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Lőrincz B, Motýl J, Friedová L, Hrych D, Kubala Havrdová E, Krásenský J, Urban T, Kober T, Maréchal B, Vaněčková M, Horákova D, Vrablik M, Uher T. Lipid measures are associated with cognitive functioning in multiple sclerosis patients. Mult Scler Relat Disord 2024; 91:105879. [PMID: 39270535 DOI: 10.1016/j.msard.2024.105879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/20/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND An association between lipid measures and cognitive decline in patients with multiple sclerosis (MS) has been suggested. OBJECTIVES This study aimed to investigate relationships between lipid profile and cognitive performance in a large observational cohort of MS patients. MATERIALS AND METHODS We included 211 patients with 316 available pairs of lipid and cognitive measures performed over follow-up. The time between lipid and cognitive measures did not exceed 90 days. Baseline data were analyzed by non-parametric Spearman rank correlation test. Repeated measures were analyzed using linear mixed models adjusted for sex, age, education level, disease-modifying therapy status, and depression. RESULTS Baseline analyses showed a correlation between higher low-density lipoprotein cholesterol (LDL-C) and lower Categorical Verbal Learning Test (CVLT) (rho=-0.15; p = 0.04), lower Symbol Digit Modalities Test (SDMT) (rho=-0.16; p = 0.02) and lower Brief Visuospatial Memory Test-Revised (BVMT-R) scores (rho=-0.12; p = 0.04). Higher high-density lipoprotein cholesterol (HDL-C) was negatively correlated with lower SDMT scores (rho=-0.16; p = 0.02) and lower Paced Auditory Serial Addition Test-3 (PASAT-3) scores (rho=-0.24; p = 0.03). Mixed model analyses of repeated measures showed a negative association between higher LDL-C and lower CVLT (B=-0.02; p < 0.001, Cohen´s d = 0.08) and lower BVMT-R (B=-0.01; p = 0.03, Cohen´s d=-0.12). Also, the negative association between HDL-C and PASAT-3 was confirmed in the mixed model analysis (B=-0.18; p = 0.01, Cohen´s d = 0.07). Additional adjustments of the models for disability assessed by Expanded Disability Status Scale or Normalized Brain Volume did not change the results of the models substantially. CONCLUSIONS Our results suggest a mild negative impact of dyslipidemia on cognitive performance in patients with MS. We propose that dyslipidemia contributes, at least in part, to cognitive decline in MS patients, independent of brain atrophy.
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Affiliation(s)
- Balázs Lőrincz
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Jiří Motýl
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Lucie Friedová
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Daniel Hrych
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Eva Kubala Havrdová
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Jan Krásenský
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Tadeáš Urban
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne CH-1015, Switzerland
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne CH-1015, Switzerland
| | - Manuela Vaněčková
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Dana Horákova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Michal Vrablik
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Tomáš Uher
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic.
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Kavaliunas A, Danylaite Karrenbauer V, Hillert J. Socioeconomic consequences of multiple sclerosis-A systematic literature review. Acta Neurol Scand 2021; 143:587-601. [PMID: 33748960 DOI: 10.1111/ane.13411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022]
Abstract
Multiple sclerosis (MS) is a challenging and disabling condition, predominantly affecting individuals in their early life, and has an impact functionally, financially, and on quality of life. However, there is a lack of systematic approach towards assessing socioeconomic consequences of MS. Our objective was to systematically review observational analytical studies investigating the socioeconomic consequences of MS. We conducted a systematic review on socioeconomic consequences of MS with a focus on employment-, income-, work ability- and relationship-related outcomes between MS and the general population. Additionally, the educational characteristics were extracted. From 4958 studies identified, 187 were assessed for eligibility and a total of 27 studies from eight countries were included in this qualitative assessment; 32 different outcomes were identified. All studies indicated pronounced differences between MS patients and the general population, for example 15%-30% lower employment, lower earnings and higher social benefits, higher absenteeism and presenteeism proportions, higher work disability (eg, sick-leave days) among MS patients. Some studies also indicated differences in the family or relationship characteristics. There were no apparent differences with regard to educational level. In conclusion, socioeconomic data can serve as robust outcome measures to study various aspects of MS reflecting the broader consequences of the disease.
