#ACTRIMS2020 – Depression in MS Linked to Worsening Neurological Function

Multiple sclerosis (MS) patients with depression are more likely to have worsening neurological function compared with those who do not have the mood disorder, results from a real-world study show.

The findings were presented Feb. 27 by Jenny Feng, MD, in an oral presentation — titled “Depression In MS Is Associated With Worsening Neuroperformance, Relapses, And New Brain Lesions” — at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2020, taking place Feb. 27-29 in West Palm Beach, Florida.

Depression, likely to worsen both quality of life and MS symptoms, is the most common mood disorder in people with multiple sclerosis, with a higher prevalence rate compared with the general population.

According to Feng, depression is associated with systemic inflammation. But while it affects approximately half of MS patients, “the exact relationship of depression with disease activity is unclear — whether it is a reactive phenomenon or a contributing factor.”

Thus, researchers at the Cleveland Clinic assessed a potential association between depression and short-term neurological symptoms. In other words, Feng said, the goal was to address a key question — “in MS patients, does depression affect neurological performance and inflammatory disease activity?”

The team analyzed real-world data from almost 3,000 patients from the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) database. MS PATHS includes patient data from a total of 10 healthcare MS centers — seven in the United States and three in Europe.

Data collected from patients at the study’s start (baseline) and at 12-month routine follow-up clinical visits were assessed by the researchers. All patients had relapsing-remitting MS (RRMS).

According to Feng, RRMS patients have a higher prevalence of depression than those with secondary progressive MS or primary progressive MS.

The patients’ depression status was evaluated using the Quality of Life in Neurological Disorders (NeuroQoL) depression T-score, in which a score higher than 45 indicates the mood disorder. Neurological performance was assessed via multiple tests, including the manual dexterity test —  evaluating a person’s ability to control and make coordinated hand and finger movements — a walking speed test, and a processing speed test.

Magnetic resonance imaging (MRI) data also was analyzed to determine the number of lesions — areas of damage to myelin, the protective coat of nerve fibers — in the brain and spinal cord. Specifically, the team analyzed T2 MRI images, which provide information about disease burden or lesion load, which is the total amount of lesions, both old and new.

The data were adjusted based on baseline variables, including demographics such as age, sex, race, and employment status, and clinical variables, including disease duration, relapses, and medication, among others.

Among the patients whose data were analyzed, 1,421 (mean age of 45.69 years; 78.6% female) had depression, while 1,326 (mean age 45.20 years; 72.4% female) were found to not have the mood disorder.

The results showed that neuroperformance and disease characteristics were similar between depressed and non-depressed patients at the start of the study.

However, the individuals with depression at the study’s start were found to have a 20% or greater chance of having one or more of their neuroperformance scores worsen at month 12, compared with patients without baseline depression.

The MS patients with baseline depression also showed a trend toward increased T2 lesions burden, one or more relapses, and new contrast-enhancing lesions (active lesions) at month 12. However, according to Feng, these results “did not reach statistical significance.”

Overall, “in this large real-world cohort, the presence of depression predicted worsening neurological function at one-year follow-up,” Feng said.

“There were no significant effects of depression on follow-up MRI lesion activity or clinical relapses, but results suggest potential negative trends,” she added.

Feng emphasized that depression likely contributes to clinical worsening in the long-term among MS patients, “possibly through its influence on worsening psychomotor function.”

Interestingly, the “effect of depression on worsening neuroperformance was independent of subjective perceptions of disease activity, indicating that depression is not merely a reactive phenomenon,” she concluded. “Depression in MS should be screened for and treated proactively.”

Further studies with larger sample size and longer follow-up periods are needed, the team said. They also called for research among patients with other MS subtypes.