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Bernstein CN, Dolovich C, Prichodko M, Fisk JD, Graff LA, Patten SB, Bolton J, Hitchon C, Marrie RA. Perceived Need for Mental Health Care in a Cohort of Persons With Inflammatory Bowel Disease. J Clin Gastroenterol 2024; 58:464-470. [PMID: 37725433 DOI: 10.1097/mcg.0000000000001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/11/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Psychiatric comorbidity is common in inflammatory bowel disease (IBD) and can negatively affect disease outcomes. We explored the perceived need for mental health care among persons with IBD. STUDY Persons with IBD completed self-report questionnaires, including the Hospital Anxiety and Depression Scale (HADS), and reported whether they wanted help with their mood. Each was also assessed using the Structured Clinical Interview for DSM-IV-TR Axis-I Disorders (SCIDs). We used logistic regression analyses to determine factors associated with the perceived need for mental health care. RESULTS Of 245 participants, 28% met the criteria for a past diagnosis of depression or anxiety disorder by SCID, and nearly 23% met the criteria for a current diagnosis of depression or anxiety disorder. One-third (n = 74) reported a perceived need for mental health care. Among those meeting criteria for a current SCID diagnosis of depression or anxiety, only 58% reported needing mental health care. Need for mental health care was reported by 79% of persons currently treated for either depression or 71% treated for anxiety. Persons with a perceived need for mental health care had higher mean HADS for depression and HADS for anxiety scores and also higher IBD symptom activity scores. Of those reporting no perceived need for mental health care, 13% had a current diagnosis of depression or anxiety disorder by SCID; even fewer had symptoms of depression or anxiety. CONCLUSIONS Symptoms of depression or anxiety are more important than a formal diagnosis of depression or anxiety in predicting which persons with IBD will perceive a need for mental health care.
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Affiliation(s)
- Charles N Bernstein
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
| | - Casandra Dolovich
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
| | | | - John D Fisk
- Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Nova Scotia Health, Dalhousie University, Halifax
| | - Lesley A Graff
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
- Department of Community Health Sciences
| | | | - James Bolton
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
- Departments of Community Health Sciences and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Carol Hitchon
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
| | - Ruth Ann Marrie
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg
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Ng HS, Zhu F, Zhao Y, Yao S, Lu X, Ekuma O, Evans C, Fisk JD, Marrie RA, Tremlett H. Adverse Events Associated With Disease-Modifying Drugs for Multiple Sclerosis: A Multiregional Population-Based Study. Neurology 2024; 102:e208006. [PMID: 38181306 DOI: 10.1212/wnl.0000000000208006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/27/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES It is not possible to fully establish the safety of a disease-modifying drug (DMD) for multiple sclerosis (MS) from randomized controlled trials as only very common adverse events occurring over the short-term can be captured, and the quality of reporting has been variable. We examined the relationship between the DMDs for MS and potential adverse events in a multiregion population-based study. METHODS We identified people with MS using linked administrative health data from 4 Canadian provinces. MS cases were followed from the most recent of first MS or related demyelinating disease event on January 1, 1996, until the earliest of emigration, death, or December 31, 2017. DMD exposure primarily comprised β-interferon, glatiramer acetate, natalizumab, fingolimod, dimethyl fumarate, teriflunomide, and alemtuzumab. We examined associations between DMD exposure and infection-related hospitalizations and physician visits using recurrent events proportional means models and between DMD exposure and 15 broad categories of incident adverse events using stratified multivariate Cox proportional hazard models. RESULTS We identified 35,894 people with MS. While virtually all DMDs were associated with a 42%-61% lower risk of infection-related hospitalizations, there was a modest increase in infection-related physician visits by 10%-33% for select DMDs. For incident adverse events, most elevated risks involved a second-generation DMD, with alemtuzumab's hazard of thyroid disorders being 19.42 (95% CI 9.29-36.51), hypertension 4.96 (95% CI 1.78-13.84), and cardiovascular disease 3.72 (95% CI 2.12-6.53). Natalizumab's highest risk was for cardiovascular disease (adjusted hazard ratio [aHR] 1.61; 95% CI 1.24-2.10). For the oral DMDs, fingolimod was associated with higher hazards of cerebrovascular (aHR 2.04; 95% CI 1.27-3.30) and ischemic heart diseases (aHR 1.64; 95% CI 1.10-2.44) and hypertension (aHR 1.73; 95% CI 1.30-2.31); teriflunomide with higher hazards of thyroid disorders (aHR 2.30; 95% CI 1.11-4.74), chronic liver disease (aHR 1.94; 95% CI 1.19-3.18), hypertension (aHR 1.76; 95% CI 1.32-2.37), and hyperlipidemia (aHR 1.61; 95% CI 1.07-2.44); and from complementary analyses (in 1 province), dimethyl fumarate with acute liver injury (aHR 6.55; 95% CI 1.96-21.87). DISCUSSION Our study provides an extensive safety profile of several different DMDs used to treat MS in the real-world setting. Our findings not only complement those observed in short-term clinical trials but also provide new insights that help inform the risk-benefit profile of the DMDs used to treat MS in clinical practice. The results of this study highlight the continued need for long-term, independent safety studies of the DMDs used to treat MS. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for patients with MS, while DMD exposure reduces the risk of infection-related hospitalizations, there are increased risks of infection-related physician visits and incident adverse events for select DMDs.