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Affiliation(s)
- Andrius Kavaliunas
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Virginija Danylaite Karrenbauer
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Neurology Medical Unit Karolinska University Hospital Stockholm Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Neurology Medical Unit Karolinska University Hospital Stockholm Sweden
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Increased socioeconomic burden in patients with primary progressive multiple sclerosis: A Danish nationwide population-based study. Mult Scler Relat Disord 2020; 46:102567. [PMID: 33296969 DOI: 10.1016/j.msard.2020.102567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary progressive multiple sclerosis (PPMS) is characterized by development of more chronic neurological manifestations from disease onset compared with relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) but the following socioeconomic consequences have never been described in a nation-wide patient population. OBJECTIVE To determine if socioeconomic burden of PPMS is increased compared with RRMS and SPMS. METHODS We included patients from The Danish Multiple Sclerosis Registry diagnosed between 1998 and 2015. Yearly average health costs, public transfers and earned income was calculated from the index diagnosis date, and each year in a five-year period before and after index diagnosis date, for the three patient groups. A regression model estimating the odds ratio (OR) with PPMS as the comparator, was used to analyze the differences between PPMS vs. RRMS and PPMS vs. SPMS controlling for age and sex. RESULTS In total, 9563 MS patients were identified (1998-2015), with a characteristic distribution between different disease courses: 7012 patients with RRMS (73%), 1099 patients with PPMS (11%) and 1452 patients with SPMS (15%). Total health costs were lower in RRMS vs. PPMS (OR 0.76; 95% CI 0.74-0.78; p<0.0001) but not in SPMS vs. PPMS (OR 1.06; 95% CI 1.03-1.09; p<0.0001). Especially homecare costs were lower in RRMS vs. PPMS (OR 0.17; 95% CI 0.17-0.18; p<0.0001), less pronounced in SPMS vs. PPMS (OR 0.93; 95% CI 0.90-0.97; p = 0.0001). OR for health costs before and after diagnosis was significantly lower in RRMS vs. PPMS regarding most variables, less pronounced in SPMS vs. PPMS. CONCLUSION This nation-wide population-based study show that socioeconomic burden is significantly higher in PPMS relative to RRMS, but less pronounced compared with SPMS.
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Marrie RA, Wijnands JM, Kingwell E, Zhu F, Zhao Y, Ekuma O, Lu X, Evans C, Fisk JD, Tremlett H. Higher health care use before a clinically isolated syndrome with or without subsequent MS. Mult Scler Relat Disord 2019; 35:42-49. [DOI: 10.1016/j.msard.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
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Abstract
Background: To estimate the value of treatments in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with cost data. This, in turn, requires that cost data be regularly updated. Objectives and Methods: This study is part of a cross-sectional retrospective study in 16 countries collecting current data on resource consumption, work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in 2015 Danish Kronor (DKK). Results: A total of 830 patients (mean age of 54 years) participated; 78% were below retirement age and of these, 43% were employed. Employment was related to disease severity, and MS was felt to affect productivity at work by 73% of patients, most often through fatigue. Overall, 95% and 65% of patients felt that fatigue and cognition, respectively, were a problem. Mean utility and costs were 0.770 and 196,900DKK at Expanded Disability Status Scale (EDSS) 0–3, 0.619 and 287,300DKK at EDSS 4–6.5, and 0.302 and 533,250DKK at EDSS 7–9. The average cost of a relapse was estimated at 19,000DKK. Conclusion: This study illustrates the burden of MS on Danish patients and provides current data that are important for the development of health policies.
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Moccia M, Palladino R, Lanzillo R, Triassi M, Brescia Morra V. Predictors of the 10-year direct costs for treating multiple sclerosis. Acta Neurol Scand 2017; 135:522-528. [PMID: 27357245 DOI: 10.1111/ane.12630] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Disease-modifying treatments (DMTs) constitute the largest direct medical cost for multiple sclerosis (MS). This study aims at investigating predictors of the 10-year economic burden for DMT administration and management. MATERIALS AND METHODS This study included 537 newly diagnosed, drug naïve relapsing-remitting MS (RRMS) patients, followed up for 10.1±3.3 years. Costs for DMT administration and management were calculated, and referred to each year of observation (annual costs). Possible predictors of disease evolution were categorized into early predictors (age, gender, disease duration, baseline expanded disability status scale (EDSS), 1-point EDSS progression within 2 years, and annualized relapse rate -ARR- within 2 years), and long-term predictors (reaching of EDSS 4.0, conversion to secondary progressive -SP-, ARR, number of DMTs, follow-up duration). Association between predictors and study outcome was explored using mixed-effects log-linear regression models. RESULTS A 1-point higher EDSS at diagnosis was associated with 13.21% increase in the annual costs (95%CI=4.16-23.04%). Each additional year of age at diagnosis was associated with a 0.74% decrease in the annual costs (95%CI=-1.43 to-0.04%). Female gender was associated with a 12.43% decrease in the annual costs (95%CI=-22.61 to-0.93%). Converting to SP was associated with a 14.26% decrease in the annual costs (95%CI=-14.26 to-2.94%). Each additional year of follow-up was associated with a 3.05% decrease in the annual costs (95%CI=-4.51 to-1.57%). CONCLUSIONS An estimate of the 10-year costs associated with DMT administration and management can be calculated by analyzing different factors, and might be of particular interest for planning resources needed for treating people with MS.
