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Chamorro-de-Vega E, Calvo A, Fernández-Pacheco M, Hernández-Muniesa B, Romero-Jiménez R, Casado-Gómez A, Ramírez E, Morell A, Herrero N, Úbeda B, Ais-Larisgoitia A, Lobato-Matilla E, Muñoz Á, Casado MÁ, Escudero-Vilaplana V. Perceived quality of life by patients with immune-mediated inflammatory diseases treated with biological therapies. SACVINFA study. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00056-4. [PMID: 38789316 DOI: 10.1016/j.farma.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/19/2024] [Accepted: 04/08/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES To evaluate health-related quality of life perceived by patients with the most prevalent immune-mediated inflammatory diseases in Spain: inflammatory bowel disease (IBD), psoriasis (Ps), psoriatic arthritis (AP), rheumatoid arthritis (RA), and spondyloarthropathies (SpAs), and to determine the factors that influence patient quality of life. METHODS The SACVINFA study (SA=satisfaction, CV=quality of life, IN=immune-mediated, FA=pharmacy) consisted of an observational study conducted in 4 hospitals in the Community of Madrid. A cross-sectional analysis was made for adult patients diagnosed with an immune-mediated inflammatory disease who attended the Pharmacy Service. Quality of life was assessed using the EQ-5D-5L questionnaire (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and specific questionnaires: SIBDQ-9, DLQI, PsAQoL, QoL-RA, and ASQoL. RESULTS A total of 578 patients were analysed (inflammatory bowel disease=25.3%; psoriasis=19.7%; spondyloarthropathies=18.7%; rheumatoid arthritis=18.5%; psoriatic arthritis=17.8%). The mean age (standard deviation) was 49.8 (12.3) years and 50.7% were male. The average score (standard deviation) for the global EQ-5D-5L was 0.771 (0.2) and the mean (standard deviation) visual analogue scale score was 71.5 (20.0). Type of immune-mediated inflammatory diseases was associated with differences in quality of life showing psoriasis and inflammatory bowel disease higher values of EQ5D-5L than psoriatic arthritis, rheumatoid arthritis, and spondyloarthropathies, p<.05 in all comparisons. Patients with RA, IBD, and Ps achieved 70% of the maximum score, while patients with PsA and SpAs did not reach 50% of the maximum possible score. Female gender, a state of moderate/severe disease severity, an older age, and a higher number of previous treatments were correlated with worse quality of life. Conversely, persistence to current treatment correlated with better quality of life. CONCLUSIONS Patients with immune-mediated inflammatory diseases have markedly affected quality of life, mainly in the pain/discomfort dimension, especially in those immune-mediated inflammatory diseases with a rheumatological component.
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Affiliation(s)
- Esther Chamorro-de-Vega
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Alberto Calvo
- Pharmacy Department, Hospital Universitario La Princesa, Madrid, Spain
| | | | | | - Rosa Romero-Jiménez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | | | - Esther Ramírez
- Pharmacy Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Alberto Morell
- Pharmacy Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Nuria Herrero
- Pharmacy Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Bárbara Úbeda
- Pharmacy Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Arantza Ais-Larisgoitia
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Elena Lobato-Matilla
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Álvaro Muñoz
- Pharmacoeconomics & Outcomes Research Iberia (PORIB) S.L., Madrid, Spain
| | | | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Freedman DE, Oh J, Kiss A, Puopolo J, Wishart M, Meza C, Feinstein A. The influence of depression and anxiety on cognition in people with multiple sclerosis: a cross-sectional analysis. J Neurol 2024:10.1007/s00415-024-12409-x. [PMID: 38730098 DOI: 10.1007/s00415-024-12409-x] [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: 01/10/2024] [Revised: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024]
Abstract
There are conflicting findings about the relationships between depression, anxiety, and cognitive dysfunction in people with multiple sclerosis (MS), and a paucity of research has examined the cumulative influence on cognition of depression plus anxiety. This study aimed to determine whether elevated symptoms of depression and anxiety alone or in combination are associated with worse cognition in people with MS. In this cross-sectional analysis, people with MS consecutively seen at a tertiary neuropsychiatry clinic completed the Hospital Anxiety and Depression Scale for symptoms of depression (HADS-D) and anxiety (HADS-A), and the Minimal Assessment of Cognitive Function in MS for cognitive indices. Accounting for covariates, regression models predicted cognitive indices from scores for HADS-D, HADS-A, and the interaction. Of 831 people with MS, 72% were female, mean age was 43.2 years, and median Expanded Disability Status Scale score was 2.0. Depressive symptoms were independently predictive of lower verbal fluency (Controlled Oral Word Association Test, p < 0.01), verbal learning (California Verbal Learning Test-II (CVLT-II) total learning, p = 0.02), verbal delayed recall (CVLT-II delayed recall, p < 0.01), and processing speed (Symbol Digit Modalities Test, p < 0.01; three-second Paced Auditory Serial Addition Test (PASAT), p = 0.05; two-second PASAT, p = 0.01). Anxiety in people with depression predicted decreased visuospatial function (Judgment of Line Orientation, p = 0.05), verbal learning (p < 0.01), verbal delayed recall (p < 0.01), visuospatial recall (Brief Visuospatial Memory Test-Revised, p = 0.02), and executive function (Delis-Kaplan Executive Function System, p < 0.01). Anxiety alone was not independently predictive of cognition. In conclusion, depression, especially with comorbid anxiety, is associated with cognitive dysfunction in people with MS.
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Affiliation(s)
- David E Freedman
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, Temerty Faculty of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Alex Kiss
- Evaluative Clinical Sciences, Department of Health Policy, Management and Evaluation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Juliana Puopolo
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret Wishart
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Cecilia Meza
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anthony Feinstein
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
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3
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Zheng Y, Hou Z, Ma S, Huang Z, Peng J, Huang S, Guo R, Huang J, Lin Z, Zhuang Z, Yin J, Xie L. Altered dynamic functional network connectivity in rheumatoid arthritis associated with peripheral inflammation and neuropsychiatric disorders. RMD Open 2024; 10:e003684. [PMID: 38428977 PMCID: PMC10910624 DOI: 10.1136/rmdopen-2023-003684] [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: 09/06/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE This study explored the dynamic functional connective (DFC) alterations in patients with rheumatoid arthritis (RA) and investigated the correlation between the neuropsychiatric symptoms, peripheral inflammation and DFC alterations. METHOD Using resting-state functional MRI, we investigated the DFC based on spatial independent component analysis and sliding window method for 30 patients with RA and 30 healthy controls (HCs). The Spearman correlation was calculated between aberrant DFC alterations, Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HAD), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Diagnostic efficacy of indicators was assessed using receiver operating characteristic analysis (ROC). RESULTS Three dynamic functional states were identified. Compared with HC, patients with RA showed reduced FC variabilities between sensorimotor network (SMN) and insula, SMN and orbitofrontal cortex, which were the crucial regions of sensory processing network. The above FC variabilities were correlated with the MoCA, HAD, CRP and ESR in patients with RA. Additionally, the CRP and ESR were negatively correlated to MoCA and positively related to HAD in patients with RA. The ROC analysis results showed that MoCA, HAD and FC variabilities of the sensory processing network could distinguish patients with RA from HC and also identify patients with RA with high ESR. CONCLUSION Our findings demonstrated that abnormal DFC patterns in sensory processing networks in patients with RA were closely associated with peripheral inflammation and neuropsychiatric symptoms. This indicates that the dynamic temporal characteristics of the brain functional network may be potential neuroimaging biomarkers for revealing the pathological mechanism of RA.
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Affiliation(s)
- Yanmin Zheng
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhiduo Hou
- Department of Rheumatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuhua Ma
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zikai Huang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jianhua Peng
- Department of Rheumatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuxin Huang
- Department of Rheumatology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ruiwei Guo
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jinzhuang Huang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhirong Lin
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zelin Zhuang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jingjing Yin
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lei Xie
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Meade T, Joyce C, Perich T, Manolios N, Conaghan PG, Katz P. Prevalence, Severity, and Measures of Anxiety in Rheumatoid Arthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2024; 76:171-180. [PMID: 37779491 DOI: 10.1002/acr.25245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/07/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Many studies have reported high rates of anxiety in adults with rheumatoid arthritis (RA). The aim of this systematic review was to examine those findings and determine the overall prevalence, severity, and commonly used measures of anxiety in individuals with RA. METHODS Six databases were searched from January 2000 without restrictions on language/location, study design, or gray literature. All identified studies that examined anxiety prevalence and severity in adults with RA, as assessed with clinical diagnostic interview and/or standardized self-report measures, were considered for inclusion. Quality assessment of included studies was conducted using a modified Newcastle-Ottawa Evaluation Scale, and the findings were synthesized via a narrative approach. RESULTS Across the 47 studies (n = 11,085 participants), the sample size ranged from 60 to 1,321 participants with seven studies including healthy controls or groups with other health conditions. The studies were conducted across 23 countries, and anxiety prevalence ranged from 2.4% to 77%, predominantly determined with standardized self-report measures, of which Hospital Anxiety and Depression scale was used most frequently; only eight studies used a clinical diagnostic interview to confirm a specific anxiety diagnosis. Notable associations with anxiety in RA were physical disability, pain, disease activity, depression, and quality of life. CONCLUSION The reported prevalence of anxiety in RA varied widely potentially because of use of different self-report measures and cutoff points. Such cutoff points will need to be standardized to clinical thresholds to inform appropriate interventions for anxiety comorbidity in RA.
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Affiliation(s)
- Tanya Meade
- Western Sydney University, Sydney, New South Wales, Australia
| | - Caroline Joyce
- Western Sydney University, Sydney, New South Wales, Australia
| | - Tania Perich
- Western Sydney University, Sydney, New South Wales, Australia
| | - Nicholas Manolios
- The University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Phillip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Zhang Y, Wu X, Sun J, Yue K, Lu S, Wang B, Liu W, Shi H, Zou L. Exploring changes in brain function in IBD patients using SPCCA: a study of simultaneous EEG-fMRI. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:2646-2670. [PMID: 38454700 DOI: 10.3934/mbe.2024117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Research on functional changes in the brain of inflammatory bowel disease (IBD) patients is emerging around the world, which brings new perspectives to medical research. In this paper, the methods of canonical correlation analysis (CCA), kernel canonical correlation analysis (KCCA), and sparsity preserving canonical correlation analysis (SPCCA) were applied to the fusion of simultaneous EEG-fMRI data from 25 IBD patients and 15 healthy individuals. The CCA, KCCA and SPCCA fusion methods were used for data processing to compare the results obtained by the three methods. The results clearly show that there is a significant difference in the activation intensity between IBD and healthy control (HC), not only in the frontal lobe (p < 0.01) and temporal lobe (p < 0.01) regions, but also in the posterior cingulate gyrus (p < 0.01), gyrus rectus (p < 0.01), and amygdala (p < 0.01) regions, which are usually neglected. The mean difference in the SPCCA activation intensity was 60.1. However, the mean difference in activation intensity was only 36.9 and 49.8 by using CCA and KCCA. In addition, the correlation of the relevant components selected during the SPCCA calculation was high, with correlation components of up to 0.955; alternatively, the correlations obtained from CCA and KCCA calculations were only 0.917 and 0.926, respectively. It can be seen that SPCCA is indeed superior to CCA and KCCA in processing high-dimensional multimodal data. This work reveals the process of analyzing the brain activation state in IBD disease, provides a further perspective for the study of brain function, and opens up a new avenue for studying the SPCCA method and the change in the intensity of brain activation in IBD disease.
