modified Fatigue Impact Scale (MFIS), including physical, cognitive and psychosocial subscales, and non-somatic depressive symptomatology was examined with the Beck Depression Inventory-Fast Screen (BDI-FS). Fatigue acted as a fully mediating variable (B = -0.718, SE = 0.253) between non-somatic depressive symptomatology and HRQoL. This indirect effect became apparent in the physical (B = -0.624, SE = 0.250), psychosocial (B = -0.538, SE = 0.256) and cognitive subscales (B = -0.485, SE = 0.192) of fatigue. In contrast, non-somatic depressive symptomatology did not act as a mediator. Our findings provide novel and clinically relevant longitudinal evidence showing that the debilitating effect of non-somatic aspects of depression on HRQoL was fully mediated and therefore explainable via fatigue.
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16
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Krysko KM, Bischof A, Nourbakhsh B, Henry RG, Revirajan N, Manguinao M, Nguyen K, Akula A, Li Y, Waubant E. A pilot study of oxidative pathways in MS fatigue: randomized trial of N-acetyl cysteine. Ann Clin Transl Neurol 2021; 8:811-824. [PMID: 33675156 PMCID: PMC8045913 DOI: 10.1002/acn3.51325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/17/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To assess feasibility, tolerability, and safety of N‐acetyl cysteine (NAC) for fatigue in progressive MS. Secondary objectives evaluated changes in fatigue and oxidative pathway biomarkers on NAC versus placebo. Methods Individuals with progressive MS with Modified Fatigue Impact Scale (MFIS) > t38 were randomized 2:1 to NAC 1250mg TID or placebo for 4 weeks. The primary outcome was tolerability and safety. The secondary outcome to evaluate efficacy was MFIS change from baseline to week 4 between groups. Exploratory biomarker outcomes included change in blood GSH/GSSG ratio (reduced‐to‐oxidized glutathione (GSH)) and in vivo relative GSH using 7T MR spectroscopy (MRS) between groups. Fisher exact test was used for categorical and rank sum for continuous outcomes. Results Fifiteen were randomized (10 NAC, 5 placebo; mean age 56.1 years, 80% female, median EDSS 6.0). At least one adverse event (AE) occurred in 60% on NAC versus 80% on placebo (p = 0.75). There were two AEs attributed to NAC in one patient (abdominal pain and constipation), with 94% adherence to NAC. MFIS decreased in both groups at week 4, with the mean improvement of 11‐points on NAC versus 18‐points on placebo (p = 0.33). GSH/GSSG ratio decreased on placebo (−0.6) and NAC (−0.1) (p = 0.18). Change in GSH levels to total creatine in anterior and posterior cingulate cortex, insula, caudate, putamen, and thalamus did not differ between groups. Interpretation NAC was well‐tolerated in progressive MS, although reduction in fatigue on NAC was similar to placebo. Antioxidant blood and MRS biomarkers were not significantly altered by NAC, which could be due to dose, route of administration, time of sample collection, short half‐life, or lack of effect. Registered clinicaltrials.gov NCT02804594.
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Affiliation(s)
- Kristen M Krysko
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA.,Division of Neurology, Department of Medicine, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Antje Bischof
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roland G Henry
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Nisha Revirajan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Michael Manguinao
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Khang Nguyen
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Amit Akula
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Yan Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Emmanuelle Waubant
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
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17
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Doskas T, Vavougios GD, Karampetsou P, Kormas C, Synadinakis E, Stavrogianni K, Sionidou P, Serdari A, Vorvolakos T, Iliopoulos I, Vadikolias Κ. Neurocognitive impairment and social cognition in multiple sclerosis. Int J Neurosci 2021; 132:1229-1244. [PMID: 33527857 DOI: 10.1080/00207454.2021.1879066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE/AIM OF THE STUDY The impairment of neurocognitive functions occurs in all subtypes of multiple sclerosis, even from the earliest stages of the disease. Commonly reported manifestations of cognitive impairment include deficits in attention, conceptual reasoning, processing efficiency, information processing speed, memory (episodic and working), verbal fluency (language), and executive functions. Multiple sclerosis patients also suffer from social cognition impairment, which affects their social functioning. The objective of the current paper is to assess the effect of neurocognitive impairment and its potential correlation with social cognition performance and impairment in multiple sclerosis patients. MATERIALS AND METHODS An overview of the available-to-date literature on neurocognitive impairment and social cognition performance in multiple sclerosis patients by disease subtype was performed. RESULTS It is not clear if social cognition impairment occurs independently or secondarily to neurocognitive impairment. There are associations of variable strengths between neurocognitive and social cognition deficits and their neural basis is increasingly investigated. CONCLUSIONS The prompt detection of neurocognitive predictors of social cognition impairment that may be applicable to all multiple sclerosis subtypes and intervention are crucial to prevent further neural and social cognition decline in multiple sclerosis patients.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece.,Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | | | | | | | | | - Aspasia Serdari
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Iliopoulos
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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18
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David Ruban S, Christina Hilt C, Petersen T. Quality of life in multiple sclerosis: The differential impact of motor and cognitive fatigue. Mult Scler J Exp Transl Clin 2021; 7:2055217321996040. [PMID: 33708414 PMCID: PMC7907948 DOI: 10.1177/2055217321996040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/07/2021] [Accepted: 01/30/2021] [Indexed: 01/22/2023] Open
Abstract
Background Multiple sclerosis is a chronic disease leading to reduced quality of
life. Objectives To investigate whether motor and cognitive fatigue impact differently on
aspects of quality of life among patients with multiple sclerosis,
independently from bodily disability. Methods 79 patients with multiple sclerosis from Aalborg University Hospital, Denmark
were included in an observational, cross-sectional study. Each subject
completed two separate questionnaires regarding fatigue (Fatigue Scale for
Motor and Cognitive Functions and Modified Fatigue Impact Scale) and one
regarding quality of life (Short Form 36). Disability was measured with the
Expanded Disability Status Scale (EDSS)-scores obtained from patient
records. Results All fatigue scores were significantly correlated to all areas of quality of
life (p < 0,05). This remained significant after adjustment for age,
disease duration and EDSS-score. When looking at each type of fatigue
separately, cognitive fatigue correlated mainly with mental health aspects
of quality of life and motor fatigue with physical health areas of quality
of life. Conclusion Increased motor and cognitive fatigue lead to a differential reduction in
physical and mental quality of life, independently of bodily disability.
This underlines the importance of proper assessment and treatment of fatigue
among patients with multiple sclerosis.
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Affiliation(s)
- Sabina David Ruban
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.,Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Thor Petersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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19
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Chen XQ, Jiang XM, Zheng QX, Zheng J, He HG, Pan YQ, Liu GH. Factors associated with workplace fatigue among midwives in southern China: A multi-centre cross-sectional study. J Nurs Manag 2021; 28:881-891. [PMID: 32249450 DOI: 10.1111/jonm.13015] [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: 12/12/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 12/29/2022]
Abstract
AIMS To identify the level of workplace fatigue among midwives and factors influencing their fatigue. BACKGROUND Midwives who play an important role in medical care are prone to experience workplace fatigue, which negatively affects their well-being and work quality. METHODS A multi-centre cross-sectional study was conducted among 666 Chinese midwives from 38 hospitals in March 2019. Data were collected by four questionnaires of self-designed demographic questions, the Pittsburgh Sleep Quality Index, the Social Support Self-Rating Scale and the 14-item Fatigue Scale. Descriptive statistics, univariate analysis and multiple linear regression were used to analyse the data. RESULTS Midwives had moderate levels of fatigue with the mean scores of physical fatigue, mental fatigue and total fatigue being 9.53, 6.25 and 15.79, respectively. Multiple linear regression results showed that sleep quality, social support, job satisfaction, occupational injuries, adverse life events, frequency of irregular meals and employment type were statistically significant factors influencing fatigue among the participants. CONCLUSIONS Physical and mental fatigue were generally common among midwives and were affected by personal-related and work-related factors, sleep quality and social support. IMPLICATIONS FOR NURSING MANAGEMENT Nurse administrators have the opportunity to advocate for improved health policy under the two children rule to prevent workplace fatigue amongst midwives.
