Comorbid anxiety, depression, and cognition in MS and other immune-mediated disorders

Christiane E. Whitehouse; John D. Fisk; Charles N. Bernstein; Lindsay I. Berrigan; James M. Bolton; Lesley A. Graff; Carol A. Hitchon; James J. Marriott; Christine A. Peschken; Jitender Sareen; John R. Walker; Sherry H. Stewart; Ruth Ann Marrie

doi:10.1212/WNL.0000000000006854

Comorbid anxiety, depression, and cognition in MS and other immune-mediated disorders

Christiane E. Whitehouse, John D. Fisk, Charles N. Bernstein, Lindsay I. Berrigan, James M. Bolton, Lesley A. Graff, Carol A. Hitchon, James J. Marriott, Christine A. Peschken, Jitender Sareen, John R. Walker, Sherry H. Stewart, Ruth Ann Marrie

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83 Citas (Scopus)

Resumen

ObjectiveTo determine whether anxiety and depression are associated with cognition in multiple sclerosis (MS), and whether these associations are similar in other immune-mediated inflammatory diseases (IMID; including inflammatory bowel disease [IBD] and rheumatoid arthritis [RA]) and in anxious/depressed individuals (ANX/DEP) without an IMID.MethodsParticipants (MS: n = 255; IBD: n = 247; RA: n = 154; ANX/DEP: n = 308) completed a structured psychiatric interview, the Hospital Anxiety and Depression Scale, and cognitive testing, including the Symbol Digit Modalities Test, the California Verbal Learning Test, and Letter Number Sequencing test. Test scores were converted to age-, sex-, and education-adjusted z scores. We evaluated associations of anxiety and depression with the cognitive z scores using multivariate linear models, adjusting for disease cohort.ResultsAll cohorts exhibited higher rates of impairment (i.e., z less than or equal to -1.5) in the domains of processing speed, verbal learning, and delayed recall memory relative to general population norms. Higher levels of anxiety symptoms were associated with slower processing speed, lower verbal learning, and lower working memory performance (all p < 0.001); higher levels of depression symptoms were associated with slower processing speed. These associations did not differ across cohorts.ConclusionAnxiety and depression are associated with lower cognitive function in MS, with a similar pattern observed in persons with other IMID, including IBD and RA, and persons without an IMID. Managing symptoms of anxiety and of depression in MS, as well as other IMIDs, is important to mitigate their effect on cognition.

Idioma original	English
Páginas (desde-hasta)	E406-E417
Publicación	Neurology
Volumen	92
N.º	5
DOI	https://doi.org/10.1212/WNL.0000000000006854
Estado	Published - ene. 29 2019
Publicado de forma externa	Sí

Nota bibliográfica

Funding Information:
This study was funded by the Canadian Institutes of Health Research (THC-135234), Crohn’s and Colitis Canada, and the Waugh Family Chair in Multiple Sclerosis (to R.A.M.). Dr. Bernstein is supported in part by the Bingham Chair in Gastroenterology. Dr. Sareen is supported by CIHR #333252. Dr. Stewart is supported through a Tier 1 Canada Research Chair in Addictions and Mental Health. The sponsors had no role in the design and conduct of the study, collection and interpretation of the data, or in the decision to submit the manuscript for publication.

