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Abstract
Objective To 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.
Methods Participants (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.
Results All 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.
Conclusion Anxiety 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.
Glossary
- ANCOVA=
- analysis of covariance;
- ANOVA=
- analysis of variance;
- ANX/DEP=
- individuals with anxiety and depressive disorders;
- CVLT-II=
- California Verbal Learning Test, Second Edition;
- DSM-IV=
- Diagnostic and Statistical Manual of Mental Disorders, 4th edition;
- HADS=
- Hospital Anxiety and Depression Scale;
- HADS-A=
- Hospital Anxiety and Depression Scale–anxiety;
- HADS-D=
- Hospital Anxiety and Depression Scale–depression;
- IBD=
- inflammatory bowel disease;
- IMID=
- immune-mediated inflammatory disease;
- LNS=
- Letter Number Sequencing;
- MANOVA=
- multivariate analysis of variance;
- MDD=
- major depressive disorder;
- MS=
- multiple sclerosis;
- RA=
- rheumatoid arthritis;
- SCID-IV=
- Structured Clinical Interview for DSM-IV;
- SDMT=
- Symbol Digit Modalities Test;
- WTAR=
- Wechsler Test of Adult Reading
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
The CIHR Team coinvestigators are listed in Appendix 2 at the end of the article.
Editorial page 211
CME Course: NPub.org/cmelist
- Received May 23, 2018.
- Accepted in final form September 27, 2018.
- © 2019 American Academy of Neurology
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Letters: Rapid online correspondence
- Authors’ reply to Dr. Golan
- Anxiety and cognition association in immune-mediated inflammatory diseases may be confounded by disease severity
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