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Affiliation(s)
- Xiao-Qian Chen
- The School of Nursing, Fujian Medical University, Minhou County, Fuzhou City, Fujian Province, China
| | - Xiu-Min Jiang
- Fujian Maternal and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Qing-Xiang Zheng
- Fujian Maternal and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Jing Zheng
- The School of Nursing, Fujian Medical University, Minhou County, Fuzhou City, Fujian Province, China
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Yu-Qing Pan
- The School of Nursing, Fujian Medical University, Minhou County, Fuzhou City, Fujian Province, China
| | - Gui-Hua Liu
- Fujian Maternal and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China
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Gromisch ES, Dhari Z. Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis. Neuropsychiatr Dis Treat 2021; 17:323-337. [PMID: 33574669 PMCID: PMC7872925 DOI: 10.2147/ndt.s256689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is a debilitating disease of the central nervous system that is most commonly seen in early to middle adulthood, although it can be diagnosed during childhood or later in life. While cognitive impairment can become more prevalent and severe as the disease progresses, signs of cognitive involvement can be apparent in the early stages of the disease. In this review, we discuss the prevalence and types of cognitive impairment seen in early MS, including the specific measures used to identify them, as well as the challenges in characterizing their frequency and progression. In addition to examining the progression of early cognitive involvement over time, we explore the clinical factors associated with early cognitive involvement, including demographics, level of physical disability, disease modifying therapy use, vocational status, and psychological and physical symptoms. Given the prevalence and functional impact these impairments can have for persons with MS, considerations for clinicians are provided, such as the role of early cognitive screenings and the importance of comprehensive neuropsychological assessments.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Zaenab Dhari
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
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21
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Self-reported use of vitamin D supplements is associated with higher physical quality of life scores in multiple sclerosis. Mult Scler Relat Disord 2021; 49:102760. [PMID: 33545666 DOI: 10.1016/j.msard.2021.102760] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/25/2020] [Accepted: 01/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sun exposure and vitamin D, including intake and serum levels, have been associated with reduced risk of MS onset and less progression and may affect quality of life (QoL). We investigated the prospective relationship of these factors with QoL from baseline to 2.5 years' follow-up, in an international cohort of people with MS. METHODS Data derive from the HOLISM international cohort. Sun exposure and vitamin D supplement use were queried at both timepoints. QoL was assessed by MSQOL-54, estimating physical and mental health QoL composite scores. Characteristics of QoL were assessed by linear regression, adjusted for age, sex, socioeconomic status, treated comorbidity number, MS type, disability, clinically significant fatigue, prescription antidepressant medication use, and ongoing relapse symptoms, and baseline QoL score, as appropriate, estimating adjusted coefficients (aβ). RESULTS At 2.5-year review, QoL scores were higher among those reporting taking vitamin D supplements (physical: aβ=3.58, 95%CI=1.35-5.80; mental: aβ=3.08, 95%CI=0.72-5.44), particularly average daily dose over 5,000IU/d. Baseline-reported vitamin D supplementation was associated with greater increase in physical (aβ=1.02, 95%CI=0.22-1.81), but not mental QoL (aβ=0.11, 95%CI=-1.00-1.23). Sun exposure was cross-sectionally associated with higher QoL scores at follow-up but was not associated with change in QoL. CONCLUSIONS Self-reported vitamin D supplement use was cross-sectionally associated with higher physical and mental QoL, but prospectively only with increased physical QoL.
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22
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Sehanovic A, Kunic S, Ibrahimagic OC, Smajlovic D, Tupkovic E, Mehicevic A, Zoletic E. Contributing Factors to the Quality of Life in Multiple Sclerosis. Med Arch 2021; 74:368-373. [PMID: 33424092 PMCID: PMC7780794 DOI: 10.5455/medarh.2020.74.368-373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). Quality of life (QoL) refers to the perception of an individual’s life in the context of the system of culture and values in which they live. Aim: The aim of the study was to determine the distribution of cognitive disorders in people with MS. Methods: The prospective study included 135 participants with MS and 50 healthy participants. Participants were divided into three groups: the first group consisted of 85 participants where the disease lasted longer than one year, the second group consisted of 50 participants with newly diagnosed MS, the third group consisted of 50 healthy participants. The instruments of clinical assessment were: Extended Disability Score in Multiple Sclerosis Patients, Mini Mental Status, Beck Depression Scale, and Quality of Life Scale (SF-36, Contemporary Health Survey). Results: The quality of life related to health is impaired in the physical, mental dimension and overall quality of life. In the first group of participants, 62% had mild depression, and in the second group 38% of participants, while more severe forms were recorded in 16% of participants in both groups. As depression increases, the quality of life decreases in all measured dimensions, which would mean that depression negatively affects the quality of life. The results of all dimensions as well as the overall quality of life score are worse with the increase in the degree of clinical disability, for both groups of study patients. Conclusion: Quality of life is impaired in MS patients, and a higher degree of clinical disability and an increase in depressive disorder are predictors of deteriorating quality of life in MS patients.
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Affiliation(s)
- Aida Sehanovic
- Clinic of Neurology, University Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.,Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Suljo Kunic
- Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.,Center for Neurology, Health Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Omer C Ibrahimagic
- Clinic of Neurology, University Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.,Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Dzevdet Smajlovic
- Clinic of Neurology, University Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.,Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Emir Tupkovic
- Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.,Center for Neurology, Health Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Admir Mehicevic
- Clinic of Neurology, Medical Center of University in Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emina Zoletic
- Netherland Institute for Health Science, Erasmus Medical Center in Rotterdan, Rotterdam, Netrherlands
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23
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Gil-González I, Martín-Rodríguez A, Conrad R, Pérez-San-Gregorio MÁ. Quality of life in adults with multiple sclerosis: a systematic review. BMJ Open 2020; 10:e041249. [PMID: 33257490 PMCID: PMC7705559 DOI: 10.1136/bmjopen-2020-041249] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE In recent years, quality of life (QoL) in multiple sclerosis (MS) has been gaining considerable importance in clinical research and practice. Against this backdrop, this systematic review aimed to provide a broad overview of clinical, sociodemographic and psychosocial risk and protective factors for QoL in adults with MS and analyse psychological interventions for improving QoL. METHOD The literature search was conducted in the Scopus, Web of Science and ProQuest electronic databases. Document type was limited to articles written in English, published from January 1, 2014, to January 31, 2019. Information from the selected articles was extracted using a coding sheet and then qualitatively synthesised. RESULTS The search identified 4886 records. After duplicate removal and screening, 106 articles met the inclusion and exclusion criteria for qualitative synthesis and were assessed for study quality. Disability, fatigue, depression, cognitive impairment and unemployment were consistently identified as QoL risk factors, whereas higher self-esteem, self-efficacy, resilience and social support proved to be protective. The review analysed a wide spectrum of approaches for QoL psychological intervention, such as mindfulness, cognitive behavioural therapy, self-help groups and self-management. The majority of interventions were successful in improving various aspects of QoL. CONCLUSION Adequate biopsychosocial assessment is of vital importance to treat risk and promote protective factors to improve QoL in patients with MS in general care practice.
