A systematic review of modifiable risk factors in the progression of multiple sclerosis

Hempel, Susanne; Graham, Glenn D.; Fu, Ning; Estrada, Elena; Chen, Annie Y.; Miake-Lye, Isomi M; Miles, Jeremy N. V.; Shanman, Roberta; Shekelle, Paul G; Beroes, Jessica M; Wallin, Mitchell T.

doi:10.1177/1352458517690270

Cited by 60 publications

(62 citation statements)

References 32 publications

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“…Numerous studies have examined risk factors for the development of multiple sclerosis (MS), 1 whereas more recently, long-term and population-based studies of factors affecting MS disability worsening have become feasible. 2 Studies have shown that male sex, progressive disease course at onset, and older age at onset are associated with disability worsening. [3][4][5] A paucity of evidence remains with regard to modifiable risk factors for MS disability worsening, but comorbid conditions are being increasingly explored as a potential avenue for intervention.…”

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confidence: 99%

Disability worsening among persons with multiple sclerosis and depression

et al. 2019

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ObjectiveDepression is common in multiple sclerosis (MS), but its impact on disability worsening has not yet been determined. We explored the risk of disability worsening associated with depression in a nationwide longitudinal cohort.MethodsThis retrospective cohort study used linked data from 3 Swedish nationwide registries: the MS Register, National Patient Register, and Prescribed Drug Register. Two incident cohorts were developed: cohort 1 included all registered cases of MS in the MS Registry (2001–2014) with depression defined as ≥1 ICD-10 code for depression; and cohort 2 comprised all cases of MS in the MS Registry (2005–2014) with depression defined as ≥1 prescription filled for an antidepressant. Cox regression models were used to compare the risk of reaching sustained disability milestone scores of 3.0, 4.0, and 6.0 on the Expanded Disability Status Scale (EDSS) between persons with MS with and without depression.ResultsCohort 1 included 5,875 cases; 502 (8.5%) had depression. Cohort 2 had 3,817 cases; 1,289 (33.8%) were prescribed an antidepressant. Persons with depression were at a significantly higher risk of reaching sustained EDSS scores of 3.0, 4.0, and 6.0, with hazard ratios of 1.50 (95% confidence interval [CI] 1.20–1.87), 1.79 (95% CI 1.40–2.29), and 1.89 (95% CI 1.38–2.57), respectively. A similar increased risk among persons exposed to antidepressants was observed, with hazard ratios of 1.37 (95% CI 1.18–1.60), 1.93 (95% CI 1.61–2.31), and 1.86 (95% CI 1.45–2.40) for sustained EDSS scores of 3.0, 4.0, and 6.0, respectively.ConclusionPersons with MS and comorbid depression had a significantly increased risk of disability worsening. This finding highlights the need for early recognition and appropriate treatment of depression in persons with MS.

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confidence: 99%

Disability worsening among persons with multiple sclerosis and depression

et al. 2019

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“…Therefore, factors affecting the health of PwMS play an important role in the life of the partner and the couple. Increasingly, there is evidence of associations between modification of lifestyle-related risk factors and improved mental and physical health outcomes in MS (D'Hooghe, Nagels, Bissay, & De Keyser, 2010;Fitzgerald et al, 2018;Hempel et al, 2017;Jelinek et al, 2016;Levin et al, 2014;Marck et al, 2014). PwMS who attended an intensive residential workshop regarding evidence-based lifestyle interventions reported improved HRQOL 5 years post-intervention (Hadgkiss, Jelinek, Weiland, Rumbold, et al, 2013;Li et al, 2010).…”

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confidence: 99%

On the path together: Experiences of partners of people with multiple sclerosis of the impact of lifestyle modification on their relationship