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Affiliation(s)
- Huah Shin Ng
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Feng Zhu
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yinshan Zhao
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shenzhen Yao
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Xinya Lu
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charity Evans
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Bernstein CN, Fisk JD, Dolovich C, Hitchon CA, Graff LA, El-Gabalawy R, Lix LM, Bolton JM, Patten SB, Marrie RA. Understanding Predictors of Fatigue Over Time in Persons With Inflammatory Bowel Disease: The Importance of Depressive and Anxiety Symptoms. Am J Gastroenterol 2024:00000434-990000000-00959. [PMID: 38088416 DOI: 10.14309/ajg.0000000000002630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Fatigue is a complex and frequent symptom in persons with inflammatory bowel disease (IBD), with detrimental impact. We aimed to determine predictors of fatigue over time. METHODS Two hundred forty-seven adults with IBD participated in a prospective study conducted in Manitoba, Canada, providing data at baseline and annually for 3 years. Participants reported fatigue impact (Daily Fatigue Impact Scale [DFIS]), depression and anxiety symptoms (Hospital Anxiety and Depression Scale [HADS]), and pain (Pain Effects Scale [PES]). Physician-diagnosed comorbidities, IBD characteristics, and physical and cognitive functioning were also assessed. We tested factors associated with fatigue using multivariable generalized linear models that estimated within-person and between-person effects. RESULTS Most participants were women (63.2%), White (85.4%), and had Crohn's disease (62%). At baseline, 27.9% reported moderate-severe fatigue impact, 16.7% had clinically elevated anxiety (HADS-A ≥11), and 6.5% had clinically elevated depression (HADS-D ≥11). Overall fatigue burden was stable over time, although approximately half the participants showed improved or worsening fatigue impact between annual visits during the study. On multivariable analysis, participants with a one-point higher HADS-D score had, on average, a 0.63-point higher DFIS score, whereas participants with a one-point higher PES score had a 0.78-point higher DFIS score. Within individuals, a one-point increase in HADS-D scores was associated with 0.61-point higher DFIS scores, in HADS-A scores with 0.23-point higher DFIS scores, and in PES scores with 0.38-point higher DFIS scores. No other variables predicted fatigue. DISCUSSION Anxiety, depression, and pain predicted fatigue impact over time in IBD, suggesting that targeting psychological factors and pain for intervention may lessen fatigue burden.
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Affiliation(s)
- Charles N Bernstein
- Department of Medicine, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- University of Manitoba IBD Clinical and Research Centre
| | - John D Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Casandra Dolovich
- Department of Medicine, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol A Hitchon
- Department of Medicine, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- University of Manitoba IBD Clinical and Research Centre
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- University of Manitoba IBD Clinical and Research Centre
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- University of Manitoba IBD Clinical and Research Centre
- Department of Community Health Sciences, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- University of Manitoba IBD Clinical and Research Centre
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ruth Ann Marrie
- Department of Medicine, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- University of Manitoba IBD Clinical and Research Centre