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Affiliation(s)
- Irene Gil-González
- Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | | | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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de Sèze J, Devy R, Planque E, Delabrousse-Mayoux JP, Vandhuick O, Kabir M, Gherib A. Fatigue in teriflunomide-treated patients with relapsing remitting multiple sclerosis in the real-world Teri-FAST study. Mult Scler Relat Disord 2020; 47:102659. [PMID: 33291032 DOI: 10.1016/j.msard.2020.102659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/04/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fatigue is a frequent and disabling symptom of multiple sclerosis (MS) often associated with impaired quality of life (QoL) in patients. Teriflunomide is a once-daily oral immunomodulator used for the treatment of relapsing remitting forms of MS. However, its effect on fatigue is not well known in real life practice. We evaluated the impact of teriflunomide on fatigue in patients with relapsing remitting MS (RRMS) after 2 years of treatment in the real-world Teri-FAST study. METHODS Teri-FAST was a 2-year, prospective, observational study conducted in France in RRMS patients treated with teriflunomide 14 mg. Fatigue was assessed using the French version of the modified fatigue impact scale (EMIF-SEP). The primary endpoint was the change from baseline in EMIF-SEP score after 2 years of treatment. Secondary endpoints included evaluation of depression (Beck Depression Inventory [BDI]), health-related QoL (Two-Life Scale TLS-QoL 10), self-reported physical activity, and adverse events. RESULTS 210 eligible patients were included in the study with a mean age of 45.4 years and a mean ± SD Expanded Disability Status Scale score of 1.76 ± 1.43 at baseline. About half (52.4%) of patients had no previous treatment for MS. In the 163 patients who completed at least 1 follow-up visit, the mean change in EMIF-SEP score at Year 2 was -1.54 (95% CI: -4.02, 0.94) indicating that fatigue remained stable. Similarly, there were no changes in depression level and QoL after 2 years of treatment. Physical activity slightly improved with 57% of patients reporting being physically active after 2 years as compared to 46% at baseline. The safety profile of teriflunomide was consistent with that seen during clinical development, and compliance with treatment was high. CONCLUSION Fatigue scores remained stable in RRMS patients treated with teriflunomide 14 mg over 2 years in real-life setting. Teriflunomide did not negatively impact depression or QoL.
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Affiliation(s)
- Jérôme de Sèze
- Strasbourg University, Hôpital Civil, Strasbourg, France.
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25
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E.U. paediatric MOG consortium consensus: Part 4 - Outcome of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders. Eur J Paediatr Neurol 2020; 29:32-40. [PMID: 33183945 DOI: 10.1016/j.ejpn.2020.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
Abstract
There is increasing knowledge on the role of antibodies against myelin oligodendrocyte glycoprotein (MOG-abs) in acquired demyelinating syndromes and autoimmune encephalitis in children. Better understanding and prediction of outcome is essential to guide treatment protocol decisions. Therefore, this part of the Paediatric European Collaborative Consensus provides an oversight of existing knowledge of clinical outcome assessment in paediatric MOG-ab-associated disorders (MOGAD). The large heterogeneity in disease phenotype, disease course, treatment and follow-up protocols is a major obstacle for reliable prediction of outcome. However, the clinical phenotype of MOGAD appears to be the main determinant of outcome. Patients with a transverse myelitis phenotype in particular are at high risk of accruing neurological disability (motor and autonomic), which is frequently severe. In contrast, having a single episode of optic neuritis any time during disease course is broadly associated with a lower risk of persistent disability. Furthermore, MOG-ab-associated optic neuritis often results in good functional visual recovery, although retinal axonal loss may be severe. The field of cognitive and behavioural outcome and epilepsy following demyelinating episodes has not been extensively explored, but in recent studies acute disseminated encephalomyelitis (-like) phenotype in the young children was associated with cognitive problems and epilepsy in long-term follow-up. In conclusion, main domains of importance in determining clinical outcome in paediatric MOGAD are visual, motor, autonomic and cognitive function. A standardised evaluation of these outcome domains in all children is of importance to allow adequate rehabilitation and follow-up.
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26
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Veldhuijzen van Zanten J, Douglas MR, Ntoumanis N. Fatigue and fluctuations in physical and psychological wellbeing in people with multiple sclerosis: A longitudinal study. Mult Scler Relat Disord 2020; 47:102602. [PMID: 33176231 DOI: 10.1016/j.msard.2020.102602] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/22/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fatigue is a highly prevalent and disabling symptom of multiple sclerosis (MS). The aetiology remains unclear, potentially resulting from neuroinflammatory or neurodegenerative processes, mood disturbance, MS symptoms including pain, poor sleep, physical decompensation or medication side effects. Cross-sectional associations have been reported between fatigue and markers of physical and psychological health in people with MS. The current study examined if fluctuations in markers of physical and psychological wellbeing were associated with between-person differences in fatigue in MS. METHODS Longitudinal data of up to 7 years was available of 3369 people with MS who were enrolled in the UK MS Register. Participants completed MS impact scale ratings and MS walking scales up to 4 times per year for up to 7 years. Fatigue was assessed at one time point using the Fatigue Severity Scale. Multilevel analyses were conducted to examine the degree of variance in the outcome measures accounted for by fatigue. RESULTS Fatigue was associated with fluctuations in depression, MS impact, and walking ability, and to a lesser extent with fluctuations in anxiety and perceived health status. Interference of fatigue in participation in social activities and work-related responsibilities and the physical effects of fatigue were most strongly related to MS-related outcomes. CONCLUSION Given the strong associations between fatigue and many MS outcomes, fatigue management interventions are likely to impact on different aspects of physical and psychological wellbeing in MS.
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Affiliation(s)
- Jet Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK; Department of Neurology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Birmingham, UK.
| | - Michael R Douglas
- Department of Neurology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Birmingham, UK; College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Nikos Ntoumanis
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, Western Australia, Australia
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27
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Pashazadeh Kan F, Hoseinipalangi Z, Ahmadi N, Hosseinifard H, Dehnad A, Sadat Hoseini B, Tohidi Asl M, Ghashghaee A. Global, regional and national quality of life in patients with multiple sclerosis: a global systematic review and meta-analysis. BMJ Support Palliat Care 2020; 12:158-166. [DOI: 10.1136/bmjspcare-2020-002604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 12/26/2022]
Abstract
Background and aimThe purpose of this study was to evaluate the health-related quality of life (HRQOL) of patients with multiple sclerosis (MS) globally to provide precise information for policy makers to take necessary steps to improve the quality of life of these patients. This systematic review and meta-analysis is the first global study in the last decade.Materials and methodsData from January 2000 to April 2020 were collected from Scopus, PubMed, Embase, Web of Science and Google Scholar databases on the basis of inclusion and exclusion criteria. Data obtained were analysed by R software, and 54 articles were finally included in the study.ResultsFrom the 2126 articles collected, a total of 54 articles were included in the study. Based on the results of random-effects analysis (DerSimonian and Laird), the mental HRQOL score was 55.18 (95% CI 52.71 to 57.65) and the physical HRQOL score was 48.72 (95% CI 45.93 to 51.52). In this study, age and duration of disease had a significant and direct relationship with mental HRQOL (p≤0.01). Moreover, mental HRQOL was higher in Europe than in other continents, while physical HRQOL was higher in Asia than in other continents. HRQOL was also evaluated on the basis of three valid questionnaires: Short Form 36, Multiple Sclerosis Quality of Life-54 and Multiple Sclerosis International Quality of Life.ConclusionAccording to the results of this study, the total score for HRQOL indicates moderate quality of life. Factors such as depression, age and duration of disease have the greatest impact on HRQOL, whereas factors such as fatigue and the Expanded Disability Status Scale score have less effects on HRQOL, so that patients with MS continue their daily activities as long as they are physically able to, and this happens despite disease progression.
