Diabetes and anxiety adversely affect cognition in multiple sclerosis

PhD for the Comorbidity and Cognition in Multiple Sclerosis (CCOMS) Study Group, Ruth Ann M Marrie, Ronak Patel, Chase R. Figley, Jennifer Kornelsen, James M. Bolton, Lesley Graff, Erin L. Mazerolle, James J. Marriott, Charles N. Bernstein

    Research output: Contribution to journalArticle

    Abstract

    Objective: 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.

    LanguageEnglish (US)
    Pages164-170
    Number of pages7
    JournalMultiple Sclerosis and Related Disorders
    Volume27
    DOIs
    StatePublished - Jan 1 2019

    Fingerprint

    Cognition
    Multiple Sclerosis
    Anxiety
    Comorbidity
    Anxiety Disorders
    Depression
    Hypertension
    Relapsing-Remitting Multiple Sclerosis
    Verbal Learning
    Neurobehavioral Manifestations
    Sex Education
    Psychiatric Hospitals
    Psychiatry
    Linear Models
    Body Mass Index
    Smoking
    Interviews
    Therapeutics

    Keywords

    • Anxiety
    • Cognition
    • Comorbidity
    • Diabetes
    • Multiple sclerosis

    ASJC Scopus subject areas

    • Neurology
    • Clinical Neurology

    Cite this

    PhD for the Comorbidity and Cognition in Multiple Sclerosis (CCOMS) Study Group (2019). Diabetes and anxiety adversely affect cognition in multiple sclerosis. Multiple Sclerosis and Related Disorders, 27, 164-170. https://doi.org/10.1016/j.msard.2018.10.018

    Diabetes and anxiety adversely affect cognition in multiple sclerosis. / PhD for the Comorbidity and Cognition in Multiple Sclerosis (CCOMS) Study Group.

    In: Multiple Sclerosis and Related Disorders, Vol. 27, 01.01.2019, p. 164-170.

    Research output: Contribution to journalArticle

    PhD for the Comorbidity and Cognition in Multiple Sclerosis (CCOMS) Study Group 2019, 'Diabetes and anxiety adversely affect cognition in multiple sclerosis' Multiple Sclerosis and Related Disorders, vol. 27, pp. 164-170. https://doi.org/10.1016/j.msard.2018.10.018
    PhD for the Comorbidity and Cognition in Multiple Sclerosis (CCOMS) Study Group. Diabetes and anxiety adversely affect cognition in multiple sclerosis. Multiple Sclerosis and Related Disorders. 2019 Jan 1;27:164-170. https://doi.org/10.1016/j.msard.2018.10.018
    PhD for the Comorbidity and Cognition in Multiple Sclerosis (CCOMS) Study Group. / Diabetes and anxiety adversely affect cognition in multiple sclerosis. In: Multiple Sclerosis and Related Disorders. 2019 ; Vol. 27. pp. 164-170.
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    abstract = "Objective: 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.",
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    T1 - Diabetes and anxiety adversely affect cognition in multiple sclerosis

    AU - PhD for the Comorbidity and Cognition in Multiple Sclerosis (CCOMS) Study Group

    AU - Marrie, Ruth Ann M

    AU - Patel, Ronak

    AU - Figley, Chase R.

    AU - Kornelsen, Jennifer

    AU - Bolton, James M.

    AU - Graff, Lesley

    AU - Mazerolle, Erin L.

    AU - Marriott, James J.

    AU - Bernstein, Charles N.

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Objective: 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.

    AB - Objective: 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.

    KW - Anxiety

    KW - Cognition

    KW - Comorbidity

    KW - Diabetes

    KW - Multiple sclerosis

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