- Department of Community Health Sciences, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Marrie RA, Fisk JD, Dolovich C, Lix LM, Graff LA, Patten SB, Bernstein CN. Psychometric Performance of Fatigue Scales in Inflammatory Bowel Disease. Inflamm Bowel Dis 2024; 30:53-63. [PMID: 36917218 PMCID: PMC10769783 DOI: 10.1093/ibd/izad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Fatigue is highly prevalent in people with inflammatory bowel disease (IBD). Fatigue scales are important for studies testing fatigue interventions, but information about psychometric properties of many scales is insufficient in IBD. We compared the psychometric properties of multiple generic fatigue scales in participants with IBD. METHODS Individuals with IBD (N = 216) completed the Daily Fatigue Impact Scale (DFIS), the vitality subscale of the RAND-36, and the Patient Health Questionnaire-9 (PHQ-9) fatigue item twice. A subgroup (n = 84) also completed the Fatigue Impact Scale (FIS) once, from which we also scored the 21 items from the Modified Fatigue Impact Scale (MFIS-IBD). We assessed floor/ceiling effects, construct validity, and internal consistency reliability. Using relative efficiency (RE), we compared discriminating ability and comparative responsiveness of the measures regarding disease activity and employment status and changes. RESULTS The FIS, MFIS, and RAND-36-vitality scales did not exhibit floor or ceiling effects. The DFIS showed mild floor effects (19.4%), and the PHQ-9 fatigue item showed floor (18.1%) and ceiling (20.8%) effects. Internal consistency reliability exceeded 0.93 for FIS, MFIS-IBD, and DFIS and was 0.81 for the RAND-36-vitality scale. In the subgroup analysis, the FIS, MFIS-IBD, and DFIS were strongly correlated with each other (r ≥ 0.90). The ability to discriminate between disease activity groups was highest for the FIS and MFIS-IBD, followed by the DFIS. The FIS, MFIS-IBD, and DFIS were responsive to changes in work impairment. CONCLUSIONS The FIS, MFIS-IBDs and DFIS had adequate validity and reliability for assessing fatigue in IBD.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Casandra Dolovich
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Graf J, Ng HS, Zhu F, Zhao Y, Wijnands JMA, Evans C, Fisk JD, Marrie RA, Tremlett H. Disease-modifying drugs, multiple sclerosis and infection-related healthcare use in British Columbia, Canada: a population-based study. Lancet Reg Health Am 2024; 29:100667. [PMID: 38269206 PMCID: PMC10806332 DOI: 10.1016/j.lana.2023.100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
Background Much remains unknown surrounding the disease-modifying drugs (DMDs) used to treat multiple sclerosis and infection-related healthcare use in the 'real-world' setting. We examined if DMD exposure was associated with altered infection-related healthcare use. Methods We assessed if DMD (versus no) exposure was associated with altered infection-related hospitalizations, physician claims, and prescriptions filled in British Columbia, Canada (1996-2017). Healthcare use was assessed using negative binomial and proportional means regression models, reported as sex-/age-/comorbidity-/calendar year-/socioeconomic-adjusted rate and hazard ratios [aRR, aHR], with 95% confidence intervals [CIs]). Findings We identified 19,360 multiple sclerosis cases (13,940/19,360; 72.0% women; mean age at study start = 44.5 standard deviation, SD = 13.3; mean follow-up = 11.7 [SD = 7.3] years). Relative to unexposed periods, exposure to any DMD was associated with a lower infection-related rate of physician claims (aRR = 0.88; 95% CI:0.85-0.92) and hazard of hospitalization (aHR = 0.64; 95% CI:0.56-0.73), and a higher rate of infection-related prescriptions (aRR = 1.14; 95% CI:1.08-1.20). Exposure to any injectable or oral DMD was associated with a lower infection-related rate of physician claims (injectable aRR = 0.88; 95% CI:0.84-0.92, oral aRR = 0.83; 95% CI:0.77-0.90) and hazard of hospitalization (injectable aHR = 0.65; 95% CI:0.56-0.75, oral aHR = 0.54; 95% CI:0.38-0.77), whereas intravenous DMD exposure was not (aRR = 0.99; 95% CI:0.86-1.14, aHR = 0.73; 95% CI:0.49-1.09). Exposure to any injectable or intravenous DMD was associated with a higher rate of infection-related prescriptions (injectable aRR = 1.15; 95% CI:1.08-1.22, intravenous = 1.34; 95% CI:1.15-1.56), whereas oral DMDs were not (aRR = 0.98; 95% CI:0.91-1.05). Interpretation DMD exposure for the treatment of MS was associated with differences in infection-related healthcare use. While infection-related hospitalizations and physician visits were lower, prescription fills were higher. How these differences in infection-related healthcare use affect outcomes in persons with multiple sclerosis warrants consideration. Funding Canadian Institutes of Health Research (CIHR); German Research Foundation (DFG).