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28
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Impact of sense of coherence on quality of life in patients with multiple sclerosis. Wien Klin Wochenschr 2020; 133:173-181. [PMID: 32617708 DOI: 10.1007/s00508-020-01704-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
Abstract
AIM Aiming at finding an effective way of empowering patients with multiple sclerosis (MS) to cope with their disease, the objective of the study was to explore the impact of sense of coherence (SOC) on their health-related quality of life (HRQoL). METHODS A total of 134/150 eligible MS patients followed-up at the Department of Neurology of the University Medical Centre Maribor, Slovenia, completed a multiple sclerosis quality of life 54 questionnaire (MSQoL-54) for assessment of HRQoL, and SOC-13-item questionnaire for assessment of SOC in 2013. Multiple linear regression was used to analyze the association between the SOC score and mental and physical subscores of MSQoL-54 adjusted to disease-related and sociodemographic characteristics as potential confounders. RESULTS In a univariate analysis SOC score proved to be the strongest predictor of mental subscore of MSQoL-54 (b = 0.834; p < 0.001) explaining 35.6% of its variance. When adjusted for confounders, it retained its position as the most important predictor (b = 0.758; p < 0.001). On the other hand, SOC score was a slightly less important predictor of physical subscore of MSQoL-54, being the fourth strongest factor (b = 0.582; p < 0.001) in univariate analysis explaining 19.1% of the variance; however, when adjusted for confounders, its importance slightly increased by becoming the third most important predictor (b = 0.508; p < 0.001). CONCLUSION Based on the results of the present study, we can propose SOC as an important and suitable intervention targeted outcome to consider in managing both aspects of MS difficulties.
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29
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Phosphorus magnetic resonance spectroscopy and fatigue in multiple sclerosis. J Neural Transm (Vienna) 2020; 127:1177-1183. [DOI: 10.1007/s00702-020-02221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/17/2020] [Indexed: 02/03/2023]
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30
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Sander L, Kugler J, Elsner B. [The influence of multiple sclerosis-related symptoms on health-related quality of life]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:704-712. [PMID: 32356284 DOI: 10.1055/a-1113-7702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease that is associated with a variety of MS-specific symptoms. Many of these symptoms have a negative impact on health-related quality of life (HRQoL). Until now it is unclear which MS-specific symptoms have the highest impact on the HRQoL. METHODOLOGY The study is based on the data of a member survey of the German MS Society (DMSG) in 2015 (n = 424). Considering socio-demographic variables and general medical variables, the influence of MS-specific symptoms on HRQoL was examined. The HRQoL was collected using the Multiple Sclerosis Quality of Life-54 (MSQOL-54) instrument. In a pretest, all influencing variables were tested for a significant mean difference (p = 0.05), or a mean correlation (Pearson's r ≥ 0.3). Subsequently, the influence of the variables identified in the pretest on the HRQoL was investigated by multiple linear regression analysis. RESULTS We calculated a mean physical health composite score (PHCS) of 48.3 (sd = 17.7) and a mean mental health composite score (MHCS) of 56.0 (sd = 20.1). The most fundamental factors influencing HRQoL were the MS-specific symptoms of depression, pain and cognitive impairment. MS-related symptoms with a mobility context showed declining PHCS. Speech disorder and dizziness were associated with a decreasing MHCS. Employment status was the only socio-economic factor that significantly affected HRQoL in multiple regression. The general medical factors showed no significant influence on HRQoL. CONCLUSION MS-specific symptoms have a major impact on the HRQoL of people with MS. Our study show that especially the so-called 'hidden symptoms' such as the symptoms of depression, pain and cognitive impairment have a significant influence on the HRQoL. Greater attention should be paid to these in the care of people with MS.
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Affiliation(s)
- Lydia Sander
- Medizinische Fakultät Carl Gustav Carus, Institut für Arbeits- und Sozialmedizin, Technische Universität Dresden
| | - Joachim Kugler
- Lehrstuhl für Gesundheitswissenschaften/Public Health, Technische Universitat Dresden
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Geng Y, Gu J, Zhu X, Yang M, Shi D, Shang J, Zhao F. Negative emotions and quality of life among adolescents: A moderated mediation model. Int J Clin Health Psychol 2020; 20:118-125. [PMID: 32550851 PMCID: PMC7296238 DOI: 10.1016/j.ijchp.2020.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background/Objective Depression, anxiety and stress are known as negative emotions. Previous studies have shown that negative emotions were associated with quality of life. There are a lot of researches on quality of life. However, previous studies mainly focused on health-related quality of life among patients. This study aims to examine the relationship between negative emotions and quality of life as well as the underlying psychological mechanism among community-based samples. Method We surveyed 6,401 adolescents (age: 9-15 years old). Participants were assessed using the Depression Anxiety Stress Scale, Resilience Scale for Chinese Adolescent, Perceived Social Support Scale and the Pediatric Quality of Life Inventory 4.0 Generic Scale for Negative Emotions, Resilience, Social Support and Quality of Life. Results Results revealed that negative emotions were negatively associated with quality of life, and resilience mediated the relationship between negative emotions and quality of life. Social support moderated all the paths among negative emotions, resilience and quality of life. Conclusions Adolescents’ quality of life was indirectly affected by negative emotions via resilience, and less affected by negative emotions and more affected by resilience with the improvement of social support. The theoretical and practical implications of these results are discussed.
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Affiliation(s)
- Yaoguo Geng
- School of Education, Zhengzhou University, China
| | - Jingjing Gu
- School of Education, Zhengzhou University, China
| | - Xueli Zhu
- School of Education, Zhengzhou University, China
| | - Minqi Yang
- School of Education, Zhengzhou University, China.,School of Marxism, Zhengzhou University, China
| | - Dan Shi
- School of Education, Zhengzhou University, China
| | - Jing Shang
- School of Marxism, Zhengzhou University, China
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An analysis of the relationship of character strengths and quality of life in persons with multiple sclerosis. Qual Life Res 2020; 29:1259-1270. [PMID: 31900759 DOI: 10.1007/s11136-019-02397-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine the relationship of character strengths and quality of life (QOL) in persons with multiple sclerosis (MS). Specifically, this study examined the relationship of the 24 character strengths in Peterson and Seligman's model with QOL and three negative effects of MS (disability, fatigue, and depression). It also investigated whether the three negative effects of MS mediate the relationship of each of the character strengths and QOL. METHODS Six hundred and twenty-four individuals with MS completed an online survey measuring character strengths, QOL, as measured by the Leeds Multiple Sclerosis Quality of Life Scale, disability, fatigue, and depression. SPSS was used to complete the correlational analysis, and Hayes' PROCESS macro for SPSS was used to conduct the mediation analyses. RESULTS The strengths endorsed most frequently by the participants were honesty, kindness, and fairness. The least-endorsed strengths were self-regulation, zest, and spirituality. The strengths with the strongest association with QOL were zest, hope, and gratitude. Disability was not found to mediate any of the relationships between character strengths and QOL. Many of the character strengths were associated with QOL both directly and indirectly through fatigue and depression. CONCLUSIONS Many of the character strengths in the Peterson and Seligman model enhance QOL in persons with MS, both directly and through their influence on negative effects of MS. The results provide support for the development of character strengths interventions to impact QOL, both directly and indirectly through improvements to MS-related symptoms such as fatigue and depression.