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Affiliation(s)
- Yin Zhang
- School of Microelectronics and Control Engineering, Changzhou University, Changzhou 213164, China
| | - Xintong Wu
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Jingwen Sun
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Kecen Yue
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Shuangshuang Lu
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Bingjian Wang
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Wenjia Liu
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Haifeng Shi
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Ling Zou
- School of Microelectronics and Control Engineering, Changzhou University, Changzhou 213164, China
- School of Computer and Artificial Intelligence, Changzhou University, Changzhou, Jiangsu 213164, China
- Key Laboratory of Brain Machine Collaborative Intelligence Foundation of Zhejiang Province, Hangzhou 310018, China
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6
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Elkhooly M, Bao F, Raghib M, Millis S, Bernitsas E. Role of white matter in cognitive impairment among relapsing remitting multiple sclerosis patients. Mult Scler Relat Disord 2023; 79:105030. [PMID: 37837669 DOI: 10.1016/j.msard.2023.105030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/14/2023] [Accepted: 09/23/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) associated cognitive impairment is believed to be mostly connected with damage to gray matter. The contribution of white matter is still poorly understood. We aim to examine the relationship between cognition and white matter tracts among relapsing remitting MS (RRMS) patients. METHODS Thirty RRMS patients were selected undergo the (3-seconds-interstimulus-interval paced auditory serial addition test) PASAT-3, the (symbol digit modalities test (SDMT) and full-brain MRI scans on a SIEMENS 3 Tesla Verio scanner. Diffusion Tensor Imaging (DTI) parameters, such as fractional anisotropy (FA) and mean diffusivity (MD) were examined in 37 white matter (WM) tracts. WM tracts were selected from the association pathways, projection pathways, commissural pathways by applying Human Connectome project (HCP)842 tractography atlas after DTI data reconstruction and registration to HCP1065 diffusion template in DSI Studio (version March 2021) In SPSS v26, Spearman's rank correlation analysis was used to examine the connection between DTI WM tracts and cognitive scores. The power of the study was increased by using false discovery rate (FDR) software. RESULTS The mean scores on the PASAT-3 and SDMT were 31.5 ± 12.8 and 46.9 ± 16.7 respectively. Better cognitive performance was correlated to higher FA values, while lower cognitive function was correlated to higher MD values. There was a positive correlation between FA values in the right medial lemniscus and superior cerebellar peduncle and SDMT scores (p 0.05). Additionally, there was a trend for significance between the FA values in the left corticothalamic tract and SDMT scores. MD values in the superior cerebellar peduncle, left arcuate Fasciculus and left extreme capsule were negatively correlated with SDMT scores (p<0.05). PASAT-3 scores were negatively correlated with MD values in the right cerebellum, however, there was no significant correlation between PASAT-3 and FA values. CONCLUSIONS White matter tracts, particularly the superior cerebellar peduncle, contribute to the cognitive impairment in RRMS. Larger sample sizes for longitudinal research are necessary.
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Affiliation(s)
- Mahmoud Elkhooly
- Neurology Department, Wayne State University, Detroit, MI 48201, USA; Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Fen Bao
- Neurology Department, Wayne State University, Detroit, MI 48201, USA
| | - Muhammad Raghib
- Neurology Department, Wayne State University, Detroit, MI 48201, USA
| | - Scott Millis
- Neurology Department, Wayne State University, Detroit, MI 48201, USA
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Anderson JR, Fitzgerald KC, Murrough JW, Katz Sand IB, Sorets TR, Krieger SC, Riley CS, Fabian MT, Sumowski JF. Depression symptoms and cognition in multiple sclerosis: Longitudinal evidence of a specific link to executive control. Mult Scler 2023; 29:1632-1645. [PMID: 37772495 DOI: 10.1177/13524585231198746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Depression symptoms are prevalent in multiple sclerosis (MS) and associated with poorer cognition in cross-sectional studies; it is unknown whether changes in depression symptoms track with cognitive changes longitudinally. OBJECTIVE Investigate whether changes in depression symptoms correspond with cognitive changes over time in MS, and identify specific cognitive functions related to depression symptoms. METHOD Persons with early relapse-onset MS (n = 165) completed a depression questionnaire (Beck Depression Inventory FastScreen) and tests of cognitive speed, executive control, and memory at baseline and 3-year follow-up. One-way ANOVAs assessed differences in cognitive change across participants with worsened, stable, or improved depression symptoms from baseline to year 3. RESULTS Change in depression symptoms was related to change in executive control (p = 0.001, ηp2 = 0.08; worsened mood with worsened executive control; improved mood with improved executive control), even when adjusting for cognitive speed (p = 0.002, ηp2 = 0.08). There were no links to cognitive speed (p = 0.826) or memory (p = 0.243). Regarding individual depression symptoms, executive control was related to loss of pleasure and suicidal thoughts. CONCLUSIONS Executive control tracks with depression symptoms, raising hope that management of mood may improve executive control. The specific link between executive control and anhedonia implicates dysfunctional reward processing as a key component of MS depression.
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Affiliation(s)
- Jordyn R Anderson
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathryn C Fitzgerald
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - James W Murrough
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ilana B Katz Sand
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tali R Sorets
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephen C Krieger
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claire S Riley
- Columbia University Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michelle T Fabian
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James F Sumowski
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Gold SM, Friede T, Meyer B, Moss-Morris R, Hudson J, Asseyer S, Bellmann-Strobl J, Leisdon A, Ißels L, Ritter K, Schymainski D, Pomeroy H, Lynch SG, Cozart JS, Thelen J, Román CAF, Cadden M, Guty E, Lau S, Pöttgen J, Ramien C, Seddiq-Zai S, Kloidt AM, Wieditz J, Penner IK, Paul F, Sicotte NL, Bruce JM, Arnett PA, Heesen C. Internet-delivered cognitive behavioural therapy programme to reduce depressive symptoms in patients with multiple sclerosis: a multicentre, randomised, controlled, phase 3 trial. Lancet Digit Health 2023; 5:e668-e678. [PMID: 37775187 PMCID: PMC10921847 DOI: 10.1016/s2589-7500(23)00109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Depression is three to four times more prevalent in patients with neurological and inflammatory disorders than in the general population. For example, in patients with multiple sclerosis, the 12-month prevalence of major depressive disorder is around 25% and it is associated with a lower quality of life, faster disease progression, and higher morbidity and mortality. Despite its clinical relevance, there are few treatment options for depression associated with multiple sclerosis and confirmatory trials are scarce. We aimed to evaluate the safety and efficacy of a multiple sclerosis-specific, internet-based cognitive behavioural therapy (iCBT) programme for the treatment of depressive symptoms associated with the disease. METHODS This parallel-group, randomised, controlled, phase 3 trial of an iCBT programme to reduce depressive symptoms in patients with multiple sclerosis was carried out at five academic centres with large outpatient care units in Germany and the USA. Patients with a neurologist-confirmed diagnosis of multiple sclerosis and depressive symptoms were randomly assigned (1:1:1; automated assignment, concealed allocation, no stratification, no blocking) to receive treatment as usual plus one of two versions of the iCBT programme Amiria (stand-alone or therapist-guided) or to a control condition, in which participants received treatment as usual and were offered access to the iCBT programme after 6 months. Masking of participants to group assignment between active treatment and control was not possible, although raters were masked to group assignment. The predefined primary endpoint, which was analysed in the intention-to-treat population, was severity of depressive symptoms as measured by the Beck Depression Inventory-II (BDI-II) at week 12 after randomisation. This trial is registered at ClinicalTrials.gov, NCT02740361, and is complete. FINDINGS Between May 3, 2017, and Nov 4, 2020, we screened 485 patients for eligibility. 279 participants were enrolled, of whom 101 were allocated to receive stand-alone iCBT, 85 to receive guided iCBT, and 93 to the control condition. The dropout rate at week 12 was 18% (50 participants). Both versions of the iCBT programme significantly reduced depressive symptoms compared with the control group (BDI-II between-group mean differences: control vs stand-alone iCBT 6·32 points [95% CI 3·37-9·27], p<0·0001, effect size d=0·97 [95% CI 0·64-1·30]; control vs guided iCBT 5·80 points [2·71-8·88], p<0·0001, effect size d=0·96 [0·62-1·30]). Clinically relevant worsening of depressive symptoms was observed in three participants in the control group, one in the stand-alone iCBT group, and none in the guided iCBT group. No occurrences of suicidality were observed during the trial and there were no deaths. INTERPRETATION This trial provides evidence for the safety and efficacy of a multiple sclerosis-specific iCBT tool to reduce depressive symptoms in patients with the disease. This remote-access, scalable intervention increases the therapeutic options in this patient group and could help to overcome treatment barriers. FUNDING National Multiple Sclerosis Society (USA).
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Affiliation(s)
- Stefan M Gold
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Medizinische Klinik mS Psychosomatik, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; German Center for Mental Health (DZPG), Berlin, Germany; Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany.
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Meyer
- Research Department, GAIA AG, Hamburg, Germany
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Joanna Hudson
- Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Susanna Asseyer
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Leisdon
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Leonie Ißels
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kristin Ritter
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David Schymainski
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hayley Pomeroy
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Sharon G Lynch
- Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Julia S Cozart
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Joan Thelen
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Cristina A F Román
- Kessler Foundation, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Margaret Cadden
- Harvard Medical School, Massachusetts General Hospital/Brigham and Women's Hospital, Boston, MA, USA
| | - Erin Guty
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Stephanie Lau
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Caren Ramien
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Susan Seddiq-Zai
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anna-Maria Kloidt
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Wieditz
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nancy L Sicotte
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Jared M Bruce
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Peter A Arnett
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
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9
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Graff LA, Geist R, Kuenzig ME, Benchimol EI, Kaplan GG, Windsor JW, Bitton A, Coward S, Jones JL, Lee K, Murthy SK, Peña-Sánchez JN, Targownik LE, Jannati N, Jones May T, Akhtar Sheekha T, Davis T, Weinstein J, Dahlwi G, Im JHB, Amankwah Osei J, Rohatinsky N, Ghandeharian S, Goddard Q, Gorospe J, Gertsman S, Louis M, Wagner R, Brass C, Sanderson R, Bernstein CN. The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2023; 6:S64-S75. [PMID: 37674499 PMCID: PMC10478810 DOI: 10.1093/jcag/gwad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn's disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There is some signal that low resilience in adolescence could be a risk factor for developing IBD and that enhancing resilience may improve mental health and intestinal disease outcomes in IBD. Psychological therapies used to treat anxiety and depression occurring in the context of IBD have been shown to significantly improve the quality of life for persons with IBD and reduce anxiety and depression. There is less evidence in regard to the impact of psychotropic medications on mental health or disease outcomes in persons with IBD. There is consensus, however, that mental health must be addressed as part of comprehensive IBD care for children and adults.
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Affiliation(s)
- Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Rose Geist
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nazanin Jannati
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tyrel Jones May
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tasbeen Akhtar Sheekha
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ghaida Dahlwi
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Amankwah Osei
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shira Gertsman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Richelle Wagner
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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10
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Marrie RA, Fisk JD, Fitzgerald K, Kowalec K, Maxwell C, Rotstein D, Salter A, Tremlett H. Etiology, effects and management of comorbidities in multiple sclerosis: recent advances. Front Immunol 2023; 14:1197195. [PMID: 37325663 PMCID: PMC10266935 DOI: 10.3389/fimmu.2023.1197195] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023] Open
Abstract
Comorbid conditions commonly affect people with multiple sclerosis (MS). Population-based studies indicate that people with MS have an increased incidence of ischemic heart disease, cerebrovascular disease, peripheral vascular disease, and psychiatric disorders as compared to people without MS. People with MS from underrepresented minority and immigrant groups have higher comorbidity burdens. Comorbidities exert effects throughout the disease course, from symptom onset through diagnosis to the end of life. At the individual level, comorbidity is associated with higher relapse rates, greater physical and cognitive impairments, lower health-related quality of life, and increased mortality. At the level of the health system and society, comorbidity is associated with increased health care utilization, costs and work impairment. A nascent literature suggests that MS affects outcomes from comorbidities. Comorbidity management needs to be integrated into MS care, and this would be facilitated by determining optimal models of care.