Neate

Taylor

Jelinek

et al. 2019

Health Soc Care Community

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Multiple sclerosis (MS) has a major impact on the relationship of couples living with the illness. Although some positives of dealing with MS as a couple have been identified, MS has been associated with higher rates of relationship breakdown and worse Quality of Life (QOL) for both people in the relationship, especially if the person with MS experiences a decline in mental or physical health or develops disability. Modification of lifestyle‐related risk factors has been associated with improved outcomes for people with MS, including physical and mental health‐related QOL, and these improved outcomes may lead to improved experiences for their partners. We aimed to explore the perspectives and experiences of the partners of people with MS, when the people with MS had undertaken an intensive residential workshop regarding healthy lifestyle, to understand the impact of MS and lifestyle modification on these partners’ experiences of their relationship. Within the framework of Heidegger's interpretive phenomenology, semi‐structured interviews were thematically analysed. Participants were in a spousal relationship with people with MS who had attended an intensive residential workshop regarding modification of lifestyle‐related risk factors between 2002 and 2016. Participants lived in Australia, New Zealand, the United Kingdom and Europe. Three major themes were identified relating to the couple's relationships: providing support, remaining connected and togetherness. Aspects of these themes, not commonly previously reported, included the personal and relationship benefits experienced from providing support with lifestyle modification, improved communication, and the resultant greater sense of closeness. These experiences of partners of people with MS improve our understanding of both the complexities of living with MS and adopting lifestyle modification, and suggest some potential benefits to relationships.

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“…Overall, 11 records were included in this review [100,[204][205][206][207][208][209][210][211][212][213] (Supplemental Figure S6). We focused on publications that examined the association between vitamin D and the development of MS or clinical activity of MS. Supplemental Tables S22-S24 provide information about the included studies and the assessed quality based on AMSTAR 2.…”

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confidence: 99%

“…Regarding clinical outcomes, eight publications that conducted SRs of mainly RCTs [204,205,207,[209][210][211][212][213] focused on changes in the expanded disability status scale (EDSS). In summary, the studies found no significant therapeutic effect of vitamin D on EDSS and/or concluded that vitamin D supplementation had no effects on EDSS.…”

Section: Therapeutic or Adjuvant Vitamin D Supplementation In Ms Patimentioning

confidence: 99%

Role of Vitamin D in Preventing and Treating Selected Extraskeletal Diseases—An Umbrella Review

Maretzke¹,

Bechthold²,

Egert

et al. 2020

Nutrients

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Evidence is accumulating that vitamin D may have beneficial effects on respiratory tract, autoimmune, neuro-degenerative, and mental diseases. The present umbrella review of systematic reviews (SRs) of cohort studies and randomised controlled trials (RCTs), plus single Mendelian randomisation studies aims to update current knowledge on the potential role of vitamin D in preventing and treating these extraskeletal diseases. Altogether, 73 SRs were identified. Observational data on primary prevention suggest an inverse association between vitamin D status and the risk of acute respiratory tract infections (ARI), dementia and cognitive decline, and depression, whereas studies regarding asthma, multiple sclerosis (MS), and type 1 diabetes mellitus (T1DM) are scarce. SRs of RCTs support observational data only for the risk of ARI. No respective RCTs are available for the prevention of chronic obstructive pulmonary disease (COPD), MS, and T1DM. SRs of RCTs indicate beneficial therapeutic effects in vitamin D-deficient patients with asthma and COPD, while effects on major depression and T1DM need to be further elucidated. Mendelian randomisation studies do not consistently support the results of SRs. Since several limitations of the included SRs and existing RCTs do not permit definitive conclusions regarding vitamin D and the selected diseases, further high-quality RCTs are warranted.

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A systematic review of modifiable risk factors in the progression of multiple sclerosis

Cited by 60 publications

References 32 publications

Disability worsening among persons with multiple sclerosis and depression

Disability worsening among persons with multiple sclerosis and depression

On the path together: Experiences of partners of people with multiple sclerosis of the impact of lifestyle modification on their relationship

Role of Vitamin D in Preventing and Treating Selected Extraskeletal Diseases—An Umbrella Review

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