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Affiliation(s)
- Jonas Graf
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Huah Shin Ng
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Feng Zhu
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Yinshan Zhao
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - José MA. Wijnands
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D. Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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Yusuf FLA, Zhu F, Evans C, Fisk JD, Zhao Y, Marrie RA, Tremlett H. Gastrointestinal conditions in the multiple sclerosis prodrome. Ann Clin Transl Neurol 2024; 11:185-193. [PMID: 38115680 PMCID: PMC10791028 DOI: 10.1002/acn3.51945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To investigate gastrointestinal (GI)-related physician visits and drug dispensations in the 5 years preceding a first recorded demyelinating event or multiple sclerosis (MS) onset. METHODS Using linked administrative and clinical data from British Columbia (1996-2013), Canada, we identified an administrative cohort via a validated algorithm (n = 6863), a clinical cohort diagnosed at a MS clinic (n = 966), and matched controls (administrative cohort: n = 31,865; clinical cohort: n = 4534). In each cohort, the 5 years before a first demyelinating event or MS symptom onset (i.e., index date) were examined. We compared rates of GI-related physician visits and risk of ≥1 GI-related dispensation between MS cases and controls using negative binomial and robust Poisson models. Sex differences were tested using interaction terms. RESULTS The administrative cohort MS cases had higher rates of physician visits related to gastritis and duodenitis (adjusted rate/risk ratio (aRR):1.42, 95% CI: 1.10-1.83) and diseases of the esophagus (aRR: 1.46, 95% CI: 1.06-2.02) prior to the index date. MS cases also had greater risk of at least one dispensation for several drug classes, including constipation-related (aRR: 1.82, 95% CI: 1.50-2.22), antiemetics/antinauseants (aRR: 1.64, 95% CI: 1.43-1.89), and propulsives (promotility drugs; aRR: 1.62, 95% CI: 1.47-1.79). Men had a disproportionally higher relative risk for propulsives than women (aRR: men = 2.32, 95% CI: 1.79-3.00; women = 1.54, 95% CI: 1.36-1.72). Several findings were similar in the smaller clinical cohort though none reached statistical significance. INTERPRETATION GI-related physician visits and drug dispensations were more common in the 5 years before the first demyelinating event versus matched controls. GI symptoms are a measurable feature of the prodromal or early phase of MS, with a sex difference evident.
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Affiliation(s)
- Fardowsa L. A. Yusuf
- Medicine (Neurology), the Djavad Mowafaghian Centre for Brain HealthUniversity of British Columbia2211 Wesbrook MallVancouverBritish ColumbiaV6T 2B5Canada
- School of Population and Public Health, University of British Columbia2206 East MallVancouverBritish ColumbiaV6T 1Z3Canada
| | - Feng Zhu
- Medicine (Neurology), the Djavad Mowafaghian Centre for Brain HealthUniversity of British Columbia2211 Wesbrook MallVancouverBritish ColumbiaV6T 2B5Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan2A20.4 Health Sciences Bldg, 107 Wiggins AveSaskatoonSaskatchewanS7N 5E5Canada
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and MedicineDalhousie University4066 A.J. Lane Memorial Building, 5909 Veterans' Memorial LaneHalifaxNova ScotiaB3H 2E2Canada
| | - Yinshan Zhao
- Medicine (Neurology), the Djavad Mowafaghian Centre for Brain HealthUniversity of British Columbia2211 Wesbrook MallVancouverBritish ColumbiaV6T 2B5Canada
| | - Ruth A. Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Health Sciences CentreMax Rady College of Medicine, University of ManitobaGF543, 820 Sherbrook StreetWinnipegManitobaR3A 1R9Canada
| | - Helen Tremlett
- Medicine (Neurology), the Djavad Mowafaghian Centre for Brain HealthUniversity of British Columbia2211 Wesbrook MallVancouverBritish ColumbiaV6T 2B5Canada
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Graf J, Ng HS, Zhu F, Zhao Y, Wijnands JMA, Evans C, Fisk JD, Marrie RA, Tremlett H. Multiple sclerosis disease-modifying drug use by immigrants: a real-world study. Sci Rep 2023; 13:21235. [PMID: 38040796 PMCID: PMC10692166 DOI: 10.1038/s41598-023-46313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023] Open
Abstract
Little is known about disease-modifying drug (DMD) initiation by immigrants with multiple sclerosis (MS) in countries with universal health coverage. We assessed the association between immigration status and DMD use within 5-years after the first MS-related healthcare encounter. Using health administrative data, we identified MS cases in British Columbia (BC), Canada. The index date was the first MS-related healthcare encounter (MS/demyelinating disease-related diagnosis or DMD prescription filled), and ranged from 01/January/1996 to 31/December/2012. Those included were ≥ 18 years old, BC residents for ≥ 1-year pre- and ≥ 5-years post-index date. Persons becoming permanent residents 1985-2012 were defined as immigrants, all others were long-term residents. The association between immigration status and any DMD prescription filled within 5-years post-index date (with the latest study end date being 31/December/2017) was assessed using logistic regression, reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). We identified 8762 MS cases (522 were immigrants). Among immigrants of lower SES, odds of filling any DMD prescription were reduced, whereas they did not differ between immigrants and long-term residents across SES quintiles (aOR 0.96; 95%CI 0.78-1.19). Overall use (odds) of a first DMD within 5 years after the first MS-related encounter was associated with immigration status.