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Schriefer D, Haase R, Kullmann JS, Ziemssen T. Health-Related Quality of Life and the Relationship to Treatment Satisfaction in Patients with Multiple Sclerosis: Insights from a Large Observational Study. Patient Prefer Adherence 2020; 14:869-880. [PMID: 32546981 PMCID: PMC7250312 DOI: 10.2147/ppa.s248272] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/05/2020] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION In patients with multiple sclerosis (MS), fatigue, depression, and physical disability are important determinants that negatively affect health-related quality of life (HRQoL). In studies about MS, HRQoL and treatment satisfaction are emerging endpoints representing the patients' perspective. However, the association of HRQoL and MS treatment satisfaction has not been evaluated so far. PURPOSE Our objective was to evaluate the relationship of different dimensions of HRQoL and treatment satisfaction (effectiveness, side effects, convenience), and to assess which factors of treatment satisfaction, besides disease-related and sociodemographic explanatory factors, can best describe HRQoL. PATIENTS AND METHODS We analyzed data from a cross-sectional, observational multicenter study in Germany (THEPA-MS, N=2990 eligible patients for first-line treatment). The instruments used were the SF-36 for HRQoL and the TSQM for treatment satisfaction. Correlation analyses, classification and regression trees and multivariate linear regression with the least absolute shrinkage and selection operator (LASSO) for global variable selection were used to analyze explanatory factors of HRQoL. RESULTS The SF-36 physical summary score was 45.49 ±12.03 and mental component summary score 42.87 ±12.12, with currently untreated patients (N=250) reporting lower HRQoL than patients under first-line treatment (N=2740) (p<0.001). Physical disability (standardized beta (b)=0.408) was the strongest cross-sectional predictor for physical health, followed by employment status (b=0.163), age (b=0.159) and treatment satisfaction in terms of side effects (b=0.146) and effectiveness (b=0.137). For the mental summary health dimension, presence of a major depressive episode (b=0.234) had the greatest impact, followed by satisfaction with side effects (b=0.152) and effectiveness (b=0.131). CONCLUSION Satisfaction with the effectiveness and side effects of treatment was part of the main independent explanatory variables for mental and physical HRQoL in patients with MS. To improve HRQoL, patients' needs and satisfaction measures may be integral part of disease management beyond treatment of physical disability, depression or fatigue.
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Affiliation(s)
- Dirk Schriefer
- University Clinic Carl Gustav Carus Dresden, Center of Clinical Neuroscience, Dresden, Germany
| | - Rocco Haase
- University Clinic Carl Gustav Carus Dresden, Center of Clinical Neuroscience, Dresden, Germany
| | | | - Tjalf Ziemssen
- University Clinic Carl Gustav Carus Dresden, Center of Clinical Neuroscience, Dresden, Germany
- Correspondence: Tjalf Ziemssen Tel +49-351-458-4465Fax +49-351-458-5717 Email
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Biernacki T, Sandi D, Kincses ZT, Füvesi J, Rózsa C, Mátyás K, Vécsei L, Bencsik K. Contributing factors to health-related quality of life in multiple sclerosis. Brain Behav 2019; 9:e01466. [PMID: 31709732 PMCID: PMC6908891 DOI: 10.1002/brb3.1466] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/09/2019] [Accepted: 10/05/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is lower in people with multiple sclerosis (PwMS) compared to the healthy population, psychological symptoms accompanying multiple sclerosis (MS) have a serious impact on the HRQoL of PwMS. Data regarding the subject, however, remain conflicting. OBJECTIVES To evaluate the patients' sociodemographic attributes, education, fatigue, depression, and cognitive impairment level of impact on the HRQoL for the whole cohort as well as comparing the sexes. MATERIALS AND METHODS Three hundred and twenty-two relapse-remitting MS patients filled out the Fatigue Impact Scale (FIS), Beck Depression Inventory (BDI), MS Quality of Life-54 (MSQoL-54) questionnaires, cognitive impairment were identified using Brief International Cognitive Assessment for MS (BICAMS) test. The patients' data were acquired from our clinic's MS registry or from patients' files. RESULTS Depression and fatigue were found to have the most ubiquitous and robust effect on the overall and any given subdivision of the HRQoL composite. Other factors had a slight effect on some of the subscales when the whole cohort was evaluated. When the genders were compared, differences were found on 10 domains. CONCLUSION Psychopathological symptoms have a more powerful influence on the HRQoL of MS patients than physical impairment, also these symptoms influence men's and women's HRQoL with different power. This invokes the need for complex and personalized care in the treatment of PwMS. Ours is the first study to show a difference between the sexes in this regard.
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Affiliation(s)
- Tamás Biernacki
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Csilla Rózsa
- Jahn Ferenc Dél-Pest Hospital, Budapest, Hungary
| | | | - László Vécsei
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.,MTA - SZTE Neuroscience Research Group, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
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Fatigue scores correlate with other self-assessment data, but not with clinical and biomarker parameters, in CIS and RRMS. Mult Scler Relat Disord 2019; 36:101424. [PMID: 31586802 DOI: 10.1016/j.msard.2019.101424] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/07/2019] [Accepted: 09/30/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fatigue is common in multiple sclerosis and is associated with reduced quality of life. This study aimed to assess the correlation between fatigue scores and data from other self-assessment questionnaires, neuropsychological tests and neuroimaging, as well as data on neuroimmunological markers in cerebrospinal fluid (CSF) and serum/plasma, in clinically isolated syndrome (CIS) and relapsing remitting MS (RRMS). METHODS Modified fatigue impact scale (MFIS) scores were determined in 38 patients with newly diagnosed CIS or RRMS at baseline and after one year in a prospective longitudinal cohort study. Non-parametric correlation analyses were used to assess associations between MFIS scores and other self-assessment questionnaire data (Hospital Anxiety and Depression scale (HAD), Multiple Sclerosis Impact Scale 29 (MSIS-29) and Short Form 36 (SF-36)), as well as with neuropsychological test performances (e.g. Auditory Consonant Trigram Test (ACTT)), clinical parameters (e.g. disease duration and expanded disability status scale (EDSS)), magnetic resonance imaging (MRI) data (number of T2 lesions in brain MRI and total brain volume) and several neurodegenerative/neuroinflammatory markers in CSF and serum/plasma (IL-1β, IL-6, CXCL1, CXCL10, CXCL13, CCL-22 in plasma; neurofilament light chain (NFL) in serum; IL-6, CXCL1, CXCL10, CXCL13, CCL22, NFL and chitinase-3-like-1 (CHI3L1) in CSF. CSF and serum/plasma from 21 age- and sex-matched healthy controls were available for comparison. RESULTS At both baseline and one-year follow-up, fatigue scores correlated significantly with HAD, MSIS-29 and SF-36 scores and ACTT performance (Spearman´s rho 0.45-0.78, all p ≤ 0.01) but not with the other neuropsychological test results, disease duration, EDSS ratings, number of T2 lesions, total brain volume or neurodegenerative/neuroinflammatory markers, including neurofilament light chain levels in CSF and serum. In group comparisons, MFIS scores were similar in patients fulfilling no evidence of disease activity-3 (NEDA-3) (n = 18) and patients not fulfilling NEDA-3 (n = 20) during one year of follow-up (p > 0.01). CONCLUSIONS In this cohort of patients with newly diagnosed CIS and RRMS, fatigue scores were associated with mood, disease impact on daily life and quality of life as well as with alterations of attentive functions. Study results indicate that subjective fatigue scores are not well reflected by some commonly used and objectively measurable disease parameters like EDSS, T2 lesions and NFL levels.