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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
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kathryn Fitzgerald
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kaarina Kowalec
- College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Dalia Rotstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- St. Michael’s Hospital, Toronto, ON, Canada
| | - Amber Salter
- Department of Neurology, UT Southwestern, Dallas, TX, United States
| | - Helen Tremlett
- Department of Medicine (Neurology) and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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11
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Bartocci B, Dal Buono A, Gabbiadini R, Busacca A, Quadarella A, Repici A, Mencaglia E, Gasparini L, Armuzzi A. Mental Illnesses in Inflammatory Bowel Diseases: mens sana in corpore sano. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040682. [PMID: 37109640 PMCID: PMC10145199 DOI: 10.3390/medicina59040682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023]
Abstract
Background and aims: Inflammatory bowel diseases (IBD) are chronic disorders associated with a reduced quality of life, and patients often also suffer from psychiatric comorbidities. Overall, both mood and cognitive disorders are prevalent in chronic organic diseases, especially in the case of a strong immune component, such as rheumatoid arthritis, multiple sclerosis, and cancer. Divergent data regarding the true incidence and prevalence of mental disorders in patients with IBD are available. We aimed to review the current evidence on the topic and the burden of mental illness in IBD patients, the role of the brain-gut axis in their co-existence, and its implication in an integrated clinical management. Methods: PubMed was searched to identify relevant studies investigating the gut-brain interactions and the incidence and prevalence of psychiatric disorders, especially of depression, anxiety, and cognitive dysfunction in the IBD population. Results: Among IBD patients, there is a high prevalence of psychiatric comorbidities, especially of anxiety and depression. Approximately 20-30% of IBD patients are affected by mood disorders and/or present with anxiety symptoms. Furthermore, it has been observed that the prevalence of mental illnesses increases in patients with active intestinal disease. Psychiatric comorbidities continue to be under-diagnosed in IBD patients and remain an unresolved issue in the management of these patients. Conclusions: Psychiatric illnesses co-occurring in IBD patients deserve acknowledgment from IBD specialists. These comorbidities highly impact the management of IBD patients and should be studied as an adjunctive therapeutic target.
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Affiliation(s)
- Bianca Bartocci
- IBD Center, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Arianna Dal Buono
- IBD Center, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Roberto Gabbiadini
- IBD Center, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Anita Busacca
- IBD Center, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Alessandro Quadarella
- IBD Center, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Emanuela Mencaglia
- Medical Oncology and Haematology Unit, Humanitas Cancer Center, Humanitas Research Hospital IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Linda Gasparini
- Child Neuropsychiatry Unit, Niguarda Hospital, 20162 Milan, Italy
| | - Alessandro Armuzzi
- IBD Center, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
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12
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London F, El Sankari S, De Haan A, Benyahia Z, Landenne G, Duprez T, van Pesch V. Patient-reported outcome measurements in a selective cohort of relapsing-remitting multiple sclerosis patients: relationships with physical disability, cognitive impairment, and MRI-derived metrics. Acta Neurol Belg 2023:10.1007/s13760-023-02225-x. [PMID: 36877357 DOI: 10.1007/s13760-023-02225-x] [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: 10/04/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND The added value of patient-reported outcome measures (PROMs) in addition to standard clinical outcome tools in the assessment of relapsing-remitting multiple sclerosis (RRMS) patients' status is increasingly recognized. PROMs facilitate the detection of hidden aspects of MS and help to integrate the patient's subjective experience of health-related quality of life (HRQoL) status and treatment satisfaction in a holistic way. However, the relationship between PROMs and clinical and cognitive status has been scarcely investigated up to now. OBJECTIVE To investigate the association of PROMs with physical and cognitive disability in a cohort of RRMS patients at initiation of a new disease-modifying treatment. METHODS In this cross-sectional bicenter study, 59 consecutive RRMS patients underwent neurological examination with EDSS assessment, comprehensive cognitive tests (BVMT-R, SDMT, CVLT-II) and a set of self-reported questionnaires. Lesion and brain volumes were analyzed and processed by the automated MSmetrix® software (Icometrix®, Leuven, Belgium). Spearman's correlation coefficient was used to evaluate the association of collected variables. A cross-sectional logistic regression analysis was performed to find baseline correlates of cognitive impairment. RESULTS Of the 59 RRMS patients (mean age 39 ± 9.8 years, 79.7% female, median EDSS 2.0), 33 (56%) had cognitive impairment. While almost all dimensions of health, explored by PROMs, were impacted in the overall sample, no significant difference was observed in patients with and without cognitive impairment. All PROMs were significantly associated with EDSS (R = 0.37-0.55; p < 0.05), except for the psychological component of MSIS-29, BDI and DEX-Q scores. No significant correlation was found between PROMs and cognitive performances. The cross-sectional logistic regression analysis included age, gender (female), education, EDSS, hippocampus and FLAIR lesion volumes as significant predictors of cognitive impairment. CONCLUSIONS The data highlight that PROMs provide valuable information on the well-being of PwMS closely paralleling the extent of MS-related disability, as measured by the EDSS. Additional research should determine the relevance of PROMs as longitudinal outcome measures.
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Affiliation(s)
- Frédéric London
- Department of Neurology, CHU UCL Namur Site Godinne, Université catholique de Louvain (UCLouvain), 1 avenue G. Thérasse, B-5530, Yvoir, Belgium.
| | - Souraya El Sankari
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Alice De Haan
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Zohra Benyahia
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Gaëtane Landenne
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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13
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Rademacher TD, Meuth SG, Wiendl H, Johnen A, Landmeyer NC. Molecular biomarkers and cognitive impairment in multiple sclerosis: State of the field, limitations, and future direction - A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 146:105035. [PMID: 36608917 DOI: 10.1016/j.neubiorev.2023.105035] [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: 10/12/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Multiple sclerosis (MS) is associated with cognitive impairment (CI) such as slowed information processing speed (IPS). Currently, no immunocellular or molecular markers have been established in cerebrospinal fluid and serum analysis as surrogate biomarkers with diagnostic or predictive value for the development of CI. This systematic review and meta-analysis aims to sum up the evidence regarding currently discussed markers for CI in MS. METHODS A literature search was conducted on molecular biomarkers of CI in MS, such as neurofilament light chain, chitinases, and vitamin D. RESULTS 5543 publications were screened, of which 77 entered the systematic review. 13 studies were included in the meta-analysis. Neurofilament light chain (CSF: rp = -0.294, p = 0.003; serum: rp = -0.137, p = 0.001) and serum levels of vitamin D (rp = 0.190, p = 0.014) were associated with IPS outcomes. CONCLUSIONS Neurofilament light chain and vitamin D are promising biomarkers to track impairments in IPS in MS. Further longitudinal research is needed to establish the use of molecular biomarkers to monitor cognitive decline.
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Affiliation(s)
| | - Sven G Meuth
- Department of Neurology, University Hospital Düsseldorf, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Germany
| | - Andreas Johnen
- Department of Neurology, University Hospital Münster, Germany
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14
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Foong YC, Bridge F, Merlo D, Gresle M, Zhu C, Buzzard K, Butzkueven H, van der Walt A. Smartphone monitoring of cognition in people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2023; 73:104674. [DOI: 10.1016/j.msard.2023.104674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/30/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023]
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15
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Peres DS, Rodrigues P, Viero FT, Frare JM, Kudsi SQ, Meira GM, Trevisan G. Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis. Brain Behav Immun Health 2022; 24:100484. [PMID: 35856061 PMCID: PMC9287158 DOI: 10.1016/j.bbih.2022.100484] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 06/28/2022] [Indexed: 10/31/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neurodegenerative and autoimmune disease. Motor, sensory and cognitive deficits in MS are commonly accompanied by psychiatric disorders. Depression and anxiety affect the quality of life of MS patients, and the treatment is still not well-established. Prevalence rates in MS patients for depression and anxiety vary widely between studies. However, the prevalence of these psychiatric disorders in the subgroups of MS patients and their association with a disability has not been studied yet. Therefore, this systematic review and meta-analysis proposes to estimate the prevalence of depression and anxiety in MS and to perform subgroup analyses (study type, Extended Disability Status Scale/EDSS, duration of MS, region, type of MS) on observational studies. The protocol was registered in PROSPERO (4202125033). A computerized search on PubMed, EMBASE and Scopus for studies on depression and anxiety in MS was performed from 2015 to 2021, and 12 articles were included. Most of the studies in the meta-analysis had a low risk of bias. The prevalence of depression was 27.01% (MS), 15.78% (relapsing-remitting multiple sclerosis/RRMS), and 19.13% (progressive multiple sclerosis/PMS). For anxiety the prevalence was 35.19% (MS), 21.40% (RRMS), and 24.07% (PMS). The prevalence of depression/anxiety for patients with EDSS <3 was 26.69/45.56% and for EDSS >3 was 22.96/26.70%. Using HADS-A (8) the prevalence was 38.5% and for depression was 22.4%. Then, our study brought together current data regarding psychiatric disorders in MS patients, which are comorbidities that affect the quality of life of these patients. Prevalence of depression/anxiety for the MS patients was 27.01%/35.19%. Prevalence of depression was 15.78% (RRMS) and 19.13% (PMS). Prevalence of anxiety was 21.40% (RRMS) and 24.07% (PMS). Prevalence of depression/anxiety for the patients with EDSS <3 was 26.69/45.56% and for EDSS >3 was 22.96/26.70%. Prevalence of anxiety using HADS-A (8) was 38.5% and for depression was 22.4%.
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16
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ERAY U, AYRIBAŞ B, ÇAĞLAR ÖF, HACIOĞLU T, ALİBEYOĞLU F. Post-COVID syndrome? COVID-19 survivors suffer from cognitive difficulties, somatic complaints and anxiety. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Although primarily known as a respiratory system pathology, COVID-19 may cause various systems and cause serious complications including neuropsychiatric problems. These complications may be formulized as post-COVID syndrome. The current study aims to investigate prolonged cognitive, somatic and psychiatric effects of COVID-19.
Material and Method: A total number of 120 COVID-19 survivors were compared with 120 health controls in means of three measures, which are Cognitive Failures Questionnaire (CFQ), Body Sensations Questionnaire (BSQ), Hospital Anxiety and Depression Scale (HADS) to assess cognitive difficulties, body perceptions and anxiety/depression.
Results: Our findings show that COVID-19 survivors have reported significantly more cognitive difficulties, increased body sensations and higher levels of anxiety. The groups did not differ in means of depression scores. Further, the measures were significantly correlated with each other.
Conclusion: This study reveal that COVID-19 survivors suffer from significant cognitive deficits in everyday activities, are significantly more sensitive to various body sensations and have increased anxiety levels. In discordance with the current literature, our findings showed that COVID-19 patients are not more depressed than healthy subjects. In summary, the current study showed that various neuropsychiatric complications may be an important part of prolonged effects of COVID-19.
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Affiliation(s)
- Uğur ERAY
- KARS HARAKANİ STATE HOSPİTAL, DEPARTMENT OF PSYCHİATRY
| | | | | | | | - Fatih ALİBEYOĞLU
- KAFKAS UNIVERSITY, FACULTY OF ENGINEERING AND ARCHITECTURE, DEPARTMENT OF BIOENGINEERING
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17
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van Ballegooijen H, van der Hiele K, Enzinger C, de Voer G, Visser LH. The longitudinal relationship between fatigue, depression, anxiety, disability, and adherence with cognitive status in patients with early multiple sclerosis treated with interferon beta-1a. eNeurologicalSci 2022; 28:100409. [PMID: 35733640 PMCID: PMC9207145 DOI: 10.1016/j.ensci.2022.100409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cognitive dysfunction is common in multiple sclerosis and may worsen with reduced treatment adherence. We examined longitudinal relationships between anxiety, depression, fatigue, disability and adherence with cognitive status in patients with relapsing-remitting multiple sclerosis (MS) treated with interferon beta-1a in four countries. Methods The Confidence study is a prospective study in 165 people with MS with four visits (baseline/12/24/36 months). Physical and psychological symptoms were assessed using standardized questionnaires. Adherence was calculated as the number of injections divided by number of expected injections. Cognitive status was assessed by the Brief Repeatable Battery of Neuropsychological Tests and converted to a global Z-score. Results At baseline, mean age was 35.7 ± 11 years and 66% were female (n = 109). Adherence to treatment was very high throughout the study (>99%). A depression score ≥ 8 was significantly associated with a higher risk of low cognitive status compared with a lower score (0–7): relative risk 1.79 (1.14–2.83) adjusted for education and time since diagnosis. The P-value-for-time was not significant (P = 0.304) meaning that associations existed since baseline and remained stable during follow-up. Conclusion Our findings provide evidence for a longitudinal association between depression and low cognitive status in patients treated with interferon beta-1a in routine medical practice. Long-term effects of adherence to treatment and MS symptoms with cognition are largely unknown. Depression was longitudinally associated with a higher risk of low cognitive status in a real-world population. Clinical consideration and additional investigation in the treatment of depression for cognitive benefits should be considered.