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Affiliation(s)
- Jonas Graf
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Huah Shin Ng
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Feng Zhu
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Yinshan Zhao
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - José M A Wijnands
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia Vancouver, Rm S126, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Chertcoff AS, Yusuf FLA, Zhu F, Evans C, Fisk JD, Zhao Y, Marrie RA, Tremlett H. Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis. Neurology 2023; 101:e2026-e2034. [PMID: 37748884 PMCID: PMC10662981 DOI: 10.1212/wnl.0000000000207843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/03/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Psychiatric morbidity is common after a multiple sclerosis (MS) diagnosis. However, little is known about psychiatric comorbidity during the prodromal phase (before MS onset). To compare the prevalence and relative burden of psychiatric morbidity in individuals with MS with matched controls before MS onset. METHODS Using linked administrative and clinical data from British Columbia, Canada, we identified cases with MS through a validated algorithm or from neurologist-diagnosed MS clinic attendees. Cases were matched by age, sex, and geographical location with up to 5 general population controls. We identified psychiatric morbidity through a validated definition and determined its prevalence in cases/controls in the 5 years before the first demyelinating claim of cases with MS ("administrative cohort") or symptom onset ("clinical cohort") and estimated case/control prevalence ratios with 95% CIs. We also compared the yearly number of physician visits for psychiatric morbidity, visits to psychiatrists, psychiatric-related admissions, and psychotropic dispensations pre-MS onset in cases/controls regardless of whether psychiatric morbidity algorithm was fulfilled using negative binomial regression fitted through generalized estimating equations; results were reported as adjusted rate ratios with 95% CIs. We assessed yearly trends through interaction terms between cases/controls and each year pre-MS onset. RESULTS The administrative cohort comprised 6,863/31,865 cases/controls; the clinical cohort comprised 966/4,534 cases/controls. Over the entire 5-year period pre-MS onset, 28.0% (1,920/6,863) of cases and 14.9% (4,738/31,865) of controls (administrative cohort) had psychiatric morbidity, as did 22.0% (213/966) of clinical cases and 14.1% (638/4,534) controls. Psychiatric morbidity prevalence ratios ranged from 1.58; 95% CI 1.38-1.81 (clinical cohort) to 1.91; 95% CI 1.83-2.00 (administrative cohort). In the administrative cohort, health care use was higher for cases in each year pre-MS onset (all 95% CIs >1); physician visits were 78% higher in year 5 pre-MS onset and 124% 1 year before; visits to psychiatrists were 132% higher in year 5 and 146% in year 1; hospitalizations were 129% higher in year 5 and 197% in year 1; and prescription dispensations were 72% higher in year 5 and 100% in year 1. Results were not significant in the clinical cohort. DISCUSSION Psychiatric morbidity represents a significant burden before MS onset and may be a feature of the MS prodrome.
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Affiliation(s)
- Anibal S Chertcoff
- From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Fardowsa L A Yusuf
- From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Feng Zhu
- From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charity Evans
- From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yinshan Zhao
- From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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Enns MW, Bernstein CN, Graff L, Lix LM, Hitchon CA, Fisk JD, Dufault B, Marrie RA. A longitudinal study of distress symptoms and work impairment in immune-mediated inflammatory diseases. J Psychosom Res 2023; 174:111473. [PMID: 37660681 DOI: 10.1016/j.jpsychores.2023.111473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/12/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE We investigated the association between distress symptoms (pain, fatigue, depression, anxiety) and work impairment in four patient populations: multiple sclerosis (N = 107), rheumatoid arthritis (N = 40), inflammatory bowel disease (N = 136) and psychiatric disorders (N = 167). METHODS Four waves of data collection were completed over three years. The relationship between distress symptoms and overall work impairment was evaluated with univariate and multivariable quantile logistic regression at the 25th, 50th and 75th percentiles. Models were fit to participant average scores and change scores on distress symptom measures. Covariates included sociodemographic factors, comorbidity, physical disability and cognitive function. RESULTS In the primary univariate analyses of overall work impairment at the 50th percentile, greater severity of distress symptoms was associated with greater work impairment: pain (average β = 0.27, p < 0.001; change β = 0.08, p < 0.001), fatigue (average β = 0.21, p < 0.001; change β = 0.09, p < 0.001) depression (average, β = 0.35, p < 0.001; change, β = 0.16, p < 0.001), anxiety (average, β = 0.24, p < 0.001; change, β = 0.08, p < 0 0.01). Findings were similar in multivariable analyses. CONCLUSION Pain, fatigue, depression, and anxiety symptoms are important determinants of work impairment in persons with immune-mediated diseases and persons with psychiatric disorders. Successful clinical management of these symptoms has potential to improve work-related outcomes across IMIDs.
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Affiliation(s)
- Murray W Enns
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada.
