Changes in the brains of patients with clinically isolated syndrome (CIS), the first clinical presentation of multiple sclerosis (MS), may be partly responsible for depressive symptoms and reduced quality of life in these patients, a study shows.
The study with that finding, “Health-related quality of life, neuropsychiatric symptoms and structural brain changes in clinically isolated syndrome,” was published in the journal PLoS ONE.
MS symptoms usually include loss of exercise capacity and brain functions, as well as increased frequency of neuropsychiatric episodes such as depression, anxiety, apathy, and fatigue.
Most of the patients experiencing these symptoms recognize the negative impact on their quality of life. Since the symptoms start to appear in the early stages of MS, physicians expect to see similar disturbances in CIS patients.
To date, however, little is known about the correlation between the frequency of neuropsychiatric symptoms, reduced health-related quality of life, and changes in the brain structure of CIS patients.
To better understand this correlation, researchers from Motol University Hospital, in Prague, Czech Republic, recruited 113 individuals (67 CIS patients and 46 healthy individuals) to undergo neurological and psychological examinations.
The study participants were analyzed in terms of perception of their quality of life, neuropsychiatric symptoms, and learning capacity, using well-established questionnaires. They also were submitted to MRI brain scans to detect changes in the structure of different regions of the brain, as well as in brain volume.
Analysis of the data collected showed that CIS patients had more symptoms of depression, which were considered mostly mild, anxiety, and lower quality of life at physical and social levels, compared to the healthy controls. A deeper analysis revealed a link between the neuropsychiatric symptoms and patients’ quality of life.
Researchers also found that the patients’ learning ability and cognitive function depends on the degree of their depressive symptoms and the perception of their quality of life.
Because the appearance of these disturbances in MS patients is caused by changes in brain structure, the team investigated the origin of the symptoms in this group.
MRI scans confirmed this association also for CIS patients. Symptoms of depression and apathy were linked to lesion size in specific parts of the brain, including the right temporal, left insular and right occipital zones. Anxiety symptoms were attributed to the lower volume of the brain’s white matter of CIS patients.
The data gathered by the research team demonstrate that the depressive symptoms experienced by CIS patients may be related to changes in their brain structure, and not only to the diagnosis of the disease.
“Our findings indicate that neuropsychiatric symptoms contributing to decreased quality of life may not be only a psychological reaction to unfavorable diagnosis but also a result of disease activity itself and thus complex therapeutic approach including antidepressant therapy, disease modifying drugs and psychosocial intervention may be beneficial in patients with CIS,” the researchers concluded.