Neurologic and psychiatric comorbidities pose additional challenges for treating patients with MS.
HONOLULU—A survey comparing adults with multiple sclerosis (MS) and healthy controls revealed that persons with the disease have a higher prevalence of comorbid neurologic, psychiatric, and cardiovascular symptoms and conditions, all of which may complicate disease management. The research was presented at the 63rd Annual Meeting of the American Academy of Neurology.
“A better understanding of the nature and prevalence of comorbid illness in MS may guide development of treatment protocols to improve outcomes in individuals with MS with comorbidities,” reported Michelle Stewart, PhD, from Pfizer Global Research and Development in New London, Connecticut, and colleagues.
The researchers collected data from the National Health and Wellness Survey, an internet-based annual study of health care attitudes in the United States. Dr. Stewart’s group analyzed responses from 549 patients with MS (mean age, 48.6) and 74,451 healthy controls (mean age, 47.9). Respondents’ demographics, health status information, and comorbid symptoms and conditions were recorded.
“Compared with controls, a greater proportion of individuals with MS reported being female and white,” the researchers reported. Although patients with MS were more likely to be poor and unemployed, they were also more likely to have health insurance. Regarding health status, “individuals with MS were less likely to use alcohol, less likely to exercise, and more likely to smoke.”
Common Neurologic, Psychiatric, and Cardiovascular Comorbidities
When the researchers compared data from patients with MS and healthy controls, they found statistically significant differences for several neurologic, psychiatric, and cardiovascular symptoms and conditions.
Pain, headache, migraine, restless legs syndrome, stroke, epilepsy, dementia, Parkinson’s disease, and Alzheimer’s disease were all more prevalent in patients with MS than in persons without the disorder. More than 50% of the MS cohort reported pain and headache as neurologic symptoms; Parkinson’s disease (2.0%) and Alzheimer’s disease (1.9%) were the least commonly reported conditions.
Among psychiatric comorbidities that were recorded, sleep difficulties, depression, and anxiety were the most commonly reported symptoms in both populations. Statistically significant differences were also found between patients with MS and controls in the following conditions and symptoms: insomnia, panic disorder, bipolar disorder, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder, and narcolepsy.
Patients with MS had a higher prevalence of cardiovascular symptoms, including angina, arrhythmia, transient ischemic stroke, and deep vein thrombosis, compared with controls. However, the investigators reported, “rates for hypertension, high cholesterol, ever had a heart attack, congestive heart failure, and atrial fibrillation were similar for individuals with and without MS.”
Impact of Comorbid Illness on MS Treatment
“An increasing amount of evidence suggests that physical and mental comorbidities, and adverse health factors such as smoking and obesity, are common in MS,” the authors stated. “These comorbidities and lifestyle factors may affect the diagnostic delay between symptom onset and diagnosis, disability progression, and health-related quality of life.”
In this study, persons with MS had significant comorbid illness, compared with controls, as the researchers expected. “Neurologic and psychiatric comorbid conditions and symptoms are common and typically more prevalent in MS,” the authors explained. “Cardiovascular risk factors in individuals with MS are similar to risk factors in controls, although some conditions have a higher association.
“The presence of comorbidities in individuals with MS merits attention as they may present challenges in managing this chronic and progressive disorder,” the researchers concluded.
—Ariel Jones