Diabetes and anxiety adversely affect cognition in multiple sclerosis

Abstract

A B S T R A C TObjective: To determine whether comorbid diabetes and hypertension are associated with cognition in multiple sclerosis (MS) after accounting for psychiatric comorbidities. Methods: Participants completed a structured psychiatric interview, the Hospital Anxiety and Depression Scale (HADS), a comorbidity questionnaire, and cognitive testing including the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test (CVLT-II), Brief Visuospatial Memory Test-Revised (BVMT-R), and verbal fluency. Test scores were converted to age-, sex-and education-adjusted z-scores. We evaluated associations between diabetes and hypertension and the four cognitive z-scores using a multivariate linear model, adjusting for comorbid depression and anxiety disorders, psychotropic medications, disease-modifying therapies, smoking status and body mass index. Results: Of 111 participants, most were women (82.9%) with relapsing remitting MS (83.5%), of mean (SD) age 49.6 (12.7) years. Comorbidity was common; 22.7% participants had hypertension, 10.8% had diabetes, 9.9% had current major depression, and 9.9% had current anxiety disorders. Mean (SD) z-scores were: SDMT −0.66 (1.15), CVLT-II −0.43 (1.32), BVMT-R −0.49 (1.07) and fluency −0.59 (0.86). Diabetes (p = 0.02) and anxiety disorder (p = 0.02) were associated with cognitive function overall. Diabetes was associated with lower BVMT-R (β = −1.18, p = 0.0015) and fluency (β = −0.63, p = 0.037) z-scores. Anxiety was associated with lower SDMT (β = -1.07, p = 0.0074) z-scores. Elevated anxiety symptoms (HADS-A ≥ 11) were associated with lower z-scores on the SDMT and CVLT-II. Conclusion: Comorbidities, including diabetes and anxiety, are associated with cognitive dysfunction in MS. Their presence may contribute to the heterogeneous pattern of impairments seen across individuals and they may represent targets for improved management of cognitive symptoms.

Higher Framingham Risk Scores are associated with greater loss of brain volume over time in multiple sclerosis

“…Brain volume loss in this group was seen even after accounting for age, gender, age at MS symptom onset and current use of disease-modifying therapy and was substantial; being about 2 cm 3 or 6.6% per year for every 1 point rise in the FRS. This adverse effect of greater vascular risk on brain volume is consistent with prior observations that diabetes is associated with cognitive impairment, and that diabetes, hypertension and hyperlipidemia are associated with greater disability and progression of disability in MS (Marrie et al, 2010;Moccia et al, 2015, Patel et al 2019.…”

“…Of 111 participants enrolled, 98 completed MRIs that passed quality control for brain volumes at both time points. Most participants were women with relapsing remitting MS and at least a moderate level of disability (Table 1) (Marrie et al, 2019). Over half of participants were currently taking a disease-modifying therapy.…”

“…As described previously, (Marrie et al, 2019) we enrolled a subgroup of 111 persons with MS participating in a longitudinal study regarding psychiatric comorbidity in immune-mediated inflammatory diseases. This subgroup included persons aged ≥18 years with definite MS, (Polman et al, 2011) as confirmed by a neurologist and medical records review.…”

“…In addition to reporting physician-diagnosed comorbidities, they also reported whether the condition was currently treated. This information was augmented by medical records review and other assessments as described previously (Marrie et al, 2019). We measured blood pressure once in the seated position using an automatic blood pressure machine and recorded systolic and diastolic blood pressure separately.…”

“…Hypertension is among the most common comorbidities at the time of MS diagnosis, and the prevalence of diabetes, hypertension and hyperlipidemia increase with age. These comorbidities have been found to be associated with accelerated ambulatory and visual disability progression, (Marrie et al, 2010, Cutter et al 2011) cognitive impairment, (Marrie et al, 2019) and increased mortality (Marrie et al, 2015) in MS.…”