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Aristotelous P, Stefanakis M, Pantzaris M, Pattichis C, Hadjigeorgiou GM, Giannaki CD. Associations between functional capacity, isokinetic leg strength, sleep quality and cognitive function in multiple sclerosis patients: a cross-sectional study. Postgrad Med 2019; 131:453-460. [DOI: 10.1080/00325481.2019.1662271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Manos Stefanakis
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Goischke HK. Comorbidities in multiple sclerosis-a plea for interdisciplinary collaboration to improve the quality of life of MS patients. Degener Neurol Neuromuscul Dis 2019; 9:39-53. [PMID: 31354380 PMCID: PMC6584285 DOI: 10.2147/dnnd.s204555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/15/2019] [Indexed: 12/21/2022] Open
Abstract
The negative influence of comorbidities on the quality of life of people with multiple sclerosis is evident and the problem is increasingly acknowledged by numerous international studies in long-term care. One therapeutic option would be an add-on therapy with vitamin D (VD), with the aim of achieving a therapeutically effective dose. The individually required VD dose must be tested, since the response to a certain dose is subject to variations between individuals. A possible toxicity with increased 1.25(OH)D3 (active VD metabolite) is largely prevented by increased activity of 24-hydroxylase (CYP24A1). Monitoring of serum VD levels as well as serum calcium and phosphate levels (optional Ca excretion in 24-hour urine, Ca creatinine ratio in urine) provides safety and is necessary because possible mutations on the (catabolic) CYP24A1 gene can lead to a partial or total loss of 24-hydroxylase activity and provoke hypercalcemia/hyperphosphatemia. The main therapeutic objective is to maintain functional and social independence by using drugs with a high safety profile. The prevention and optimal management of comorbidities can influence the quality of life of patients with MS (PwMS) when included in patient care. Adequate measures can reduce the burden of MS only if the risk of comorbidity is reduced through targeted monitoring, early detection and diagnosis. Such a strategy will contribute to influencing the premature mortality of patients with MS. If VD is recognized as a "multipurpose steroid hormone", it could also be used to maintain cognitive function and prevent premature possible dementia, especially as there is evidence that VD deficiency correlates with brain atrophy (hippocampus). At present, MS therapy is still a balancing act between therapeutically efficient action and the management of unexpected side effects, with VD add-on therapy being almost unproblematic and most likely to be accepted by PwMS.
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Malygin VL, Boyko AN, Konovalova OE, Iskandirova AS, Dumbrova EV, Boyko OV, Malygin YV. [Influence of psychopathological factors and personality traits on the results of the study of quality of life in patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:42-48. [PMID: 31156240 DOI: 10.17116/jnevro20191192242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the influence of psychopathological factors and personality traits on the results of the study of quality of life (QoL) in patients with multiple sclerosis (MS). MATERIAL AND METHODS Forty-three patients with relapsing MS were included in the study (74.4% female; mean age 33.1 years). SF-36 was used to evaluate QoL. Effects of psychopathological factors, cognitive regulation of emotions and personality traits on QoL were studied. Statistical analysis was performed using multiple linear model. RESULTS AND DISCUSSION A wide number of strategies of cognitive regulation of emotions has conflicting effects on the physical component of QoL; subscales of anhedonic depression and anxious arousal (MASQ), which probably represent depressive and anxiety disorders, decrease the physical component of QoL. The key factors of the mental component of QoL include psychopathological factors (mostly obsessive-compulsive symptoms) and personality traits (the more intense they are the lower is QoL). Strategies of cognitive regulation of emotions have low impact on the mental component of QoL.
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Affiliation(s)
- V L Malygin
- Evdokimov Moscow State University of Medical Dentistry, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O E Konovalova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A S Iskandirova
- Evdokimov Moscow State University of Medical Dentistry, Moscow, Russia
| | - E V Dumbrova
- Evdokimov Moscow State University of Medical Dentistry, Moscow, Russia
| | - O V Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ya V Malygin
- Pirogov Russian National Research Medical University, Moscow, Russia
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Cederberg KLJ, Jeng B, Sasaki JE, Braley TJ, Walters AS, Motl RW. Restless legs syndrome and health-related quality of life in adults with multiple sclerosis. J Sleep Res 2019; 29:e12880. [PMID: 31157499 DOI: 10.1111/jsr.12880] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/23/2019] [Accepted: 05/06/2019] [Indexed: 01/30/2023]
Abstract
Restless legs syndrome (RLS) is a sleep disorder that may exacerbate many of the symptoms and consequences of multiple sclerosis (MS), and may have further implications for health-related quality of life (HRQOL). The present study examined the relationships among RLS, symptoms and HRQOL in people with MS. Participants with MS (n = 275) completed the Cambridge-Hopkins Restless Legs Syndrome Questionnaire, the International Restless Legs Syndrome Study Group Scale, the Multiple Sclerosis Impact Scale, the Pittsburgh Sleep Quality Index, the Fatigue Severity Scale, the Hospital Anxiety and Depression Scale and the Patient Determined Disease Steps. There were 74 (26.9%) persons with MS who had RLS (MS + RLS). The MS + RLS group reported worse physical and psychological HRQOL (p = 0.020 and p = 0.017, respectively) and greater perceived fatigue (p = 0.006) and anxiety symptoms (p = 0.042) than the MS-only group. Within the MS + RLS group, RLS severity was associated with physical (r = 0.43) and psychological (r = 0.46) HRQOL, sleep quality (r = 0.38), perceived fatigue (r = 0.28), depression (r = 0.38) and anxiety (r = 0.28). The relationships between RLS severity and the domains of HRQOL were attenuated when accounting for fatigue, depression and/or anxiety. Worse RLS severity was associated with reduced HRQOL, which was accounted for by fatigue, depression and anxiety.
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Affiliation(s)
- Katie L J Cederberg
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffer E Sasaki
- Department of Sports Sciences, Universidade Federal do Triângulo Mineiro, Bairro Tutunas, Uberabam, Brazil
| | - Tiffany J Braley
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Arthur S Walters
- Department of Neurology, Vanderbilt University, Nashville, Tennessee
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
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Cognitive Functioning in Patients with Pediatric-Onset Multiple Sclerosis, an Updated Review and Future Focus. CHILDREN-BASEL 2019; 6:children6020021. [PMID: 30720736 PMCID: PMC6406784 DOI: 10.3390/children6020021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS) is relatively rare, but as technology and neuroimaging advance, an increasing number of cases are identified, and our understanding of how multiple sclerosis (MS) impacts the developing brain improves. There are consistent findings in the literature highlighting the impact of MS and other demyelinating diseases on cognitive functioning and cognitive development. We also have a better understanding of how POMS impacts psychosocial functioning and functional outcomes in daily living. This paper hopes to review findings associated with cognitive and psychosocial functioning in patients with POMS, as well as explore more recent advances in the field and how they relate to cognitive and psychosocial outcomes. We also discuss the ongoing need for future studies with a focus on better understanding deficits and disease correlates, but also preventative measures and potential rehabilitation.