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Affiliation(s)
| | - Karin van der Hiele
- Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | | | - Gert de Voer
- Merck BV, Schiphol-Rijk, The Netherlands, an affiliate of Merck KGaA, Germany
| | - Leo H Visser
- St Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
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Uddin MN, Figley TD, Kornelsen J, Mazerolle EL, Helmick CA, O'Grady CB, Pirzada S, Patel R, Carter S, Wong K, Essig MR, Graff LA, Bolton JM, Marriott JJ, Bernstein CN, Fisk JD, Marrie RA, Figley CR. The comorbidity and cognition in multiple sclerosis (CCOMS) neuroimaging protocol: Study rationale, MRI acquisition, and minimal image processing pipelines. FRONTIERS IN NEUROIMAGING 2022; 1:970385. [PMID: 37555178 PMCID: PMC10406313 DOI: 10.3389/fnimg.2022.970385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/29/2022] [Indexed: 08/10/2023]
Abstract
The Comorbidity and Cognition in Multiple Sclerosis (CCOMS) study represents a coordinated effort by a team of clinicians, neuropsychologists, and neuroimaging experts to investigate the neural basis of cognitive changes and their association with comorbidities among persons with multiple sclerosis (MS). The objectives are to determine the relationships among psychiatric (e.g., depression or anxiety) and vascular (e.g., diabetes, hypertension, etc.) comorbidities, cognitive performance, and MRI measures of brain structure and function, including changes over time. Because neuroimaging forms the basis for several investigations of specific neural correlates that will be reported in future publications, the goal of the current manuscript is to briefly review the CCOMS study design and baseline characteristics for participants enrolled in the three study cohorts (MS, psychiatric control, and healthy control), and provide a detailed description of the MRI hardware, neuroimaging acquisition parameters, and image processing pipelines for the volumetric, microstructural, functional, and perfusion MRI data.
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Affiliation(s)
- Md Nasir Uddin
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Teresa D. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Department of Physiology and Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Erin L. Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Carl A. Helmick
- Division of Geriatric Medicine, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Christopher B. O'Grady
- Department of Anesthesia and Biomedical Translational Imaging Centre, Dalhousie University, Halifax, NS, Canada
| | - Salina Pirzada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Department of Physiology and Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sean Carter
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Kaihim Wong
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Marco R. Essig
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, 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
| | - James M. Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J. Marriott
- Department of Internal Medicine, 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
| | - John D. Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - 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
| | - Chase R. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Department of Physiology and Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Neue DC, Linden M, Muschalla B. Capacity limitations in neurology patients, with and without comorbid mental disorders. J Psychosom Res 2022; 159:110928. [PMID: 35597116 DOI: 10.1016/j.jpsychores.2022.110928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND According to the International Classification of Functioning, Disability, and Health (ICF) symptoms of illness and capacity limitations must be kept apart and assessed separately. Psychological capacities are more important than physical capacities in today's world. Patients with neurological disorders not only show limitations in physical but also in psychological capacities. As in many cases there is comorbidity of neurological and mental disorders the question is to what degree this can increase psychological incapacity. METHODS Using a cross-sectional study design, neurological patients with and without mental comorbidity were recruited in a department of neurological phase D rehabilitation. A total of 114 inpatients with both neurological and mental disorders (NM) were compared with 214 unselected patients with neurological disorders only (N). Mental comorbidity was diagnosed with the standardized "International Neuropsychiatric Interview". Capacity limitations were assessed with the "Activities and Participation in Psychological Disorders according to the International Classification of Functioning, Disability and Health" scale (Mini-ICF-APP). Qualitative reports of patients were used to validate the Mini-ICF-APP ratings. Clinical diagnoses were taken from the routine patient evaluation. RESULTS Severe capacity limitations, which are in need of support by others, could be observed especially for endurance (NM: 73.7% vs. N: 59.8% of patients), flexibility (NM: 43.0% vs. N: 22.4%), professional competency (NM: 36.0% vs. N: 16.8%), structuring of tasks (NM: 32.5% vs. N: 15.0%). Least frequent were impairment in dyadic relationships (NM: 23.7% vs. N: 7.9%). The rank order and the qualitative descriptions of impairments were similar in both groups. CONCLUSION Patients with neurological disorders in general show a relevant degree of capacity limitations. This is further substantially increased by mental comorbidity. Specific treatment is necessary.
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Affiliation(s)
- Diana Carolina Neue
- Technische Universität Braunschweig, Department of Clinical Psychology, Psychotherapy and Diagnostics, Braunschweig, Germany.
| | - Michael Linden
- Research Group Psychosomatic Rehabilitation, Department of Psychosomatic Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Beate Muschalla
- Technische Universität Braunschweig, Department of Clinical Psychology, Psychotherapy and Diagnostics, Braunschweig, Germany
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Glasmacher SA, Kearns PK, Hassan Z, Connick P, Tauber S, Reetz K, Foley P, Chandran S. The influence of disease-modifying therapy on hidden disability burden in people with newly diagnosed relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 63:103837. [PMID: 35576728 DOI: 10.1016/j.msard.2022.103837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/02/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND In addition to motor disability, "hidden disability" such as depression, anxiety, fatigue, sleep disturbance, cognitive impairment and pain is a major complaint of people with multiple sclerosis. We explored changes in hidden disability burden in the early post-diagnostic period and examined the hypothesis that disease modifying therapies have a beneficial effect on hidden disability burden. METHODS Adults with recently diagnosed (< 6 months) relapsing-remitting multiple sclerosis (n = 440, mean age 37.4 ± 10.4, 76% female), from a national multicentre cohort study (FutureMS) underwent testing with clinical and neuropsychological instruments as well as brain MRI at baseline and after 12-months. Disease modifying therapies were only started after baseline assessment and were classified into injectables (n = 70, interferons, glatiramer acetate), other DMTs (n = 215) and no DMT (n = 117, reference). Sensitivity analyses were undertaken using alternative classifications (disease modifying therapy vs none, and a 3-category system). We performed latent transition analysis with hidden disability burden as the latent variable including propensity score weights. RESULTS We identified three classes with low (58%), moderate (25%) and high (17%) hidden disability burden. 70% did not transition ("unchanged", reference), 26% transitioned into a lower burden class ("improvement") and 4% transitioned into a higher burden class ("worsening"). Median treatment duration was 11 months (IQR 9-12). Injectables [OR 1.3 (95%CIs 0.7, 2.3); P = 0.4] and other DMTs [OR 1.4 (95%CIs 0.9, 2.1); P = 0.2] were not associated with significant change in hidden disability burden in either direction ("improvement" or "worsening"). In the alternative 3-category classification, category 2 treatment (fingolimod, cladribine, n = 22) was associated with improvement [OR 4.3 (2.6, 7.0); P < 0.001]. CONCLUSION Hidden disability was present in most newly diagnosed people with multiple sclerosis. The majority remained unchanged and approximately a quarter improved over the immediate post-diagnostic period. Disease modifying therapy had no significant influence on hidden disability burden in the study period of one year following diagnosis. The trend towards favourable outcomes with fingolimod and cladribine should be interpreted with caution due to the small sample size. Our exploratory data are observational, with scope for attendant biases, but highlight the need for further study including longer-term evaluation as well as randomised trials for non-motor disability.
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Affiliation(s)
- Stella A Glasmacher
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK; RWTH Aachen University, Department of Neurology, Aachen, Germany
| | - Patrick Ka Kearns
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK; MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Zackary Hassan
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Peter Connick
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Simone Tauber
- RWTH Aachen University, Department of Neurology, Aachen, Germany
| | - Kathrin Reetz
- RWTH Aachen University, Department of Neurology, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Euan MacDonald Centre for Motor Neurone Disease Research, Chancellor's Building, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at University of Edinburgh, Chancellor's Building, Edinburgh, UK.
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Riccitelli GC, Pacifico D, Manconi M, Sparasci D, Sacco R, Gobbi C, Zecca C. RELATIONSHIP BETWEEN COGNITIVE DISTURBANCES AND SLEEP DISORDERS IN MULTIPLE SCLEROSIS IS MODULATED BY PSYCHIATRIC SYMPTOMS. Mult Scler Relat Disord 2022; 64:103936. [DOI: 10.1016/j.msard.2022.103936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
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22
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Marrie RA, Patel R, Figley CR, Kornelsen J, Bolton JM, Graff LA, Mazerolle EL, Helmick C, Uddin MN, Figley TD, Marriott JJ, Bernstein CN, Fisk JD. Effects of Vascular Comorbidity on Cognition in Multiple Sclerosis Are Partially Mediated by Changes in Brain Structure. Front Neurol 2022; 13:910014. [PMID: 35685743 PMCID: PMC9170886 DOI: 10.3389/fneur.2022.910014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 01/09/2023] Open
Abstract
ObjectiveVascular comorbidities are associated with reduced cognitive performance and with changes in brain structure in people with multiple sclerosis (MS). Understanding causal pathways is necessary to support the design of interventions to mitigate the impacts of comorbidities, and to monitor their effectiveness. We assessed the inter-relationships among vascular comorbidity, cognition and brain structure in people with MS.MethodsAdults with neurologist-confirmed MS reported comorbidities, and underwent assessment of their blood pressure, HbA1c, and cognitive functioning (i.e., Symbol Digit Modalities Test, California Verbal Learning Test, Brief Visuospatial Memory Test-Revised, and verbal fluency). Test scores were converted to age-, sex-, and education-adjusted z-scores. Whole brain magnetic resonance imaging (MRI) was completed, from which measures of thalamic and hippocampal volumes, and mean diffusivity of gray matter and normal-appearing white matter were converted to age and sex-adjusted z-scores. Canonical correlation analysis was used to identify linear combinations of cognitive measures (cognitive variate) and MRI measures (MRI variate) that accounted for the most correlation between the cognitive and MRI measures. Regression analyses were used to test whether MRI measures mediated the relationships between the number of vascular comorbidities and cognition measures.ResultsOf 105 participants, most were women (84.8%) with a mean (SD) age of 51.8 (12.8) years and age of symptom onset of 29.4 (10.5) years. Vascular comorbidity was common, with 35.2% of participants reporting one, 15.2% reporting two, and 8.6% reporting three or more. Canonical correlation analysis of the cognitive and MRI variables identified one pair of variates (Pillai's trace = 0.45, p = 0.0035). The biggest contributors to the cognitive variate were the SDMT and CVLT-II, and to the MRI variate were gray matter MD and thalamic volume. The correlation between cognitive and MRI variates was 0.50; these variates were used in regression analyses. On regression analysis, vascular comorbidity was associated with the MRI variate, and with the cognitive variate. After adjusting for the MRI variate, vascular comorbidity was not associated with the cognitive variate.ConclusionVascular comorbidity is associated with lower cognitive function in people with MS and this association is partially mediated via changes in brain macrostructure and microstructure.
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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
- *Correspondence: Ruth Ann Marrie
| | - Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, 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
| | - Erin L. Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Carl Helmick
- Department of Psychiatry and Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Md Nasir Uddin
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Neurology, University of Rochester, Rochester, New York, NY, United States
| | - Teresa D. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J. Marriott
- Department of Internal Medicine, 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
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
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Matisz C, Gruber A. Neuroinflammatory remodeling of the anterior cingulate cortex as a key driver of mood disorders in gastrointestinal disease and disorders. Neurosci Biobehav Rev 2022; 133:104497. [DOI: 10.1016/j.neubiorev.2021.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 02/08/2023]
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Kowalec K, Salter A, Fitzgerald KC, Patel M, Han J, Lu Y, Bolton JM, Hitchon C, Bernstein CN, Patten S, Graff LA, Marriott JJ, Marrie RA. Depressive symptom trajectories and polygenic risk scores in individuals with an immune-mediated inflammatory disease. Gen Hosp Psychiatry 2022; 77:21-28. [PMID: 35461162 PMCID: PMC9724746 DOI: 10.1016/j.genhosppsych.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop group-based trajectories of depressive symptoms in immune-mediated inflammatory disease (IMID) to understand their evolution and identify any associated factors, with the overall goal of identifying those at highest risk of higher depressive symptom burden. METHOD 922 participants had an IMID or anxiety/depression. The PHQ-9 was administered at four visits, and polygenic risk scores (PRS) for major depressive disorder, depressive symptoms, and body mass index (BMI) were generated. Group-based trajectory modelling of PHQ-9 scores estimated distinct trajectories. Regression tested whether specific factors were associated with the trajectories. Mediation analyses assessed whether IMID mediated the association between BMI PRS and trajectories. RESULTS Three trajectories were identified. Regression demonstrated those in Group 3 ('high symptoms') had significantly higher PRS for the three traits, compared to Group 1 ('minimal symptoms') (OR: 1.34-1.66, P < 0.01). Stratified analyses in the IMID subgroup revealed an increased effect for BMI PRS in Group 3 (OR: 2.31, P < 0.001), in contrast, BMI PRS was no longer associated in the non-IMID sample. No significant indirect effect of BMI PRS on depressive symptoms trajectories was identified via IMID. CONCLUSIONS A significant association between polygenicity and PHQ-9 trajectories supports a role for genetic inheritance in the variability in depressive symptoms in IMID.