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Canada
| | - Lesley Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Canada; Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Canada
| | - John D Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Canada
| | - Brenden Dufault
- Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Canada; Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Canada
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Carter SL, Patel R, Fisk JD, Figley CR, Marrie RA, Mazerolle EL, Uddin MN, Wong K, Graff LA, Bolton JM, Marriott JJ, Bernstein CN, Kornelsen J. Differences in resting state functional connectivity relative to multiple sclerosis and impaired information processing speed. Front Neurol 2023; 14:1250894. [PMID: 37928146 PMCID: PMC10625423 DOI: 10.3389/fneur.2023.1250894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background Fifty-one percent of individuals with multiple sclerosis (MS) develop cognitive impairment (CI) in information processing speed (IPS). Although IPS scores are associated with health and well-being, neural changes that underlie IPS impairments in MS are not understood. Resting state fMRI can provide insight into brain function changes underlying impairment in persons with MS. Objectives We aimed to assess functional connectivity (FC) differences in (i) persons with MS compared to healthy controls (HC), (ii) persons with both MS and CI (MS-CI) compared to HC, (iii) persons with MS that are cognitively preserved (MS-CP) compared to HC, (iv) MS-CI compared to MS-CP, and (v) in relation to cognition within the MS group. Methods We included 107 participants with MS (age 49.5 ± 12.9, 82% women), and 94 controls (age 37.9 ± 15.4, 66% women). Each participant was administered the Symbol Digit Modalities Test (SDMT) and underwent a resting state fMRI scan. The MS-CI group was created by applying a z-score cut-off of ≤ -1.5 to locally normalized SDMT scores. The MS-CP group was created by applying a z-score of ≥0. Control groups (HCMS-CI and HCMS-CP) were based on the nearest age-matched HC participants. A whole-brain ROI-to-ROI analysis was performed followed by specific contrasts and a regression analysis. Results Individuals with MS showed FC differences compared to HC that involved the cerebellum, visual and language-associated brain regions, and the thalamus, hippocampus, and basal ganglia. The MS-CI showed FC differences compared to HCMS-CI that involved the cerebellum, visual and language-associated areas, thalamus, and caudate. SDMT scores were correlated with FC between the cerebellum and lateral occipital cortex in MS. No differences were observed between the MS-CP and HCMS-CP or MS-CI and MS-CP groups. Conclusion Our findings emphasize FC changes of cerebellar, visual, and language-associated areas in persons with MS. These differences were apparent for (i) all MS participants compared to HC, (ii) MS-CI subgroup and their matched controls, and (iii) the association between FC and SDMT scores within the MS group. Our findings strongly suggest that future work that examines the associations between FC and IPS impairments in MS should focus on the involvement of these regions.
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Affiliation(s)
- Sean L. Carter
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Ronak Patel
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Chase R. Figley
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Departments of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Erin L. Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Md Nasir Uddin
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Neurology, School of Medicine & Dentistry, University of Rochester, Rochester, NY, United States
- Department of Biomedical Engineering, Hajim School of Engineering & Applied Sciences, University of Rochester, Rochester, NY, United States
| | - Kaihim Wong
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A. Graff
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M. Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J. Marriott
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N. Bernstein
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Departments of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Kornelsen J, McIver T, Uddin MN, Figley CR, Marrie RA, Patel R, Fisk JD, Carter S, Graff L, Mazerolle EL, Bernstein CN. Altered voxel-based and surface-based morphometry in inflammatory bowel disease. Brain Res Bull 2023; 203:110771. [PMID: 37797750 DOI: 10.1016/j.brainresbull.2023.110771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023]
Abstract
Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is characterized by inflammation of the gastrointestinal tract and is a disorder of the brain-gut axis. Neuroimaging studies of brain function and structure have helped better understand the relationships between the brain, gut, and comorbidity in IBD. Studies of brain structure have primarily employed voxel-based morphometry to measure grey matter volume and surface-based morphometry to measure cortical thickness. Far fewer studies have employed other surface-based morphometry metrics such as gyrification, cortical complexity, and sulcal depth. In this study, brain structure differences between 72 adults with IBD and 90 healthy controls were assessed using all five metrics. Significant differences were found for cortical thickness with the IBD group showing extensive left-lateralized thinning, and for cortical complexity with the IBD group showing greater complexity in the left fusiform and right posterior cingulate. No significant differences were found in grey matter volume, gyrification, or sulcal depth. Within the IBD group, a post hoc analysis identified that disease duration is associated with cortical complexity of the right supramarginal gyrus, albeit with a more lenient threshold applied.