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Yalachkov Y, Soydaş D, Bergmann J, Frisch S, Behrens M, Foerch C, Gehrig J. Determinants of quality of life in relapsing-remitting and progressive multiple sclerosis. Mult Scler Relat Disord 2019; 30:33-37. [PMID: 30735970 DOI: 10.1016/j.msard.2019.01.049] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/06/2019] [Accepted: 01/29/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Numerous factors can affect multiple sclerosis (MS) patients' quality of life (QoL). We investigated how physical impairment, upper extremity function, cognitive impairment, cognitive reserve, symptoms of psychological distress, depression, fatigue as well as age and disease duration contribute to patient-reported measures of QoL in relapse-remitting MS (RRMS) and progressive MS (PMS). METHODS 39 patients with RRMS and 16 patients with PMS were evaluated for physical impairment (EDSS assessed by a neurologist), upper extremity function (9-hole peg test), cognitive deficits (broad neuropsychological test battery), cognitive reserves (highest obtained degree of education and vocabulary), symptoms of psychological distress (Symptom Checklist-90-R), depression (Beck Depression Inventory) and fatigue (Fatigue Scale for Motor and Cognitive Functions). The effects of these variables on QoL, as measured with the EQ-5D-3L, were tested with a multivariate analysis of variance. RESULTS Degree of education, MS disease type, disease duration, BDI and SCL-90-R-scores affected significantly the EQ-5D index. Post-hoc analysis revealed that patients with university education, RRMS, shorter disease duration as well as less depression and psychological distress symptoms had significantly higher EQ-5D indices. No significant effects were observed for measures of physical disability, cognitive impairment or fatigue. CONCLUSIONS Depression and psychological distress symptoms are among the factors with the most essential impact on subjective well-being in MS patients. Since they can be targeted by both psychopharmacological and psychotherapeutic treatment, focusing on mental comorbidity could substantially increase QoL in MS.
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Affiliation(s)
- Yavor Yalachkov
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany.
| | - Dilara Soydaş
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Johannes Bergmann
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Stefan Frisch
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany; Institute of Psychology, Goethe-University, Frankfurt am Main, Germany
| | - Marion Behrens
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Christian Foerch
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
| | - Johannes Gehrig
- University Hospital Frankfurt, Department of Neurology, Frankfurt am Main, Germany
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Hyncicova E, Kalina A, Vyhnalek M, Nikolai T, Martinkovic L, Lisy J, Hort J, Meluzinova E, Laczó J. Health-related quality of life, neuropsychiatric symptoms and structural brain changes in clinically isolated syndrome. PLoS One 2018; 13:e0200254. [PMID: 29979757 PMCID: PMC6034869 DOI: 10.1371/journal.pone.0200254] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 06/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Neuropsychiatric symptoms and reduced health-related quality of life (HRQoL) are frequent in multiple sclerosis, where are associated with structural brain changes, but have been less studied in clinically isolated syndrome (CIS). Objective To characterize HRQoL, neuropsychiatric symptoms (depressive symptoms, anxiety, apathy and fatigue), their interrelations and associations with structural brain changes in CIS. Methods Patients with CIS (n = 67) and demographically matched healthy controls (n = 46) underwent neurological and psychological examinations including assessment of HRQoL, neuropsychiatric symptoms and cognitive functioning, and MRI brain scan with global, regional and lesion load volume measurement. Results The CIS group had more, mostly mild, depressive symptoms and anxiety, and lower HRQoL physical and social subscores (p≤0.037). Neuropsychiatric symptoms were associated with most HRQoL subscores (β≤-0.34, p≤0.005). Cognitive functioning unlike clinical disability was associated with depressive symptoms and lower HRQoL emotional subscores (β≤-0.29, p≤0.019). Depressive symptoms and apathy were associated with right temporal, left insular and right occipital lesion load (ß≥0.29, p≤0.032). Anxiety was associated with lower white matter volume (ß = -0.25, p = 0.045). Conclusion Mild depressive symptoms and anxiety with decreased HRQoL are present in patients with CIS. Neuropsychiatric symptoms contributing to decreased HRQoL are the result of structural brain changes and require complex therapeutic approach in patients with CIS.
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Affiliation(s)
- Eva Hyncicova
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Adam Kalina
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Martin Vyhnalek
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Tomas Nikolai
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Lukas Martinkovic
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jiri Lisy
- Department of Radiology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jakub Hort
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Eva Meluzinova
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jan Laczó
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
- * E-mail:
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Salhofer-Polanyi S, Friedrich F, Löffler S, Rommer PS, Gleiss A, Engelmaier R, Leutmezer F, Vyssoki B. Health-related quality of life in multiple sclerosis: temperament outweighs EDSS. BMC Psychiatry 2018; 18:143. [PMID: 29792188 PMCID: PMC5966924 DOI: 10.1186/s12888-018-1719-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 05/03/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The influence of personality on health-related quality of life in patients with multiple sclerosis has been the focus of previous studies showing that introversion and neuroticism were related with reduced health related quality of life. However, no data exist on the impact of temperament on quality of life in this patient group. METHODS Between April 2014 and March 2016 139 multiple sclerosis patients were recruited from a specialized outpatient clinic of the general hospital of Vienna. Health-related quality of life was measured by "The Multiple Sclerosis International Quality of Life Questionnaire (MusiQol)", temperament by "Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Questionnaire - Münster version" (briefTEMPS-M), and disability by the "Expanded disability status scale". All patients underwent a diagnostic psychiatric semi-structured interview (MINI). RESULTS Known predictors (like disease duration, EDSS, psychiatric co-morbidities, immunomodulatory treatments) explain the proportion of variation in the outcome of MusiQol global index score in 30.9% in multi-variable linear regression analysis. It increased respectively to 40.3, 42.5, and 45.8% if adding the depressive, cyclothymic, or hyperthymic temperament to the list of variables. An increase of depressive and cyclothymic temperament scores significantly reduced global index score of MusiQol (p = 0.005, p = 0.002, respectively), while the hyperthymic temperament significantly raised it (p < 0.001). CONCLUSION In MS patients, the depressive and cyclothymic temperament predict a lower and hyperthymic temperament an increased health-related quality of life, independent of current disability status, immunomodulatory treatments, and affective co-morbidities.
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Affiliation(s)
- S. Salhofer-Polanyi
- 0000 0000 9259 8492grid.22937.3dDepartment of Neurology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
| | - F. Friedrich
- 0000 0001 2286 1424grid.10420.37Department of Psychiatry and Psychotherapy Division of Social Psychiatry, University of Vienna, Vienna, Austria
| | - S. Löffler
- 0000 0000 9259 8492grid.22937.3dDepartment of Neurology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
| | - P. S. Rommer
- 0000 0000 9259 8492grid.22937.3dDepartment of Neurology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
| | - A. Gleiss
- 0000 0001 2286 1424grid.10420.37Center for Medical Statistics, Informatics, and Intelligent Systems of the Medical, University of Vienna, Vienna, Austria
| | - R. Engelmaier
- 0000 0001 2286 1424grid.10420.37Department of Psychiatry and Psychotherapy Division of Social Psychiatry, University of Vienna, Vienna, Austria
| | - F. Leutmezer
- 0000 0000 9259 8492grid.22937.3dDepartment of Neurology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
| | - B. Vyssoki
- 0000 0001 2286 1424grid.10420.37Department of Psychiatry and Psychotherapy Division of Social Psychiatry, University of Vienna, Vienna, Austria
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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.