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Affiliation(s)
- Kaarina Kowalec
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Canada; Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Sweden.
| | - Amber Salter
- Department of Neurology, UT Southwestern, Dallas, TX, USA
| | | | - Mitulkumar Patel
- Department of Physics and Astronomy, Auroral Imaging Group, University of Calgary, Canada
| | | | - Yi Lu
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Sweden
| | - James M. Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Carol Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada,Department of Rheumatology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Charles N. Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Lesley A. Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - James J. Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Ruth Ann Marrie
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:891-903. [DOI: 10.1093/arclin/acac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/12/2022] Open
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Landrigan J, Bessenyei K, Leitner D, Yakovenko I, Fisk JD, Prentice JL. A systematic review of the effects of cannabis on cognition in people with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103338. [DOI: 10.1016/j.msard.2021.103338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
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Schorr EM, Kurz D, Rossi KC, Zhang M, Yeshokumar AK, Jette N, Dhamoon MS. Depression readmission risk is elevated in multiple sclerosis compared to other chronic illnesses. Mult Scler 2021; 28:139-148. [PMID: 34787004 DOI: 10.1177/13524585211051316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Assess readmissions for depression or suicide attempt (SA) after MS admission versus other chronic inflammatory illnesses. METHODS This retrospective cohort study identified MS, asthma, rheumatoid arthritis (RA), depression, and SA in the 2013 National Readmissions Database by International Classification of Diseases codes. Index admissions (MS, n = 7698; asthma, n = 93,590; RA, n = 3685) and depression or SA readmission rates were analyzed. Hazard ratios (HRs) estimated 1-year depression/SA readmission hazard, comparing MS to asthma or RA, adjusting for age, sex, psychiatric comorbidity, substance abuse, tobacco use, income, and index hospitalization characteristics. RESULTS MS had more baseline depression (24.7%) versus asthma (15.6%) and RA (14.6%). Ninety-day depression readmission rate was higher in MS (0.5%) than asthma (0.3%) and RA (0.03%). Depression readmission HR was higher after MS admission versus asthma (HR = 1.37, 95% confidence interval (CI) = 1.00-1.86, p = 0.0485) and RA (HR = 4.68, 95% CI = 1.60-13.62, p = 0.0047). HR was not different for SA readmission across groups. Depression readmission HR was more than double in MS patients with psychiatric disease or substance abuse versus RA or asthma patients with either comorbidity. CONCLUSION Depression readmission risk after MS hospitalization was elevated versus asthma/RA. Substance use and baseline psychiatric comorbidity were more strongly associated with depression readmission in MS patients.
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Affiliation(s)
- Emily M Schorr
- Division of Neuroimmunology and Neuroinfectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Kurz
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Kyle C Rossi
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Margaret Zhang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anusha K Yeshokumar
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Liuzza MT, Spagnuolo R, Antonucci G, Grembiale RD, Cosco C, Iaquinta FS, Funari V, Dastoli S, Nistico S, Doldo P. Psychometric evaluation of an Italian custom 4-item short form of the PROMIS anxiety item bank in immune-mediated inflammatory diseases: an item response theory analysis. PeerJ 2021; 9:e12100. [PMID: 34760342 PMCID: PMC8556715 DOI: 10.7717/peerj.12100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/10/2021] [Indexed: 12/26/2022] Open
Abstract
Background There has recently been growing interest in the roles of inflammation in contributing to the development of anxiety in people with immune-mediated inflammatory diseases (IMID). Patient-reported outcome measures can facilitate the assessment of physical and psychological functioning. The National Institutes of Health (NIH)'s Patient-Reported Outcomes Measurement Information System (PROMIS®) is a set of Patient-Reported Outcomes (PROs) that cover physical appearance, mental health, and social health. The PROMIS has been built through an Item Response Theory approach (IRT), a model-based measurement in which trait level estimates depend on both persons' responses and on the properties of the items that were administered. The aim of this study is to test the psychometric properties of an Italian custom four-item Short Form of the PROMIS Anxiety item bank in a cohort of outpatients with IMIDs. Methods We selected four items from the Italian standard Short Form Anxiety 8a and administered them to consecutive outpatients affected by Inflammatory Bowel disease (n = 246), rheumatological (n = 100) and dermatological (n = 43) diseases, and healthy volunteers (n = 280). Data was analyzed through an Item Response Theory (IRT) analysis in order to evaluate the psychometric properties of the Italian adaptation of the PROMIS anxiety short form. Results Taken together, Confirmatory Factor Analysis and Exploratory Factor analysis suggest that the unidimensionality assumption of the instrument holds. The instrument has excellent reliability from a Classical Theory of Test (CTT) standpoint (Cronbach's α = 0.93, McDonald's ω = 0.92). The 2PL Graded Response Model (GRM) model provided showed a better goodness of fit as compared to the 1PL GRM model, and local independence assumption appears to be met overall. We did not find signs of differential item functioning (DIF) for age and gender, but evidence for uniform (but not non-uniform) DIF was found in three out of four items for the patient vs. control group. Analysis of the test reliability curve suggested that the instrument is most reliable for higher levels of the latent trait of anxiety. The groups of patients exhibited higher levels of anxiety as compared to the control group (ps < 0.001, Bonferroni-corrected). The groups of patients were not different between themselves (p = 1, Bonferroni-corrected). T-scores based on estimated latent trait and raw scores were highly correlated (Pearson's r = 0.98) and led to similar results. Discussion The Italian custom four-item short form from the PROMIS anxiety form 8a shows acceptable psychometric properties both from a CTT and an IRT standpoint. The Test Reliability Curve shows that this instrument is mostly informative for people with higher levels of anxiety, making it particularly suitable for clinical populations such as IMID patients.
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Affiliation(s)
- Marco Tullio Liuzza
- Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Calabria, Italy
| | - Rocco Spagnuolo
- Department of Clinical and Experimental Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Calabria, Italy
| | - Gabriella Antonucci
- IRCCS Santa Lucia Foundation, Rome, Lazio, Italy.,Department of Psychology, University of Roma "La Sapienza", Rome, Lazio, Italy
| | - Rosa Daniela Grembiale
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Calabria, Italy
| | - Cristina Cosco
- Department of Clinical and Experimental Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Calabria, Italy
| | | | - Vanessa Funari
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Calabria, Italy
| | - Stefano Dastoli
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Calabria, Italy
| | - Steven Nistico
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Calabria, Italy
| | - Patrizia Doldo
- Department of Clinical and Experimental Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Calabria, Italy
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Talley S, Valiauga R, Anderson L, Cannon AR, Choudhry MA, Campbell EM. DSS-induced inflammation in the colon drives a proinflammatory signature in the brain that is ameliorated by prophylactic treatment with the S100A9 inhibitor paquinimod. J Neuroinflammation 2021; 18:263. [PMID: 34758843 PMCID: PMC8578918 DOI: 10.1186/s12974-021-02317-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is established to drive pathological sequelae in organ systems outside the intestine, including the central nervous system (CNS). Many patients exhibit cognitive deficits, particularly during disease flare. The connection between colonic inflammation and neuroinflammation remains unclear and characterization of the neuroinflammatory phenotype in the brain during colitis is ill-defined. Methods Transgenic mice expressing a bioluminescent reporter of active caspase-1 were treated with 2% dextran sodium sulfate (DSS) for 7 days to induce acute colitis, and colonic, systemic and neuroinflammation were assessed. In some experiments, mice were prophylactically treated with paquinimod (ABR-215757) to inhibit S100A9 inflammatory signaling. As a positive control for peripheral-induced neuroinflammation, mice were injected with lipopolysaccharide (LPS). Colonic, systemic and brain inflammatory cytokines and chemokines were measured by cytokine bead array (CBA) and Proteome profiler mouse cytokine array. Bioluminescence was quantified in the brain and caspase activation was confirmed by immunoblot. Immune cell infiltration into the CNS was measured by flow cytometry, while light sheet microscopy was used to monitor changes in resident microglia localization in intact brains during DSS or LPS-induced neuroinflammation. RNA sequencing was performed to identify transcriptomic changes occurring in the CNS of DSS-treated mice. Expression of inflammatory biomarkers were quantified in the brain and serum by qRT-PCR, ELISA and WB. Results DSS-treated mice exhibited clinical hallmarks of colitis, including weight loss, colonic shortening and inflammation in the colon. We also detected a significant increase in inflammatory cytokines in the serum and brain, as well as caspase and microglia activation in the brain of mice with ongoing colitis. RNA sequencing of brains isolated from DSS-treated mice revealed differential expression of genes involved in the regulation of inflammatory responses. This inflammatory phenotype was similar to the signature detected in LPS-treated mice, albeit less robust and transient, as inflammatory gene expression returned to baseline following cessation of DSS. Pharmacological inhibition of S100A9, one of the transcripts identified by RNA sequencing, attenuated colitis severity and systemic and neuroinflammation. Conclusions Our findings suggest that local inflammation in the colon drives systemic inflammation and neuroinflammation, and this can be ameliorated by inhibition of the S100 alarmin, S100A9. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02317-6.
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Affiliation(s)
- Sarah Talley
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL, USA
| | - Rasa Valiauga
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Lillian Anderson
- Alcohol Research Program, Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Science Division, Maywood, IL, USA
| | - Abigail R Cannon
- Alcohol Research Program, Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Science Division, Maywood, IL, USA
| | - Mashkoor A Choudhry
- Alcohol Research Program, Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Science Division, Maywood, IL, USA
| | - Edward M Campbell
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL, USA. .,Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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Kopchak OO, Odintsova TA. Cognitive impairment and depression in patients with relapsing-remitting multiple sclerosis depending on age and neuroimaging findings. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:119. [PMID: 34511865 PMCID: PMC8424158 DOI: 10.1186/s41983-021-00376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Multiple sclerosis is an insidious, disabling, both physically and mentally, demyelinating disease of the central nervous system. This work aims to evaluate relationships between cognitive impairment in separate domains, depression and their correspondence with MRI-findings, as well as the influence on each other’s manifestations, in patients with relapsing–remitting multiple sclerosis.
Results Visual–spatial/executive functions and memory domains suffered more frequently than others in the study subjects under 40 years; in patients over 40 years old memory, visual–spatial/executive functions and abstract thinking impairment prevailed the most. Such cognitive domains as memory, language, abstract thinking, visual–spatial and executive functions were impacted in both groups of patients even without the apparent cognitive decline according to MoCA scale. Presence of depression impacted language and attention more prominently than the rest of the domains only in participants younger 40 years. According to the MRI, frontal lobe, corpus callosum and periventricular area were affected more often compared to other brain regions in case of cognitive impairment; meanwhile, combined lesions of frontal lobe and corpus callosum, fronto-temporal region were associated with depression. Conclusion Cognitive impairment and depression are one of the common, yet disabling and socially disrupting manifestations of MS. Quite frequently such complaints are neglected or considered as parts of comorbidities. At the same time cognitive impairment can be amplified by depression, especially in patients under 40 years.