Funding Information:
C. Whitehouse is supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award. J. Fisk receives research grant support from the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, the Nova Scotia Health Authority Research Fund, and the Dalhousie Medical Research Fund. C. Bernstein has consulted to AbbVie Canada, Ferring Canada, Janssen Canada, Pfizer Canada, Shire Canada, Takeda Canada, Napo Pharmaceuticals, 4D-Pharma, and Mylan Pharmaceuticals. He has received unrestricted educational grants from AbbVie Canada, Janssen Canada, Shire Canada, Pfizer Canada, and Takeda Canada. He has been on speaker’s bureaus of AbbVie Canada, Ferring Canada, and Shire Canada. L. Berrigan receives research funding from the Canada Foundation for Innovation (CFI) and SSHRC. J. Bolton receives research funding from CIHR, Brain and Behavior Research Foundation, and the MS Society of Canada. L. Graff receives research funding from CIHR, the MS Society of Canada, and the Health Sciences Centre Foundation. C. Hitchon has research funds for unrelated studies from UCB Canada and Pfizer. J. Marriott has conducted trials for Biogen Idec and Roche and receives research funding from the MS Society of Canada and the MS Scientific Foundation and Research Manitoba. C. Peschken receives research funds from CIHR and the Lupus Research Alliance; has consulted to Astra Zeneca, Baxalta, and GlaxoSmithKline; and has conducted clinical trials for Celgene. J. Sareen receives research funding from CIHR and holds stocks in Johnson and Johnson. J. Walker receives research funding from CIHR. S. Stewart receives research funding from Canadian Institutes of Health Research, Social Sciences and Humanities Research Council, Manitoba Gambling Research Program, Nova Scotia Health Research Foundation, National Center for Responsible Gaming, and Nova Scotia Health Authority Research Fund. R.A. Marrie receives research funding from CIHR, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Crohn’s and Colitis Canada, National Multiple Sclerosis Society, and CMSC. She serves on the Editorial Board of Neuro-

Publisher Copyright:
© 2019 American Academy of Neurology.

ASJC Scopus Subject Areas

Clinical Neurology

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10.1212/WNL.0000000000006854

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Whitehouse, C. E., Fisk, J. D., Bernstein, C. N., Berrigan, L. I., Bolton, J. M., Graff, L. A., Hitchon, C. A., Marriott, J. J., Peschken, C. A., Sareen, J., Walker, J. R., Stewart, S. H., & Marrie, R. A. (2019). Comorbid anxiety, depression, and cognition in MS and other immune-mediated disorders. Neurology, 92(5), E406-E417. https://doi.org/10.1212/WNL.0000000000006854

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abstract = "ObjectiveTo determine whether anxiety and depression are associated with cognition in multiple sclerosis (MS), and whether these associations are similar in other immune-mediated inflammatory diseases (IMID; including inflammatory bowel disease [IBD] and rheumatoid arthritis [RA]) and in anxious/depressed individuals (ANX/DEP) without an IMID.MethodsParticipants (MS: n = 255; IBD: n = 247; RA: n = 154; ANX/DEP: n = 308) completed a structured psychiatric interview, the Hospital Anxiety and Depression Scale, and cognitive testing, including the Symbol Digit Modalities Test, the California Verbal Learning Test, and Letter Number Sequencing test. Test scores were converted to age-, sex-, and education-adjusted z scores. We evaluated associations of anxiety and depression with the cognitive z scores using multivariate linear models, adjusting for disease cohort.ResultsAll cohorts exhibited higher rates of impairment (i.e., z less than or equal to -1.5) in the domains of processing speed, verbal learning, and delayed recall memory relative to general population norms. Higher levels of anxiety symptoms were associated with slower processing speed, lower verbal learning, and lower working memory performance (all p < 0.001); higher levels of depression symptoms were associated with slower processing speed. These associations did not differ across cohorts.ConclusionAnxiety and depression are associated with lower cognitive function in MS, with a similar pattern observed in persons with other IMID, including IBD and RA, and persons without an IMID. Managing symptoms of anxiety and of depression in MS, as well as other IMIDs, is important to mitigate their effect on cognition.",

author = "Whitehouse, {Christiane E.} and Fisk, {John D.} and Bernstein, {Charles N.} and Berrigan, {Lindsay I.} and Bolton, {James M.} and Graff, {Lesley A.} and Hitchon, {Carol A.} and Marriott, {James J.} and Peschken, {Christine A.} and Jitender Sareen and Walker, {John R.} and Stewart, {Sherry H.} and Marrie, {Ruth Ann}",

