Disability worsening among persons with multiple sclerosis and depression

Binzer, Stefanie; McKay, Kyla A.; Brenner, Philip; Hillert, Jan; Manouchehrinia, Ali

doi:10.1212/wnl.0000000000008617

Cited by 74 publications

(54 citation statements)

References 44 publications

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“…It is not always obvious which disease costs relate to, as some comorbidity is independent of MS and yet others may be a result of MS [ 64 ]. Furthermore, comorbidity may alter the MS clinical course, as observed with depression [ 65 ], and consequently further MS-specific healthcare may be needed. The reference group and use of excess costs also adjusted for aging and wider societal changes over time [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group

et al. 2021

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Background Multiple sclerosis (MS) is a chronic disease associated with increased healthcare utilisation and productivity losses.Objective The objective of this study was to explore the progression of healthcare costs and productivity losses before and after diagnosis of MS in comparison to that of a population-based matched reference group. Methods We conducted a nationwide, Swedish register-based cohort study of working-aged people with MS diagnosed in 2010-12 (n = 1988) and population-based matched references without MS (n = 7981). Nine years of observation spanned from 4 years prior (Y −4 ) to 4 years (Y +4 ) after the year of diagnosis (Y 0 ). Differences in annual all-cause healthcare costs (inpatient and specialised outpatient healthcare as well as pharmacy-dispensed prescribed drugs) and costs of productivity loss (days with sickness absence and disability pension) were estimated between the people with MS and references using t tests with 95% confidence intervals. The average excess costs of MS were estimated using generalised estimating equation models. Results People with multiple sclerosis had higher costs before the diagnosis of MS and also thereafter. The mean differences in healthcare costs and productivity losses between the people with MS and matched references in Y −4 were 216 EUR (95% confidence interval 58-374) and 1540 EUR (95% confidence interval 848-2233), with larger cost excesses observed in later study years. Summarising the 9 study years, people with MS had fivefold higher excess healthcare costs than references, and more than twice as high productivity losses. Conclusions Excess healthcare costs and productivity losses occur already before the diagnosis of MS and increase with time. The excess costs findings before diagnosis could suggest that an earlier diagnosis might lead to reduced excess costs of MS over time. Plain Language SummaryMultiple sclerosis (MS) is a neurological disease that can affect many parts of everyday life, including work. We studied the extra costs related to MS. Extra costs were defined as the difference in costs between people with MS and the general population in Sweden. To do this, we compared the costs of working-aged individuals with MS from 4 years before to 4 years after the year of MS diagnosis with those of individuals without MS. For each year, we measured the healthcare consumption and days absent owing to sickness absence or a disability pension. We found that people with MS had larger costs already before the diagnosis of MS. For all types of costs we studied, there were extra costs. The extra costs became larger with time and had a steep increase around the year of MS diagnosis. When we summarised the costs from all 9 years, people with MS had five times higher annual costs related to healthcare consumption than those without MS. There were also twice as high costs for lost production from days absent with sickness absence or a disability pension. While our data from national registers had

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Section: Discussionmentioning

confidence: 99%

Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group

et al. 2021

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“…Moreover, the presence of depression was associated with a significantly higher subsequent disability over an average of 10 years of follow-up in women who constituted two-thirds of the investigated population ( 72 ). The impact of depression was also investigated in more than 15,000 patients from The Swedish MS registry, which found that MS patients with depression or bipolar disorder showed a significantly higher risk of progression on the Expanded Disability Status Scale (EDSS) score ( 73 ).…”

Section: Investigating Comorbidities In Populations With Msmentioning

confidence: 99%

Comorbidity in Multiple Sclerosis

2020

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Comorbidities in patients with multiple sclerosis (MS) has become an area of increasing interest in the recent years. A comorbidity is defined as any additional disease that coexists in an individual with a given index disease and that is not an obvious complication of the index disease. The aim of this review is to describe the current evidence regarding the range of comorbidities in the population with MS reported in different countries and the current knowledge about the influence of comorbidities on the clinical features and therapeutic challenges in MS. Certain comorbidities are more prevalent in people with MS such as depression, anxiety, cerebro-and cardiovascular diseases, and certain autoimmune disorders such as diabetes, thyroid disease, and inflammatory bowel disease. A previous perception of a trend toward a lower overall risk of cancer in patients with MS appears to be challenged, but there is no evidence on any higher occurrence of malignancies in the population with MS. Comorbidities may modify the clinical presentation of MS, and have implications for treatment choice, adherence, and outcome. Several comorbid conditions are associated with increased disability progression, including diabetes, hypertension, and chronic obstructive pulmonary disease. Comorbidities are common in MS from the time of diagnosis and may account for some of the heterogeneity observed in MS, including diagnostic delay, clinical presentation, degree of disability progression, rate of health care utilization, working ability, employment status, and quality of life. Coexisting diseases and polypharmacy increase the complexity of patient management and poses major challenges, particularly with the increasing number of immunosuppressive disease-modifying therapies.

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“…The main consequence of depressive symptoms is scarce adherence to pharmacological treatments or rehabilitative programs associated to worsening of functional outcomes (Binzer et al, 2019). Although these symptoms represent one of the main determinants for quality of life in MS, they are currently undervalued and undertreated in clinical practice.…”

Section: Depressive Symptoms In Msmentioning

confidence: 99%

Inflammation-Associated Synaptic Alterations as Shared Threads in Depression and Multiple Sclerosis

Bruno

Dolcetti

Rizzo

et al. 2020

Front. Cell. Neurosci.

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In the past years, several theories have been advanced to explain the pathogenesis of Major Depressive Disorder (MDD), a neuropsychiatric disease that causes disability in general population. Several theories have been proposed to define the MDD pathophysiology such as the classic “monoamine-theory” or the “glutamate hypothesis.” All these theories have been recently integrated by evidence highlighting inflammation as a pivotal player in developing depressive symptoms. Proinflammatory cytokines have been indeed claimed to contribute to stress-induced mood disturbances and to major depression, indicating a widespread role of classical mediators of inflammation in emotional control. Moreover, during systemic inflammatory diseases, peripherally released cytokines circulate in the blood, reach the brain and cause anxiety, anhedonia, social withdrawal, fatigue, and sleep disturbances. Accordingly, chronic inflammatory disorders, such as the inflammatory autoimmune disease multiple sclerosis (MS), have been associated to higher risk of MDD, in comparison with overall population. Importantly, in both MS patients and in its experimental mouse model, Experimental Autoimmune Encephalomyelitis (EAE), the notion that depressive symptoms are reactive epiphenomenon to the MS pathology has been recently challenged by the evidence of their early manifestation, even before the onset of the disease. Furthermore, in association to such mood disturbance, inflammatory-dependent synaptic dysfunctions in several areas of MS/EAE brain have been observed independently of brain lesions and demyelination. This evidence suggests that a fine interplay between the immune and nervous systems can have a huge impact on several neurological functions, including depressive symptoms, in different pathological conditions. The aim of the present review is to shed light on common traits between MDD and MS, by looking at inflammatory-dependent synaptic alterations associated with depression in both diseases.

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Disability worsening among persons with multiple sclerosis and depression

Cited by 74 publications

References 44 publications

Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group

Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group

Comorbidity in Multiple Sclerosis

Inflammation-Associated Synaptic Alterations as Shared Threads in Depression and Multiple Sclerosis

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