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Affiliation(s)
- Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada; University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada.
| | - Theresa McIver
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Md Nasir Uddin
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Neurology, School of Medicine & Dentistry, University of Rochester, Rochester, NY, United States; Department of Biomedical Engineering, Hajim School of Engineering & Applied Sciences, University of Rochester, Rochester, NY, United States
| | - Chase R Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - John D Fisk
- Nova Scotia Health and Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sean Carter
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Erin L Mazerolle
- Department of Psychology, Computer Science, and Biology, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Marrie RA, Bernstein CN, Dolovich C, Bolton JM, Graff LA, Hitchon CA, Lix LM, Marriott JJ, Fisk JD. Within-person fluctuations over three years in depression, anxiety, fatigue, and health-related quality of life in multiple sclerosis. Mult Scler 2023; 29:1503-1513. [PMID: 37537962 PMCID: PMC10580669 DOI: 10.1177/13524585231190771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Longitudinal studies of health-related quality of life (HRQoL) in multiple sclerosis (MS) are limited. Most have examined average changes within the population, rather than dynamic changes within individuals. OBJECTIVE To assess the between- and within-individual association between depression, anxiety, fatigue, cognition, physical functioning, and physical comorbidities and HRQoL. METHODS Adults with MS underwent physical and cognitive assessments and reported symptoms of fatigue (Daily Fatigue Impact Scale), depression and anxiety (Hospital Anxiety and Depression Scale (HADS)), and HRQoL (RAND-36) annually (n = 4 visits). We evaluated associations of elevated symptoms of anxiety (HADS-A) and depression (HADS-D), fatigue, physical function (timed-walk and nine-hole peg test), cognitive function and comorbidity count with physical (PCS-36) and mental (MCS-36) HRQoL using multivariable linear models-estimating between-person and within-person effects. RESULTS Of 255 participants with MS enrolled, 81.6% were women. After adjustment, within-person increases in depression and fatigue were associated with decreases in physical HRQoL. Increases in depression, anxiety, and comorbidity count were associated with decreases in mental HRQoL. CONCLUSIONS Within-person increases in symptoms of depression, anxiety and fatigue, and comorbidity count are associated with HRQoL decreases among adults with MS, highlighting the potential magnitude of individual benefit of intervention for these symptoms.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Casandra Dolovich
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J Marriott
- Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
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Patel R, Marrie RA, Bernstein CN, Bolton JM, Graff LA, Marriott JJ, Figley CR, Kornelsen J, Mazerolle EL, Helmick C, Uddin MN, Fisk JD. Vascular Disease Is Associated With Differences in Brain Structure and Lower Cognitive Functioning in Inflammatory Bowel Disease: A Cross-Sectional Study. Inflamm Bowel Dis 2023:izad204. [PMID: 37740523 DOI: 10.1093/ibd/izad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Vascular disease and cognitive impairment have been increasingly documented in inflammatory bowel disease (IBD), and both have been individually correlated with changes in brain structure. This study aimed to determine if both macro- and microstructural brain changes are prevalent in IBD and whether alterations in brain structure mediate the relationship between vascular disease and cognitive functioning. METHODS Eighty-four IBD participants underwent multimodal magnetic resonance imaging. Volumetric and mean diffusivity measures of the thalamus, hippocampus, normal-appearing white matter, and white matter lesions were converted to age- and sex-adjusted z scores. Vascular comorbidity was assessed using a modified Framingham Risk Score and cognition was assessed using a battery of neuropsychological tests. Test scores were standardized using local regression-based norms. We generated summary statistics for the magnetic resonance imaging metrics and cognitive tests, and these were examined using canonical correlation analysis and linear regression modeling. RESULTS Greater vascular comorbidity was negatively correlated with thalamic, normal-appearing white matter, and white matter lesion volumes. Higher Framingham Risk Score were also correlated with lower processing speed, learning and memory, and verbal fluency. Increased vascular comorbidity was predictive of poorer cognitive functioning, and this effect was almost entirely mediated (94.76%) by differences in brain structure. CONCLUSIONS Vascular comorbidity is associated with deleterious effects on brain structure and lower cognitive functioning in IBD. These findings suggest that proper identification and treatment of vascular disease is essential to the overall management of IBD, and that certain brain areas may serve as critical targets for predicting the response to therapeutic interventions.
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Affiliation(s)
- Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- PrairieNeuro Research Centre, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- PrairieNeuro Research Centre, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Erin L Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Carl Helmick
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Md Nasir Uddin
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - John D Fisk
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
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14
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Marrie RA, Lix LM, Bolton JM, Fisk JD, Fitzgerald KC, Graff LA, Hitchon CA, Kowalec K, Marriott JJ, Patten SB, Salter A, Bernstein CN. Assessment of differential item functioning of the PHQ-9, HADS-D and PROMIS-depression scales in persons with and without multiple sclerosis. J Psychosom Res 2023; 172:111415. [PMID: 37331268 DOI: 10.1016/j.jpsychores.2023.111415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE We tested for the presence of differential item functioning (DIF) in commonly used measures of depressive symptoms, in people with multiple sclerosis (MS) versus people with a psychiatric disorder without MS. METHODS Participants included individuals with MS, or with a lifetime history of a depressive or anxiety disorder (Dep/Anx) but no immune-mediated inflammatory disease. Participants completed the Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), and the Patient Reported Outcome Measurement Information System (PROMIS)-Depression. We assessed unidimensionality of the measures using factor analysis. We evaluated DIF using logistic regression, with and without adjustment for age, gender and body mass index (BMI). RESULTS We included 555 participants (MS: 252, Dep/Anx: 303). Factor analysis showed that each depression symptom measure had acceptable evidence of unidimensionality. In unadjusted analyses comparing the MS versus Dep/Anx groups we identified multiple items with evidence of DIF, but few items showed DIF effects that were large enough to be clinically meaningful. We observed non-uniform DIF for one PHQ-9 item, and three HADS-D items. We also observed DIF with respect to gender (one HADS-D item), and BMI (one PHQ-9 item). For the MS versus Dep/Anx groups, we no longer observed DIF post-adjustment for age, gender and BMI. On unadjusted and adjusted analyses, we did not observe DIF for any PROMIS-D item. CONCLUSION Our findings suggest that DIF exists for the PHQ-9 and HADS-D with respect to gender and BMI in clinical samples that include people with MS whereas DIF was not observed for the PROMIS-Depression scale.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada.