note = "Funding Information: This study was funded by the Canadian Institutes of Health Research (THC-135234), Crohn{\textquoteright}s and Colitis Canada, and the Waugh Family Chair in Multiple Sclerosis (to R.A.M.). Dr. Bernstein is supported in part by the Bingham Chair in Gastroenterology. Dr. Sareen is supported by CIHR #333252. Dr. Stewart is supported through a Tier 1 Canada Research Chair in Addictions and Mental Health. The sponsors had no role in the design and conduct of the study, collection and interpretation of the data, or in the decision to submit the manuscript for publication. Funding Information: C. Whitehouse is supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award. J. Fisk receives research grant support from the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, the Nova Scotia Health Authority Research Fund, and the Dalhousie Medical Research Fund. C. Bernstein has consulted to AbbVie Canada, Ferring Canada, Janssen Canada, Pfizer Canada, Shire Canada, Takeda Canada, Napo Pharmaceuticals, 4D-Pharma, and Mylan Pharmaceuticals. He has received unrestricted educational grants from AbbVie Canada, Janssen Canada, Shire Canada, Pfizer Canada, and Takeda Canada. He has been on speaker{\textquoteright}s bureaus of AbbVie Canada, Ferring Canada, and Shire Canada. L. Berrigan receives research funding from the Canada Foundation for Innovation (CFI) and SSHRC. J. Bolton receives research funding from CIHR, Brain and Behavior Research Foundation, and the MS Society of Canada. L. Graff receives research funding from CIHR, the MS Society of Canada, and the Health Sciences Centre Foundation. C. Hitchon has research funds for unrelated studies from UCB Canada and Pfizer. J. Marriott has conducted trials for Biogen Idec and Roche and receives research funding from the MS Society of Canada and the MS Scientific Foundation and Research Manitoba. C. Peschken receives research funds from CIHR and the Lupus Research Alliance; has consulted to Astra Zeneca, Baxalta, and GlaxoSmithKline; and has conducted clinical trials for Celgene. J. Sareen receives research funding from CIHR and holds stocks in Johnson and Johnson. J. Walker receives research funding from CIHR. S. Stewart receives research funding from Canadian Institutes of Health Research, Social Sciences and Humanities Research Council, Manitoba Gambling Research Program, Nova Scotia Health Research Foundation, National Center for Responsible Gaming, and Nova Scotia Health Authority Research Fund. R.A. Marrie receives research funding from CIHR, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Crohn{\textquoteright}s and Colitis Canada, National Multiple Sclerosis Society, and CMSC. She serves on the Editorial Board of Neuro- Publisher Copyright: {\textcopyright} 2019 American Academy of Neurology.",

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month = jan,

day = "29",

doi = "10.1212/WNL.0000000000006854",

language = "English",

volume = "92",

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TY - JOUR

T1 - Comorbid anxiety, depression, and cognition in MS and other immune-mediated disorders

AU - Whitehouse, Christiane E.

AU - Fisk, John D.

AU - Bernstein, Charles N.

AU - Berrigan, Lindsay I.

AU - Bolton, James M.

AU - Graff, Lesley A.

AU - Hitchon, Carol A.

AU - Marriott, James J.

AU - Peschken, Christine A.

AU - Sareen, Jitender

AU - Walker, John R.

AU - Stewart, Sherry H.

AU - Marrie, Ruth Ann

N1 - Funding Information: This study was funded by the Canadian Institutes of Health Research (THC-135234), Crohn’s and Colitis Canada, and the Waugh Family Chair in Multiple Sclerosis (to R.A.M.). Dr. Bernstein is supported in part by the Bingham Chair in Gastroenterology. Dr. Sareen is supported by CIHR #333252. Dr. Stewart is supported through a Tier 1 Canada Research Chair in Addictions and Mental Health. The sponsors had no role in the design and conduct of the study, collection and interpretation of the data, or in the decision to submit the manuscript for publication. Funding Information: C. Whitehouse is supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award. J. Fisk receives research grant support from the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, the Nova Scotia Health Authority Research Fund, and the Dalhousie Medical Research Fund. C. Bernstein has consulted to AbbVie Canada, Ferring Canada, Janssen Canada, Pfizer Canada, Shire Canada, Takeda Canada, Napo Pharmaceuticals, 4D-Pharma, and Mylan Pharmaceuticals. He has received unrestricted educational grants from AbbVie Canada, Janssen Canada, Shire Canada, Pfizer Canada, and Takeda Canada. He has been on speaker’s bureaus of AbbVie Canada, Ferring Canada, and Shire Canada. L. Berrigan receives research funding from the Canada Foundation for Innovation (CFI) and SSHRC. J. Bolton receives research funding from CIHR, Brain and Behavior Research Foundation, and the MS Society of Canada. L. Graff receives research funding from CIHR, the MS Society of Canada, and the Health Sciences Centre Foundation. C. Hitchon has research funds for unrelated studies from UCB Canada and Pfizer. J. Marriott has conducted trials for Biogen Idec and Roche and receives research funding from the MS Society of Canada and the MS Scientific Foundation and Research Manitoba. C. Peschken receives research funds from CIHR and the Lupus Research Alliance; has consulted to Astra Zeneca, Baxalta, and GlaxoSmithKline; and has conducted clinical trials for Celgene. J. Sareen receives research funding from CIHR and holds stocks in Johnson and Johnson. J. Walker receives research funding from CIHR. S. Stewart receives research funding from Canadian Institutes of Health Research, Social Sciences and Humanities Research Council, Manitoba Gambling Research Program, Nova Scotia Health Research Foundation, National Center for Responsible Gaming, and Nova Scotia Health Authority Research Fund. R.A. Marrie receives research funding from CIHR, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Crohn’s and Colitis Canada, National Multiple Sclerosis Society, and CMSC. She serves on the Editorial Board of Neuro- Publisher Copyright: © 2019 American Academy of Neurology.