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Affiliation(s)
- M. Moccia
- Multiple Sclerosis Clinical Care and Research Centre; Department of Neuroscience, Reproductive Science and Odontostomatology; Federico II University; Naples Italy
| | - R. Palladino
- Department of Primary Care and Public Health; Imperial College; London UK
- Department of Public Health; Federico II University; Naples Italy
| | - R. Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre; Department of Neuroscience, Reproductive Science and Odontostomatology; Federico II University; Naples Italy
| | - M. Triassi
- Department of Public Health; Federico II University; Naples Italy
| | - V. Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre; Department of Neuroscience, Reproductive Science and Odontostomatology; Federico II University; Naples Italy
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Jennum P, Iversen HK, Ibsen R, Kjellberg J. Cost of stroke: a controlled national study evaluating societal effects on patients and their partners. BMC Health Serv Res 2015; 15:466. [PMID: 26464109 PMCID: PMC4604706 DOI: 10.1186/s12913-015-1100-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 09/22/2015] [Indexed: 11/12/2022] Open
Abstract
Background To estimate the direct and indirect costs of stroke in patients and their partners. Description Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients and compared with 364,433, 103,741 and 500,490 matched controls, respectively. Results Independent of age and gender, stroke patients had significantly higher rates of mortality, health-related contacts, medication use and lower employment, lower income and higher social-transfer payments than controls. The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls for hemorrhagic, ischemic and unspecified stroke, respectively. The negative social- and health-related status could be identified up to eleven years before the first diagnosis. Conclusion Stroke has significant mortality, morbidity and socioeconomic consequences for patients, their partners and society.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, DK 2600, Copenhagen, Glostrup, Denmark. .,Danish Institute for Health Services Research, Copenhagen, Denmark.
| | - Helle K Iversen
- Stroke Unit, Department of Neurology, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark. .,Danish Institute for Health Services Research, Copenhagen, Denmark.
| | - Rikke Ibsen
- 2minds, Klosterport 4E, 4, Aarhus, Denmark. .,Danish Institute for Health Services Research, Copenhagen, Denmark.
| | - Jakob Kjellberg
- Stroke Unit, Department of Neurology, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark. .,Danish Institute for Health Services Research, Copenhagen, Denmark.
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Svensson J, Borg S, Nilsson P. Costs and quality of life in multiple sclerosis patients with spasticity. Acta Neurol Scand 2014; 129:13-20. [PMID: 23683163 DOI: 10.1111/ane.12139] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The resource use and health-related quality of life (HRQoL) of patients with multiple sclerosis (MS) spasticity are not well known. The purpose of this study was to obtain estimates of resource utilization, costs, and HRQoL, for patients with different levels of MS spasticity in southern Sweden. MATERIAL AND METHODS Cross-sectional data on spasticity severity (using a Numerical Rating Scale, NRS), resource use and HRQoL (using EQ-5D) were collected using a patient questionnaire and chart review. Patients were recruited through a clinic in southern Sweden. The study reviews direct medical, direct non-medical and indirect costs. RESULTS Total costs were estimated to €114,293 per patient and year. Direct medical costs (€7898) accounted for 7% of total costs. Direct non-medical costs (€68,509) accounted for 60% of total costs. Total costs increased with severity of spasticity: for patients with severe spasticity, the total cost was 2.4 times greater than those for patients with mild spasticity. HRQoL decreased as spasticity increases. CONCLUSION The results of this study show that MS spasticity is associated with a substantial burden on society in terms of costs and HRQoL.
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Affiliation(s)
- J. Svensson
- The Swedish Institute for Health Economics (IHE); Lund Sweden
| | - S. Borg
- The Swedish Institute for Health Economics (IHE); Lund Sweden
- Faculty of Medicine; Lund University; Lund Sweden
| | - P. Nilsson
- Department of Neurology; Skåne University Hospital; Lund Sweden
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Myhr KM, Grytten N, Torkildsen Ø, Wergeland S, Bø L, Pugliatti M, Aarseth JH. A need for national registries and international collaborative research in multiple sclerosis. Acta Neurol Scand 2012:1-3. [PMID: 23278648 DOI: 10.1111/ane.12039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is a growing need to identify biomarkers for early diagnosis and treatment in multiple sclerosis (MS). Such markers may also be involved in the cause and pathogenesis of the disease. METHODS Established national MS registries have through several decades allowed data collection to facilitate MS research. The European MS Registry (EUReMS) is a recent international collaborative effort to ultimately promote MS research and quality in health care across European countries. International collaborations based on such initiatives can facilitate studies on new biomarkers in MS. RESULTS Important studies on data from MS registries, as well as national- and international collaboration networks have been conducted. CONCLUSION The symposium "National MS Registries--to improve health care and research in Multiple Sclerosis" held in Bergen, Norway, earlier this year aimed to highlight the need and benefit from national MS registries and promote international collaborative research in MS.
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Affiliation(s)
| | | | | | | | | | - M. Pugliatti
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari; Italy
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