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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
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Schapira AHV. Advances and insights into neurological practice 2016−17. Eur J Neurol 2017; 24:1425-1434. [DOI: 10.1111/ene.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Planche V, Moisset X, Morello R, Dumont E, Gibelin M, Charré-Morin J, Saubusse A, Mondou A, Reuter F, Defer G, Pelletier J, Brochet B, Clavelou P. Improvement of quality of life and its relationship with neuropsychiatric outcomes in patients with multiple sclerosis starting treatment with natalizumab: A 3-year follow-up multicentric study. J Neurol Sci 2017; 382:148-154. [PMID: 29111011 DOI: 10.1016/j.jns.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/25/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is impaired in multiple sclerosis (MS) but can be improved by disease-modifying therapies such as natalizumab. However, the predictive factors and neuropsychiatric correlates of HRQoL improvement are unknown. METHODS In this study, 48 patients with relapsing-remitting MS were included in a 3-year open-label, single group, multicenter, clinical trial (NCT01392872). HRQoL was measured by the disease-specific MusiQoL questionnaire, together with physical disability, cognition, fatigue, anxiety and depression scores at baseline, 6months, 12months, 18months and 36months after starting natalizumab therapy. RESULTS Compared to baseline, global HRQoL, as measured with the index of the MusiQoL, was significantly increased 6months after the beginning of natalizumab therapy, with medium effect-size (58.6±16.2 vs 69.8±18.9, p<0.001, Cohen's d=0.63). This improvement was maintained over time for up to 3years and mainly concerned activity of daily living, psychological well-being, symptoms and coping (p<0.001 for every dimensions). The variation of global HRQoL after 3years was negatively correlated with the variation of fatigue score (r=-0.44, p=0.015). Furthermore, a higher fatigue score at baseline was correlated with improvement in global HRQoL 3years afterwards (r=0.34, p=0.041), independently of age, educational level, disease duration and disability at baseline (β=2.45, p=0.020). Disability at baseline, cognitive impairment, anxiety and depression failed to predict or correlate with global HRQoL improvement in multivariate analyses. CONCLUSION Natalizumab improved HRQoL quickly and sustainably in patients with relapsing-remitting MS. In terms of HRQoL, natalizumab seems to benefit mostly patients with more marked fatigue at baseline.
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Affiliation(s)
- Vincent Planche
- Service de Neurologie, CHU de Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France.
| | - Xavier Moisset
- Service de Neurologie, CHU de Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; Neuro-Dol, Inserm U1107, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Remy Morello
- Unité de Biostatistique et Recherche Clinique, CHU de Caen, Université de Normandie, F-14033 Caen, France
| | - Emilie Dumont
- Service de Neurologie, CHU de Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | | | - Julie Charré-Morin
- Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, F-33007 Bordeaux, France
| | - Aurore Saubusse
- Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, F-33007 Bordeaux, France
| | - Audrey Mondou
- Service de Neurologie, CHU de Caen, Université de Normandie, F-14033 Caen, France
| | - Françoise Reuter
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, F-13000 Marseille, France
| | - Gilles Defer
- Service de Neurologie, CHU de Caen, Université de Normandie, F-14033 Caen, France
| | - Jean Pelletier
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, F-13000 Marseille, France
| | - Bruno Brochet
- Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, F-33007 Bordeaux, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; Neuro-Dol, Inserm U1107, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
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Nowinski CJ, Miller DM, Cella D. Evolution of Patient-Reported Outcomes and Their Role in Multiple Sclerosis Clinical Trials. Neurotherapeutics 2017; 14:934-944. [PMID: 28913785 PMCID: PMC5722775 DOI: 10.1007/s13311-017-0571-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Patient-reported outcomes (PROs) are playing an increasing role in multiple sclerosis (MS) research and practice, and are essential for understanding the effects that MS and MS treatments have on patients' lives. PROs are captured directly from patients and include symptoms, function, health status, and health-related quality of life. In this article, we review different categories (e.g., generic, targeted, preference-based) of PRO measures and considerations in selecting a measure. The PROs included in MS clinical research have evolved over time, as have the measures used to assess them. We describe findings from recent MS clinical trials that included PROs when evaluating Food and Drug Administration-approved disease-modifying therapies (e.g., daclizumab, teriflunomide). Variation in the measures used in these trials makes it difficult to draw any conclusions from the data. We therefore suggest a standardized approach to PRO assessment in MS research and describe 2 generic, National Institutes of Health-supported measurement systems [Neuro-QoL and the Patient-Reported Outcomes Measurement Information System (PROMIS)] that would facilitate such an approach. The use of PROs in MS care and research is expanding beyond clinical trials, as is demonstrated by examples from comparative effectiveness and other patient-centered research. The importance of PRO assessment is expected to continue to grow in the future.
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Affiliation(s)
- Cindy J Nowinski
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lurati AR. An Accident-Prone Employee: No, Multiple Sclerosis. Workplace Health Saf 2017; 66:5-7. [PMID: 28856976 DOI: 10.1177/2165079917728947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An employee is labeled "accident-prone," and sustained an acute lumbar injury at work. Upon physical examination, a diagnosis of multiple sclerosis was suspected. She was referred to a public health clinic for further evaluation. This is a review article of multiple sclerosis and workplace interventions.
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Gordon-Lipkin E, Banwell B. An update on multiple sclerosis in children: diagnosis, therapies, and prospects for the future. Expert Rev Clin Immunol 2017; 13:975-989. [PMID: 28738749 DOI: 10.1080/1744666x.2017.1360135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS), a chronic demyelinating disease of the central nervous system, is increasingly being recognized in children and adolescents. Pediatric MS follows a relapsing-remitting course at onset, with a risk for early cognitive impairment. Areas covered: In this review, we discuss the clinical features of acute demyelinating syndromes in children and risk factors that increase the likelihood of a diagnosis of MS. We also address the application of diagnostic criteria for MS in children, immunological features, therapeutic options and psychosocial considerations for children and adolescents with MS. Expert commentary: Collaborative multicenter clinical trials and research efforts are key to the advancement in understanding the pathophysiology and therapeutic strategies for multiple sclerosis across the lifespan.
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Affiliation(s)
- Eliza Gordon-Lipkin
- a Department of Neurology and Developmental Medicine , Kennedy Krieger Institute and Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Brenda Banwell
- b Children's Hospital of Philadelphia , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
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Cai S, Lin H, Hu X, Cai YX, Chen K, Cai WZ. High fatigue and its associations with health and work related factors among female medical personnel at 54 hospitals in Zhuhai, China. PSYCHOL HEALTH MED 2017; 23:304-316. [PMID: 28778141 DOI: 10.1080/13548506.2017.1361038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study aimed to investigate the prevalence of fatigue and determine factors associated with fatigue in female medical personnel. Based on a cross-sectional study, a total of 1608 female medical personnel at 54 hospitals in Zhuhai, China were recruited by a multistage stratified cluster sampling method. The Symptoms Checklist-90-Revised and Chalder Fatigue Scale were used to assess psychiatric symptoms and fatigue, respectively. Data regarding demographic, health, and work related variables were also collected. Multivariate logistic regression model was constructed to determine the influencing factors of fatigue. Approximately 83% of participants had experienced fatigue in the past week. The risk of fatigue was higher in aged 30-39 years old than older or younger participants; Longer sleeping time predicted a lower prevalence of fatigue (OR = .35), while tense physician-patient relationship predicted a higher prevalence of fatigue (OR = 1.77). Depression (OR = 1.76) and anxiety (OR = 1.96) were found related to fatigue. Additionally, fatigue was associated with marital status, occupation, health related factors (exercise, regular diet, and health status), and work related factors (hospital rank and turnover intention). These study findings might facilitate development and implementation of targeted interventions and preventive measures.
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Affiliation(s)
- Shu Cai
- a Shenzhen Hospital of Southern Medical University , Shenzhen , China.,b School of Nursing , Guangdong Pharmaceutical University , Guangzhou , China
| | - Hong Lin
- c Phoenix International Medical Center , The Fifth Affiliated Hospital of SUN YAT-SEN University , Zhu Hai , China
| | - Xuan Hu
- a Shenzhen Hospital of Southern Medical University , Shenzhen , China
| | | | - Ken Chen
- b School of Nursing , Guangdong Pharmaceutical University , Guangzhou , China
| | - Wen-Zhi Cai
- a Shenzhen Hospital of Southern Medical University , Shenzhen , China
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