PY - 2019/1/29

Y1 - 2019/1/29

N2 - ObjectiveTo determine whether anxiety and depression are associated with cognition in multiple sclerosis (MS), and whether these associations are similar in other immune-mediated inflammatory diseases (IMID; including inflammatory bowel disease [IBD] and rheumatoid arthritis [RA]) and in anxious/depressed individuals (ANX/DEP) without an IMID.MethodsParticipants (MS: n = 255; IBD: n = 247; RA: n = 154; ANX/DEP: n = 308) completed a structured psychiatric interview, the Hospital Anxiety and Depression Scale, and cognitive testing, including the Symbol Digit Modalities Test, the California Verbal Learning Test, and Letter Number Sequencing test. Test scores were converted to age-, sex-, and education-adjusted z scores. We evaluated associations of anxiety and depression with the cognitive z scores using multivariate linear models, adjusting for disease cohort.ResultsAll cohorts exhibited higher rates of impairment (i.e., z less than or equal to -1.5) in the domains of processing speed, verbal learning, and delayed recall memory relative to general population norms. Higher levels of anxiety symptoms were associated with slower processing speed, lower verbal learning, and lower working memory performance (all p < 0.001); higher levels of depression symptoms were associated with slower processing speed. These associations did not differ across cohorts.ConclusionAnxiety and depression are associated with lower cognitive function in MS, with a similar pattern observed in persons with other IMID, including IBD and RA, and persons without an IMID. Managing symptoms of anxiety and of depression in MS, as well as other IMIDs, is important to mitigate their effect on cognition.

AB - ObjectiveTo determine whether anxiety and depression are associated with cognition in multiple sclerosis (MS), and whether these associations are similar in other immune-mediated inflammatory diseases (IMID; including inflammatory bowel disease [IBD] and rheumatoid arthritis [RA]) and in anxious/depressed individuals (ANX/DEP) without an IMID.MethodsParticipants (MS: n = 255; IBD: n = 247; RA: n = 154; ANX/DEP: n = 308) completed a structured psychiatric interview, the Hospital Anxiety and Depression Scale, and cognitive testing, including the Symbol Digit Modalities Test, the California Verbal Learning Test, and Letter Number Sequencing test. Test scores were converted to age-, sex-, and education-adjusted z scores. We evaluated associations of anxiety and depression with the cognitive z scores using multivariate linear models, adjusting for disease cohort.ResultsAll cohorts exhibited higher rates of impairment (i.e., z less than or equal to -1.5) in the domains of processing speed, verbal learning, and delayed recall memory relative to general population norms. Higher levels of anxiety symptoms were associated with slower processing speed, lower verbal learning, and lower working memory performance (all p < 0.001); higher levels of depression symptoms were associated with slower processing speed. These associations did not differ across cohorts.ConclusionAnxiety and depression are associated with lower cognitive function in MS, with a similar pattern observed in persons with other IMID, including IBD and RA, and persons without an IMID. Managing symptoms of anxiety and of depression in MS, as well as other IMIDs, is important to mitigate their effect on cognition.

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Comorbid anxiety, depression, and cognition in MS and other immune-mediated disorders

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