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Affiliation(s)
- Oksana O Kopchak
- Department of Neurology, Psychiatry and Physical Rehabilitation, Kyiv Medical University of UAFM, Boryspilska 2, Kyiv, Ukraine
| | - Tetiana A Odintsova
- Department of Neurology, Psychiatry and Physical Rehabilitation, Kyiv Medical University of UAFM, Boryspilska 2, Kyiv, Ukraine
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Nightingale TE, Heneghan NR, Fenton SAM, Veldhuijzen van Zanten JJCS, Jutzeler CR. Physical Activity and Health-Related Quality of Life in Adults With a Neurologically-Related Mobility Disability During the COVID-19 Pandemic: An Exploratory Analysis. Front Neurol 2021; 12:699884. [PMID: 34512516 PMCID: PMC8429606 DOI: 10.3389/fneur.2021.699884] [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] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/03/2021] [Indexed: 12/18/2022] Open
Abstract
Background: During the coronavirus-19 (COVID-19) pandemic various containment strategies were employed. Their impact on individuals with neurological conditions, considered vulnerable to COVID-19 complications, remains to be determined. Objective: To investigate associations between physical activity and health-related quality of life outcomes in individuals with a neurological condition during government mandated COVID-19 restrictions. Methods: An e-survey assessing fear of COVID-19, physical activity level and health-related quality of life outcomes (functional disability and pain, anxiety and depression, loneliness, fatigue, and vitality) was distributed to individuals with a neurologically-related mobility disability living in the United Kingdom. Open-ended questions were also included to contextualize barriers and facilitators to engage in physical activity during the COVID-19 pandemic. Gamma-weighted generalized linear models and tree-structured regression models were employed to determine the associations between physical activity and health-related quality of life. Results: Of 199 responses, 69% reported performing less physical activity compared to pre-pandemic. Tree-structured regression models revealed that lower leisure-time physical activity was significantly associated (p ≤ 0.009) with higher depression and fatigue, but lower vitality. The closure of leisure facilities and organized sport (27%) was the most commonly cited barrier to engage in physical activity, while 31% of participants mentioned concerns around their physical and mental health as a facilitator. Conclusion: Our analysis identified homogenous subgroups for depression, fatigue, and vitality based specifically on leisure-time physical activity cut points, irrespective of additional demographic or situational characteristics. Findings highlight the importance of and need to safely promote leisure-time physical activity during the COVID-19 pandemic in this at-risk population to help support health-related quality of life.
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Affiliation(s)
- Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sally A M Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Jet J C S Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Catherine R Jutzeler
- Department of Biosystems Science and Engineering, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.,SIB Swiss Institute of Bioinformatics, Ecublens, Switzerland
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Bernstein CN, Nugent Z, Shaffer S, Singh H, Marrie RA. Comorbidity before and after a diagnosis of inflammatory bowel disease. Aliment Pharmacol Ther 2021; 54:637-651. [PMID: 34156724 DOI: 10.1111/apt.16444] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Comorbidity is an important predictor of how disease course in inflammatory bowel (IBD) evolves. AIMS To determine pre-diagnosis relative rates (RR) and post-diagnosis hazard ratios (HR) of component diseases of the Charlson Comorbidity Index (CCI) in a cohort study of persons with IBD. METHODS The University of Manitoba IBD Epidemiology Database includes all Manitobans with IBD from 1 April 1984 through 31 March 2018 and matched controls. All outpatient physician claims and hospital discharge abstracts were searched for diagnostic codes for CCI component diseases. Some diseases were collapsed into one group such that we assessed 12 conditions. We report the RR of these conditions prior to IBD and the incidence of these diagnoses after IBD. Using Cox proportional hazards regression we report post-diagnosis HR. Confidence intervals were adjusted for Bonferroni correction. RESULTS The RR of cardiovascular diseases, peripheral vascular diseases, chronic pulmonary diseases, connective tissue disease/rheumatic diseases, renal disease, liver diseases, peptic ulcer disease, and cancer were all increased prior to diagnoses of IBD compared to controls. All comorbidities were increased post IBD diagnosis. The increased HR for dementia in persons with Crohn's disease was a concerning novel finding. The increased association with paraplegia/hemiplegia was unexpected. For all comorbidities, except diabetes, the age at diagnosis was younger in IBD than controls. CONCLUSIONS Persons with IBD have a higher comorbidity burden than persons without IBD. Optimal care plans for persons with IBD should include an assessment for other comorbidities that include just about every other organ system.
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Affiliation(s)
- Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada
| | - Zoann Nugent
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada.,Cancercare Manitoba, Winnipeg, MB, Canada
| | - Seth Shaffer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada
| | - Harminder Singh
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes. Rev Port Cardiol 2021; 40:547-555. [PMID: 34392896 DOI: 10.1016/j.repce.2020.09.008] [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: 03/24/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood. OBJECTIVES To assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact. METHODS Prospective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6th and 12th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death. RESULTS 43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score <22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA. CONCLUSIONS Cognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis.
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Type 1 interferon mediates chronic stress-induced neuroinflammation and behavioral deficits via complement component 3-dependent pathway. Mol Psychiatry 2021; 26:3043-3059. [PMID: 33833372 PMCID: PMC8497654 DOI: 10.1038/s41380-021-01065-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
Chronic stress is a major risk factor in the pathophysiology of many neuropsychiatric disorders. Further, chronic stress conditions can promote neuroinflammation and inflammatory responses in both humans and animal models. Type I interferons (IFN-I) are critical mediators of the inflammatory response in the periphery and responsible for the altered mood and behavior. However, the underlying mechanisms are not well understood. In the present study, we investigated the role of IFN-I signaling in chronic stress-induced changes in neuroinflammation and behavior. Using the chronic restraint stress model, we found that chronic stress induces a significant increase in serum IFNβ levels in mice, and systemic blockade of IFN-I signaling attenuated chronic stress-induced infiltration of macrophages into prefrontal cortex and behavioral abnormalities. Furthermore, complement component 3 (C3) mediates systemic IFNβ-induced changes in neuroinflammation and behavior. Also, we found significant increases in the mRNA expression levels of IFN-I stimulated genes in the prefrontal cortex of depressed suicide subjects and significant correlation with C3 and inflammatory markers. Together, these findings from animal and human postmortem brain studies identify a crucial role of C3 in IFN-I-mediated changes in neuroinflammation and behavior under chronic stress conditions.
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Cognitive trajectories in multiple sclerosis: a long-term follow-up study. Neurol Sci 2021; 43:1215-1222. [PMID: 34105018 PMCID: PMC8789689 DOI: 10.1007/s10072-021-05356-2] [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: 03/01/2021] [Accepted: 05/28/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cognitive impairment occurs in multiple sclerosis (MS) and undergoes a progressive worsening over disease course. However, clinicians still struggle to predict the course of cognitive function. To evaluate baseline clinical and imaging predictors of cognitive abilities worsening over time, we performed a latent trajectory analysis for cognitive performances in MS patients, up to 15 years from disease onset. METHODS We collected age, sex, education, dominant and non-dominant 9-hole peg test (9HP) and timed 25-foot walk (T25-FW) as well as MRI measures (grey matter volume and lesion load) within 6 months from disease diagnosis for relapsing-remitting MS (RR-MS) patients. At diagnosis and over the follow-up, we also assessed cognitive status through the symbol digit modalities test (SDMT). Cognitive impairment was defined by applying age-, gender- and education-adjusted normative values. Group-based trajectory analysis was performed to determine trajectories, and the predictive value of clinical and imaging variables at baseline was assessed through multinomial logistic regression. RESULTS We included 148 RR-MS (98 females and 50 males). Over 11 ± 4 year follow-up, 51.4% remained cognitively stable whereas 48.6% cognitively worsened. Cognitively worsening patients had a higher T25FW time (p = 0.004) and a reduced hippocampal volume at baseline (p = 0.04). CONCLUSION Physical disability as well as hippocampal atrophy might depict patients at risk of cognitive worsening over the disease course. Therefore, using such predictors, clinicians may select patients to carefully evaluate for cognitive impairment as to eventually introduce cognitive rehabilitation treatments.
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Lakin L, Davis BE, Binns CC, Currie KM, Rensel MR. Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms-A Narrative Review. Neurol Ther 2021; 10:75-98. [PMID: 33877583 PMCID: PMC8057008 DOI: 10.1007/s40120-021-00239-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system, leading to neurodegeneration and manifesting as a variety of symptoms. These can include "invisible" symptoms, not externally evident to others, such as fatigue, mood disorders, cognitive impairments, pain, bladder/bowel dysfunction, sexual dysfunction, and vision changes. Invisible symptoms are highly prevalent in people living with MS, with multifactorial etiology and potential to impact the disease course. Patient experiences of these symptoms include both physical and psychosocial elements, which when unaddressed negatively influence many aspects of quality of life and perception of health. Despite the high impact on patient lives, gaps persist in awareness and management of these hidden symptoms. The healthcare provider and patient author experiences brought together here serve to raise the profile of invisible symptoms and review strategies for a team-based approach to comprehensive MS care. We summarize the current literature regarding the prevalence and etiology of invisible symptoms to convey the high likelihood that a person living with MS will contend with one or more of these concerns. We then explore how open communication between people living with MS and their care team, stigma mitigation, and shared decision-making are key to comprehensive management of invisible symptoms. We recommend validated screening tools and technological advancements that may be incorporated into MS care to regularly monitor these symptoms, offering insight into how healthcare providers can both educate and listen to patients, with the goal of improved patient quality of life. By pairing clinical knowledge with an understanding and consideration of the patient perspective, providers will be equipped to foster a patient-centered dialogue that encourages shared decision-making. Invisible symptoms of MS.
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Affiliation(s)
- Lynsey Lakin
- The Neurology Group, 9120 Haven Ave, Rancho Cucamonga, CA, USA
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Bryan E Davis
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Cherie C Binns
- Accelerated Cure Project/iConquerMS, 187 Robinson Street, Wakefield, RI, USA
| | - Keisha M Currie
- Currie Consultancy Agency LLC., 11 M. R. Watson Court, Eastover, SC, USA
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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Sumowski JF, Horng S, Brandstadter R, Krieger S, Leavitt VM, Katz Sand I, Fabian M, Klineova S, Graney R, Riley CS, Lublin FD, Miller AE, Varga AW. Sleep disturbance and memory dysfunction in early multiple sclerosis. Ann Clin Transl Neurol 2021; 8:1172-1182. [PMID: 33951348 PMCID: PMC8164863 DOI: 10.1002/acn3.51262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Sleep-dependent memory processing occurs in animals including humans, and disturbed sleep negatively affects memory. Sleep disturbance and memory dysfunction are common in multiple sclerosis (MS), but little is known about the contributions of sleep disturbance to memory in MS. We investigated whether subjective sleep disturbance is linked to worse memory in early MS independently of potential confounders. METHODS Persons with early MS (n = 185; ≤5.0 years diagnosed) and demographically matched healthy controls (n = 50) completed four memory tests to derive a memory composite, and four speeded tests to derive a cognitive efficiency composite. Z-scores were calculated relative to healthy controls. Sleep disturbance was defined by the Insomnia Severity Index score ≥ 10. ANCOVAs examined differences in memory and cognitive efficiency between patients with and without sleep disturbance controlling for potential confounds (e.g., mood, fatigue, disability, T2 lesion volume, gray matter volume). Comparisons were made to healthy controls. RESULTS Seventy-four (40%) patients reported sleep disturbance. Controlling for all covariates, patients with sleep disturbance had worse memory (z = -0.617; 95% CI: -0.886, -0.348) than patients without disturbance (z = -0.171, -0.425, 0.082, P = .003). Cognitive efficiency did not differ between groups. Relative to healthy controls, memory was worse among patients with sleep disturbance, but not among patients without sleep disturbance. INTERPRETATION Sleep disturbance contributes to MS memory dysfunction, which may help explain differential risk for memory dysfunction in persons with MS, especially since sleep disturbance is common in MS. Potential mechanisms linking sleep disturbance and memory are discussed, as well as recommendations for further mechanistic and interventional research.
