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The Relationship between Psychosocial Factors and Cognition in Multiple Sclerosis 时间:2017-07-31 11:53 来源:未知作者:admin 点击: 次 Abstract:Introduction. Multiple sclerosis (MS) is a common disorder in some regions of the world, with over 2.3 million people diagnosed worldwide. Cognitive impairment is one of the earliest symptoms to present in the course of the disease and can cause significant morbidity. We proposed a study to explore the psychosocial predictors of cognitive impairment in MS patients in Saudi Arabia, a previously unexplored patient population. Methods. Demographic data, depression scale (PHQ9), symptom burden (PHQ15), anxiety (GAD7), disease duration, and Montreal Cognitive Assessment (MOCA) scores were collected from 195 patients in a neurology clinic in Ryiadh, Saudi Arabia. Univariate and multiple regression analyses were conducted to identify variables that are significantly associated with cognitive impairment. Results. Variables that were identified to be significantly associated with cognition, , were education level, disease duration, and family history. Discussion. Both education level and disease duration were variables identified in previous studies. We showed family history to be a significant variable, and no association was found with depression or anxiety, which is unique to our study population. Conclusions. We identified several psychosocial predictors that are associated with cognition in our patient population. It was also noted that a difference exists between patient populations, highlighting the need for further studies in specific geographical regions.
1. Introduction
Multiple sclerosis (MS) is a chronic and recurrent neurological disorder with approximately 2.3 million people diagnosed worldwide, spanning every region around the world [1]. Multiple sclerosis causes significant morbidity [2] and mortality in young adults with a reduced average lifespan of less than 6 to 7 years [3]. Of particular significance is the high prevalence of cognitive symptoms in patients diagnosed with MS, which impacts overall quality of life [4]. Cognitive symptoms can be one of the earliest symptoms and are present in up to 70% of patients [5, 6]. In fact, cognitive impairments in particular as well as depression, fatigue, and motor function resulting from MS have been shown to contribute to lowered work performance [7] and increased unemployment rates [8–11], reduced social activities [12], long-term disability [10], mental health [13], and overall quality of life [14].
Cognitive impairment has been reported from the earliest stages of MS and is considered one of the main manifestations of the disease [15, 16]. Early stages of MS have been associated with significant cognitive impairment focused on attention, executive functions, memory, and learning [16]. Information processing in particular is the cognitive domain most widely affected by MS and is notably the first deficit to emerge [17–19]. MS patients with progressive disease course, especially secondary progressive, can also experience a range of cognitive deficits and associated disability [20]. MS has been associated with delayed recall performance and lower acquisition of verbal memory [21] and episodic short-term memory [22]. In addition, MS can also result in slow processing speed [23], which has been linked to executive function deficits [24].
Studies have attempted to elucidate the relationship between psychosocial variables and cognition in patients with MS. Patients with MS exhibiting depressive symptoms show increased propensity to experience cognitive symptoms, thus contributing to disability and disease duration [13]. Other studies have suggested that mood is a strong predictor of cognitive function [12, 25]. Specifically, depression was found to affect executive function [26]. However, each study reported different predictors as being more important, either fatigue or low mood, emphasizing the need for further studies. Borghi et al. have examined multiple predictors, highlighting anxiety and depression as having impact on cognition [6]. The overall symptom burden or correlation to MS lesions was not examined in this study. Interestingly, self-reported cognitive impairment has also been showed to strongly correlate with fatigue and depression, both prominent complaints in MS [27]. In addition, there is a strong correlation between the presence of active lesions and cognitive decline when compared to dormant lesions [28]. Despite this literature, variability in results and the lack of studies looking at multiple predictors in the context of function and MS lesion activity highlight the need for further research.