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Affiliation(s)
- James F. Sumowski
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sam Horng
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Rachel Brandstadter
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Stephen Krieger
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Victoria M. Leavitt
- Department of NeurologyColumbia University Medical CenterNew YorkNew YorkUSA
| | - Ilana Katz Sand
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Michelle Fabian
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sylvia Klineova
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Robin Graney
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Claire S. Riley
- Department of NeurologyColumbia University Medical CenterNew YorkNew YorkUSA
| | - Fred D. Lublin
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Aaron E. Miller
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew W. Varga
- Icahn School of Medicine at Mount SinaiDivision of PulmonaryCritical Care and Sleep MedicineNew YorkNew YorkUSA
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Lozano-Soto E, Cruz-López ÁJ, Gutiérrez R, González M, Sanmartino F, Rashid-Lopez R, Espinosa-Rosso R, Forero L, González-Rosa JJ. Predicting Neuropsychological Impairment in Relapsing Remitting Multiple Sclerosis: The Role of Clinical Measures, Treatment, and Neuropsychiatry Symptoms. Arch Clin Neuropsychol 2021; 36:475-484. [PMID: 33067616 DOI: 10.1093/arclin/acaa088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This retrospective observational study aimed to define neuropsychological impairment (NI) profiles and determine the influence of clinical, demographic, and neuropsychiatric measures in specific cognitive domains in a cohort of relapsing-remitting multiple sclerosis (RRMS) patients. METHODS Ninety-one RRMS patients underwent a neurological examination and a brief neuropsychological assessment. Patients were classified according to the disease-modifying therapies (DMTs) received (platform or high-efficacy). Differences between groups and multiple regression analyses were performed to determine the predictive value of the assessed measures in cognitive performance. RESULTS More than two-thirds of the patients showed NI. Specifically, mild to moderate NI was presented in approximately half of the participants. Paced Auditory Serial Addition Test (PASAT-3) and Symbol Digit Modalities Test (SDMT) were the most frequently impaired cognitive tests (45.3% and 41.3%, respectively) followed by phonemic verbal fluency (PVF) (27.8%). Expanded Disability Status Scale (EDSS), age, depressive symptoms, and disease duration were the best predictors of SDMT (R2 = .34; p < .01), whereas disease duration, EDSS, and anxiety-state levels predicted PASAT-3 (R2 = .33, p < .01). Educational level, age, EDSS, and depressive symptoms demonstrated the strongest association with PVF (R2 = .31, p < .01). CONCLUSIONS Our results indicated a significant prevalence of NI in RRMS patients that was not dependent on the DMT type. In addition to the meaningful working memory (PASAT-3) and information processing speed (SDMT) impairments found, PVF deficits may also be an important marker of cognitive impairment in RRMS patients. This study supports the relevance of standard clinical measures and reinforces the importance of quantifying clinical and neuropsychiatric symptoms to predict subsequent cognitive performance on a similar multiple sclerosis phenotype and disease stage.
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Affiliation(s)
- Elena Lozano-Soto
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
| | | | - Rafael Gutiérrez
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Macarena González
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Florencia Sanmartino
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
| | - Raúl Rashid-Lopez
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Lucía Forero
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Javier J González-Rosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain.,Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
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Bhattacharjee S, Yegezu Z, Kollecas K, Duhrkopf K, Hashemi L, Greene N. Influence of Comorbidities on Healthcare Expenditures and Perceived Physical and Mental Health Status Among Adults with Multiple Sclerosis: A Propensity Score-Matched US National-Level Study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:377-394. [PMID: 34017188 PMCID: PMC8129918 DOI: 10.2147/ceor.s305154] [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: 02/17/2021] [Accepted: 04/30/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the effect of comorbidities on healthcare expenditures and perceived physical and mental health status among adults with multiple sclerosis (MS) compared to propensity score-matched non-MS controls. Methods A retrospective, cross-sectional, matched cohort study was conducted using Medical Expenditure Panel Survey (2005–2015) data. The base study sample consisted of adults (age ≥18 years) who were alive and had positive total healthcare expenditures during the survey calendar year. Adults with MS were propensity-matched (1:1) to non-MS controls based on age, gender, and race/ethnicity using greedy matching algorithm. Healthcare expenditures consisted of total and subtypes of expenditures. Health status consisted of perceived physical and mental health status. Comorbidities were identified using ICD-9-CM and Clinical Classification System codes. Ordinary least squares regression and multinomial logistic regression were used to analyze the healthcare expenditures and health status variables, respectively. Results Final study sample consisted of 541 adults in each MS and non-MS control groups after propensity score matching. After adjusting for potential confounders, individuals with MS had greater total and subtypes of expenditures compared to non-MS controls, and several comorbidities (eg, depression, hypertension) were significantly associated with increased healthcare expenditures. Yearly average total expenditures (expressed in 2018 US$) were significantly (p<0.001) higher for adults with MS ($29,396) than propensity score-matched non-MS adults ($7875). Moreover, after adjusting for all individual-level factors, adults with MS experienced 363% (p<0.001) higher total expenditures compared to propensity score-matched non-MS controls. Individuals with MS were more likely to report poorer physical and good mental health status compared to propensity score-matched non-MS controls, and several comorbidities (eg, anxiety, depression) were significant independent predictors of poorer health status. For example, adults with MS were four times more likely (OR: 4.10, 95% CI: 2.42–6.96) to report fair/poor physical health status compared to excellent/very good physical health status compared with non-MS controls. Adults with MS were 42% (OR: 1.42, 95% CI: 1.01–1.99) more likely than propensity score-matched non-MS controls to report good rather than very good or excellent mental health status. However, there was no difference between adults with MS and propensity score-matched non-MS controls in terms of reporting fair or poor than very good or excellent mental health status. Conclusion Findings from this study indicate substantial economic and health status burdens among adults with MS at the US national-level that are significantly influenced by comorbidities.
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Affiliation(s)
- Sandipan Bhattacharjee
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Zufan Yegezu
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Kristin Kollecas
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
| | - Kevin Duhrkopf
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
| | - Lobat Hashemi
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
| | - Nupur Greene
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
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40
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Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes. Rev Port Cardiol 2021. [PMID: 33994046 DOI: 10.1016/j.repc.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood. OBJECTIVES To assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact. METHODS Prospective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6th and 12th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death. RESULTS 43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score <22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA. CONCLUSIONS Cognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis.
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Sarno E, Moeser AJ, Robison AJ. Neuroimmunology of depression. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2021; 91:259-292. [PMID: 34099111 DOI: 10.1016/bs.apha.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Depression is one of the leading causes of disability worldwide and a major contributor to the global burden of disease, yet the cellular and molecular etiology of depression remain largely unknown. Major Depressive Disorder (MDD) is associated with a variety of chronic physical inflammatory and autoimmune disorders, and mood disorders may act synergistically with other medical disorders to worsen patient outcomes. Here, we outline the neuroimmune complement, explore the evidence for altered immune system function in MDD, and present some of the potential mechanisms by which immune cells and molecules may drive the onset and course of MDD. These include pro-inflammatory signaling, alterations in the hypothalamic-pituitary-adrenal axis, dysregulation of the serotonergic and noradrenergic neurotransmitter systems, neuroinflammation, and meningeal immune dysfunction. Finally, we discuss the interactions between current antidepressants and the immune system and propose the possibility of immunomodulatory drugs as potential novel antidepressant treatments.
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Affiliation(s)
- Erika Sarno
- Department of Physiology, Michigan State University, East Lansing, MI, United States
| | - Adam J Moeser
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Alfred J Robison
- Department of Physiology, Michigan State University, East Lansing, MI, United States.
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Vecchiarelli HA, Morena M, Keenan CM, Chiang V, Tan K, Qiao M, Leitl K, Santori A, Pittman QJ, Sharkey KA, Hill MN. Comorbid anxiety-like behavior in a rat model of colitis is mediated by an upregulation of corticolimbic fatty acid amide hydrolase. Neuropsychopharmacology 2021; 46:992-1003. [PMID: 33452437 PMCID: PMC8115350 DOI: 10.1038/s41386-020-00939-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 12/06/2020] [Indexed: 01/29/2023]
Abstract
Peripheral inflammatory conditions, including those localized to the gastrointestinal tract, are highly comorbid with psychiatric disorders such as anxiety and depression. These behavioral symptoms are poorly managed by conventional treatments for inflammatory diseases and contribute to quality of life impairments. Peripheral inflammation is associated with sustained elevations in circulating glucocorticoid hormones, which can modulate central processes, including those involved in the regulation of emotional behavior. The endocannabinoid (eCB) system is exquisitely sensitive to these hormonal changes and is a significant regulator of emotional behavior. The impact of peripheral inflammation on central eCB function, and whether this is related to the development of these behavioral comorbidities remains to be determined. To examine this, we employed the trinitrobenzene sulfonic acid-induced model of colonic inflammation (colitis) in adult, male, Sprague Dawley rats to produce sustained peripheral inflammation. Colitis produced increases in behavioral measures of anxiety and elevations in circulating corticosterone. These alterations were accompanied by elevated hydrolytic activity of the enzyme fatty acid amide hydrolase (FAAH), which hydrolyzes the eCB anandamide (AEA), throughout multiple corticolimbic brain regions. This elevation of FAAH activity was associated with broad reductions in the content of AEA, whose decline was driven by central corticotropin releasing factor type 1 receptor signaling. Colitis-induced anxiety was reversed following acute central inhibition of FAAH, suggesting that the reductions in AEA produced by colitis contributed to the generation of anxiety. These data provide a novel perspective for the pharmacological management of psychiatric comorbidities of chronic inflammatory conditions through modulation of eCB signaling.
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Affiliation(s)
- Haley A. Vecchiarelli
- grid.22072.350000 0004 1936 7697Neuroscience Graduate Program, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Maria Morena
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Catherine M. Keenan
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Vincent Chiang
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Kaitlyn Tan
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Min Qiao
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Kira Leitl
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Alessia Santori
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Quentin J. Pittman
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Keith A. Sharkey
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Matthew N. Hill
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
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IL-33 in Mental Disorders. ACTA ACUST UNITED AC 2021; 57:medicina57040315. [PMID: 33810498 PMCID: PMC8066291 DOI: 10.3390/medicina57040315] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 01/05/2023]
Abstract
Mental disorders are common in the general population; every year about 25% of the total European population is affected by a mental condition. The prevalence of psychiatric disorders might be underestimated. Emerging evidence highlights the role of immune response as a key factor in MDs. Immunological biomarkers seem to be related to illness progression and to treatment effectiveness; several studies suggest strong associations among IL-6, TNFa, S100b, IL 1b, and PCR with affective or schizophrenic disorders. The purpose of this review is to examine and to understand the possible link between mental disorders and interleukin 33 to clarify the role of this axis in the immune system. We found 13 research papers that evaluated interleukin 33 or interleukin 31 levels in subjects affected by mental disorders. Eight studies investigated cytokines in affective disorders. Three studies measured levels of IL-33 in schizophrenia and two studies focused on patients affected by autism spectrum disorders. Alterations in brain structure and neurodevelopmental outcome are affected by multiple levels of organization. Disorders of the autoimmune response, and of the IL-33/31 axis, may therefore be one of the factors involved in this process. These results support the evidence that alarmins, particularly the IL-33/31 axis, need more consideration among researchers and practitioners.
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Hoffmeister J, Basso MR, Reynolds B, Whiteside D, Mulligan R, Arnett PA, Combs DR. Effects of diminished positive mood and depressed mood upon verbal learning and memory among people with multiple sclerosis. J Clin Exp Neuropsychol 2021; 43:117-128. [PMID: 33622171 DOI: 10.1080/13803395.2020.1853066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Cognitive impairment affects as many as 65% of people with multiple sclerosis (PWMS), and memory impairment confers greater severity of disability and functional impairment. Depression is also common among PWMS, and lifetime prevalence rates are as high as 50%. Research has yet to clearly define the relationship between memory dysfunction and depression among PWMS, and may reflect incomplete assessment of depressive symptoms. The present study examined different aspects of depressive symptoms including anhedonia (i.e., diminished positive mood) and their relationships with verbal learning and memory among PWMS.Method: Participants were 48 healthy individuals and 96 PWMS. They were primarily Caucasian (90.3%) and female (75.0%). Participants completed the California Verbal Learning Test-2 (CVLT-2) to assess verbal learning and memory and the Chicago Multiscale Depression inventory to assess depressed mood (CMDI-Mood) and diminished positive mood (CMDI-DPM).Results: Linear regression revealed that the main effect of CMDI-DPM and the interaction of CMDI-DPM and CMDI-Mood significantly explained variance across learning, recall, and recognition CVLT-2 indices. Follow-up analyses indicated that CMDI-DPM was only significant in the absence of high CMDI-Mood scores. CMDI-Mood explained variance in only CVLT-2 Trial B.Conclusions: Depressed mood had little direct effect upon memory performance in PWMS. In the absence of severe depressed mood, higher levels of positive mood corresponded to better memory performance. However, the impact of diminished positive mood was rendered null among those endorsing high levels of depressed mood. These data may imply that anhedonia corresponds with poorer memory function among PWMS, and suggests that investigators and clinicians should assess multiple mood dimensions among PWMS.
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Affiliation(s)
| | | | - Bradley Reynolds
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Ryan Mulligan
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Peter A Arnett
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Dennis R Combs
- Department of Psychology, University of Texas at Tyler, Tyler, TX, USA
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Skorve E, Lundervold AJ, Torkildsen Ø, Myhr KM. A two-year longitudinal follow-up of cognitive performance assessed by BICAMS in newly diagnosed patients with MS. Mult Scler Relat Disord 2020; 46:102577. [PMID: 33296975 DOI: 10.1016/j.msard.2020.102577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cognitive impairment is common in patients with multiple sclerosis (MS) and may occur at any stage and with any subtype of the disease. Screening and monitoring of cognitive function should therefore be implemented into everyday clinical neurology practice. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed for this purpose. Although several cross-sectional studies have validated BICAMS, longitudinal studies evaluating its use as part of a clinical follow-up routine are still lacking. OBJECTIVE To investigate cognitive function and trajectories of change assessed by the BICAMS test battery in a cohort of newly diagnosed relapsing-remitting MS (RRMS) patients examined at baseline and after 12 and 24 months. METHODS BICAMS was used to assess cognitive function in 58 RRMS patients, who also filled in the Hospital Anxiety and Depression Scale (HADS) and the Fatigue Scale for Motor and Cognitive Functions (FSMC), and underwent standard neurological evaluations at baseline and at the two follow-ups. RESULTS A total of 27 patients (46.6%) were defined as cognitively impaired at baseline on at least one test, and 22 (37.9%) were defined as impaired at follow-up after 24 months. Throughout the study, 8 (13.8%) and 4 (6.9%) patients were consistently defined as impaired on two or three tests, respectively. The mean raw scores on two BICAMS subtests (SDMT and CVLT-II) improved significantly from baseline to the first follow-up, and then remained stable the next year, whereas the visual memory test (BVMT-R) were overall unchanged from baseline to the end of the study. The correlations between the scores on HADS, FSMC and the BICAMS subtests were non-significant at baseline, but weak to moderate negative correlations were found at the one- and two-year follow-ups. CONCLUSION The patients showed improved test results from baseline to the first follow-up examination, indicating that an effect of previous practise should be taken into account when interpreting the results. With results showing both trajectories of stability and change, our study supported the validity of including BICAMS as part of a clinical follow-up routine of RRMS patients. Anxiety, depression, fatigue and cognition should always be assessed at the same time to reveal interaction effects that are expected to affect the daily-life functioning of at least some of the RRMS patients.
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Affiliation(s)
- Ellen Skorve
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Øivind Torkildsen
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Ingegnoli F, Buoli M, Antonucci F, Coletto LA, Esposito CM, Caporali R. The Link Between Autonomic Nervous System and Rheumatoid Arthritis: From Bench to Bedside. Front Med (Lausanne) 2020; 7:589079. [PMID: 33365319 PMCID: PMC7750536 DOI: 10.3389/fmed.2020.589079] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Neuronal stimulation is an emerging field of research focused on the management and treatment of various diseases through the reestablishment of physiological homeostasis. Electrical vagus nerve stimulation has recently been proposed as a revolutionary therapeutic option for rheumatoid arthritis (RA) in combination with or even as a replacement for conventional and biological drugs. In the past few years, disruption of the autonomic system has been linked to RA onset and activity. Novel research on the link between the autonomic nervous system and the immune system (immune-autonomics) has paved the way for the development of innovative RA management strategies. Clinical evidence supports this approach. Cardiovascular involvement, in terms of reduced baroreflex sensitivity and heart rate variability-derived indices, and mood disorders, common comorbidities in patients with RA, have been linked to autonomic nervous system dysfunction, which in turn is influenced by increased levels of circulating pro-inflammatory cytokines. This narrative review provides an overview of the autonomic nervous system and RA connection, discussing most of the common cardiac and mental health-related RA comorbidities and their potential relationships to systemic and joint inflammation.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flavia Antonucci
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
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Glukhovsky L, Kurz D, Brandstadter R, Leavitt VM, Krieger S, Fabian M, Katz Sand I, Klineova S, Riley CS, Lublin FD, Miller AE, Sumowski JF. Depression and cognitive function in early multiple sclerosis: Multitasking is more sensitive than traditional assessments. Mult Scler 2020; 27:1276-1283. [PMID: 33196404 PMCID: PMC10375894 DOI: 10.1177/1352458520958359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (MS) and depression symptoms report real-world cognitive difficulties that may be missed by laboratory cognitive tests. OBJECTIVE To examine the relationship of depressive symptoms to cognitive monotasking versus multitasking in early MS. METHOD Persons with early MS (n = 185; ⩽5 years diagnosed) reported mood, completed monotasking and multitasking cognitive tests, and received high-resolution 3.0 T magnetic resonance imaging (MRI). Partial correlations analyzed associations between mood and cognition, controlling for age, sex, estimated premorbid IQ, T2 lesion volume, and normalized gray matter volume. RESULTS Depression symptoms were more related to worse cognitive multitasking (-0.353, p < 0.001) than monotasking (r = -0.189, p = 0.011). There was a significant albeit weaker link to cognitive efficiency composite score (r = -0.281, p < 0.001), but not composite memory (r = -0.036, p > 0.50). Findings were replicated with a second depression measure. Multitasking was worse in patients with at least mild depression than both patients with no/minimal depression and healthy controls. Multitasking was not related to mood in healthy controls. CONCLUSIONS Depression symptoms are linked to cognitive multitasking in early MS; standard monotasking cognitive assessments appear less sensitive to depression-related cognition. Further investigation should determine directionality and mechanisms of this relationship, with the goal of enhancing treatment for cognitive dysfunction and depression in MS.
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Affiliation(s)
- Lisa Glukhovsky
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Kurz
- Department of Neurology. Maimonides Medical Center, New York, NY, USA
| | | | - Victoria M Leavitt
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Stephen Krieger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Fabian
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sylvia Klineova
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claire S Riley
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Fred D Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron E Miller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James F Sumowski
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Marrie RA, Patel R, Bernstein CN, Bolton JM, Graff LA, Marriott JJ, Hitchon CA, Figley CR, Kornelsen J, Fisk JD. Anxiety and depression affect performance on the symbol digit modalities test over time in MS and other immune disorders. Mult Scler 2020; 27:1284-1292. [PMID: 32976067 PMCID: PMC8226371 DOI: 10.1177/1352458520961534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Longitudinal studies assessing depression and anxiety effects on cognition in
multiple sclerosis (MS) are limited. Objective: We tested whether within-person fluctuations in symptoms of depression or
anxiety over time affect cognition in persons with MS, inflammatory bowel
disease (IBD), rheumatoid arthritis (RA), and a lifetime history of
depression/anxiety disorders (DEP/ANX) but without an immune-mediated
inflammatory diseases (IMID). Methods: We followed participants (MS: 255, IBD: 247, RA: 154, and DEP/ANX: 306) for
3 years. Annually, they completed the hospital anxiety and depression scale
(HADS) and cognitive tests including the symbol digit modalities test
(SDMT). We evaluated associations of elevated symptoms (scores ⩾ 11) of
anxiety (HADS-A) and depression (HADS-D) with SDMT z-scores
using multivariable linear models—estimating between-person and
within-person effects. Results: Participants with MS performed worse on the SDMT than participants in the
DEP/ANX cohort (β = −0.68; 95% CI: −0.88, −0.48). Participants with elevated
HADS-A scores performed worse on the SDMT than those without elevated scores
(β = −0.43; 95% CI: −0.65, −0.21), particularly those with RA. Time-varying
within-person elevations in depressive symptoms were associated with worse
SDMT performance (β = −0.12; 95% CI: −0.21, −0.021). Conclusions: Across persons, elevated symptoms of anxiety adversely affected information
processing. Elevated symptoms of depression within-persons over time were
associated with declines in information processing speed.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada/Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ronak Patel
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James J Marriott
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R Figley
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada/Division of Diagnostic Imaging, Health Sciences Centre, Winnipeg, MB, Canada/Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada/Division of Diagnostic Imaging, Health Sciences Centre, Winnipeg, MB, Canada/Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre, Winnipeg, MB, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
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Leavitt VM, Brandstadter R, Fabian M, Sand IK, Klineova S, Krieger S, Lewis C, Lublin F, Miller A, Pelle G, Buyukturkoglu K, Jager PLD, Li P, Riley CS, Tsapanou A, Sumowski JF. Dissociable cognitive patterns related to depression and anxiety in multiple sclerosis. Mult Scler 2020; 26:1247-1255. [PMID: 31233379 PMCID: PMC6928451 DOI: 10.1177/1352458519860319] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) frequently present with depression and anxiety, as well as cognitive impairment, challenging clinicians to disentangle interrelationships among these symptoms. OBJECTIVE To identify cognitive functions associated with anxiety and depression in MS. METHODS Mood and cognition were measured in 185 recently diagnosed patients (Reserve Against Disability in Early Multiple Sclerosis (RADIEMS) cohort), and an independent validation sample (MEM CONNECT cohort, n = 70). Partial correlations evaluated relationships of cognition to anxiety and depression controlling for age, sex, education, and premorbid verbal intelligence. RESULTS In RADIEMS cohort, lower anxiety was associated with better nonverbal memory (rp = -0.220, p = 0.003) and lower depression to better attention/processing speed (rp = -0.241, p = 0.001). Consistently, in MEM CONNECT cohort, lower anxiety was associated with better nonverbal memory (rp = -0.271, p = 0.028) and lower depression to better attention/processing speed (rp = -0.367, p = 0.002). Relationships were unchanged after controlling for T2 lesion volume and fatigue. CONCLUSION Consistent mood-cognition relationships were identified in two independent cohorts of MS patients, suggesting that cognitive correlates of anxiety and depression are separable. This dissociation may support more precise models to inform treatment development. Treatment of mood symptoms may mitigate effects on cognition and/or treatment of cognition may mitigate effects on mood.
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Affiliation(s)
- Victoria M. Leavitt
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, New York
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Rachel Brandstadter
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Michelle Fabian
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Sylvia Klineova
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Stephen Krieger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Christina Lewis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Aaron Miller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Gabrielle Pelle
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
| | - Korhan Buyukturkoglu
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, New York
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Phillip L. De Jager
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center
| | - Peipei Li
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, New York
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Claire S. Riley
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Angeliki Tsapanou
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - James F. Sumowski
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, New York
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50
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Hitchon CA, Zhang L, Peschken CA, Lix LM, Graff LA, Fisk JD, Patten SB, Bolton J, Sareen J, El-Gabalawy R, Marriott J, Bernstein CN, Marrie RA. Validity and Reliability of Screening Measures for Depression and Anxiety Disorders in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:1130-1139. [PMID: 31199570 PMCID: PMC7496677 DOI: 10.1002/acr.24011] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022]
Abstract
Objective To test the validity and reliability of screening instruments for depression and anxiety in rheumatoid arthritis (RA). Methods Participants with RA completed the Patient Health Questionnaire (PHQ‐2 or PHQ‐9), the Patient Reported Outcomes Measurement Information System depression short form 8a and anxiety short form 8a, the Hospital Anxiety and Depression Scale anxiety score (HADS‐A) and depression score (HADS‐D), the Overall Anxiety Severity and Impairment Scale, the Generalized Anxiety Disorder 2‐ and 7‐item scales, and the Kessler‐6 scale. Clinical depression and anxiety disorders were confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders (SCID‐1) research version. We reported sensitivity, specificity, positive predictive value, and negative predictive value using SCID‐1 diagnoses as the criterion standard. Test–retest reliability was assessed with the intraclass correlation coefficient. Results Of 150 participants, 11.3% had SCID‐1–diagnosed depression, 7.3% had SCID‐1–diagnosed generalized anxiety disorder, and 19.3% had any SCID‐1–diagnosed anxiety disorder. For depression, sensitivity ranged from HADS‐D (cut point 11; 35%) to PHQ‐2 (88%) and PHQ‐9 (87%). Specificity ranged from PHQ‐9 (77%) and PHQ‐2 (84%) to HADS‐D (cut point 11; 94%). Positive predictive value ranged from 30% to 43%. Negative predictive value ranged from 92% to 98%. For generalized anxiety disorder, sensitivity ranged from HADS‐A (cut point 11; 45%) to HADS‐A (cut point 8; 91%). Specificity ranged from 81% to 89% for all measures except the HADS‐A (cut point 8; 63%). Intraclass correlation coefficient estimates ranging from 0.69 to 0.88 confirmed good test–retest reliability. Conclusion Depression screening instruments had good diagnostic performance; anxiety instruments were more variable. Identified depression and anxiety require clinical confirmation.
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Affiliation(s)
- Carol A Hitchon
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lixia Zhang
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine A Peschken
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A Graff
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John D Fisk
- Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott B Patten
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James Bolton
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Marriott
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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