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, CAN, Canada
| | - Kathryn C Fitzgerald
- Department of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada
| | - Kaarina Kowalec
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada; Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, SWE, Sweden
| | - James J Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, CAN, Canada
| | - Amber Salter
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada; Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN, Canada
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Jain D, Bernstein CN, Graff LA, Patten SB, Bolton JM, Fisk JD, Hitchon C, Marriott JJ, Marrie RA. Pain and participation in social activities in people with relapsing remitting and progressive multiple sclerosis. Mult Scler J Exp Transl Clin 2023; 9:20552173231188469. [PMID: 37483527 PMCID: PMC10359714 DOI: 10.1177/20552173231188469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
Background Differences in pain between subtypes of multiple sclerosis are understudied. Objective To compare the prevalence of pain, and the association between pain and: (a) pain interference and (b) social participation in people with relapsing-remitting multiple sclerosis and progressive multiple sclerosis. Methods Participants completed the McGill Pain Questionnaire Short-Form-2, Pain Effects Scale and Ability to Participate in Social Roles and Activities-V2.0 questionnaires. We tested the association between multiple sclerosis subtype, pain severity, and pain interference/social participation using quantile regression. Results Of 231 participants (relapsing-remitting multiple sclerosis: 161, progressive multiple sclerosis: 70), 82.3% were women. The prevalence of pain was 95.2%, of more than mild pain was 38.1%, and of pain-related limitations was 87%; there were no differences between multiple sclerosis subtypes. Compared to participants with relapsing-remitting multiple sclerosis, those with progressive multiple sclerosis reported higher pain interference (mean (standard deviation) Pain Effects Scale; progressive multiple sclerosis: 15[6.0] vs relapsing-remitting multiple sclerosis: 13[5], p = 0.039) and lower social participation (Ability to Participate in Social Roles and Activities T-scores 45[9.0] vs 48.3[8.9], p = 0.011). However, on multivariable analysis accounting for age, physical disability, mood/anxiety and fatigue, multiple sclerosis subtype was not associated with differences in pain interference or social participation. Conclusions Pain was nearly ubiquitous. Over one-third of individuals with relapsing-remitting multiple sclerosis and progressive multiple sclerosis reported pronounced pain, although this did not differ by multiple sclerosis subtype.
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Affiliation(s)
- Dhruv Jain
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Carol Hitchon
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James J Marriott
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- St. Michael's Hospital, Toronto, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Almweisheer S, Bernstein CN, Graff LA, Patten SB, Bolton J, Fisk JD, Hitchon CA, Marriott JJ, Marrie RA. Well-being and flourishing mental health in adults with inflammatory bowel disease, multiple sclerosis and rheumatoid arthritis in Manitoba, Canada: a cross-sectional study. BMJ Open 2023; 13:e073782. [PMID: 37295825 PMCID: PMC10277148 DOI: 10.1136/bmjopen-2023-073782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES Among people with immune-mediated inflammatory disease (IMID), including multiple sclerosis (MS), inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) most research has focused on mental illness rather than on mental health. We assessed dimensions of mental health among persons with IMID and compared them across IMID. We also evaluated demographic and clinical characteristics associated with flourishing mental health. DESIGN Participants: Adults with an IMID (MS, 239; IBD, 225; RA 134; total 598) who were participating in a cohort study. SETTING Tertiary care centre in Manitoba, Canada. PRIMARY OUTCOME MEASURE Participants completed the Mental Health Continuum Short-Form (MHC-SF), which measures emotional, psychological and social well-being, and identifies flourishing mental health. This outcome was added midway through the study on the advice of the patient advisory group. Depression, anxiety, pain, fatigue and physical function were also assessed. RESULTS Total MHC-SF and subscale scores were similar across IMID groups. Nearly 60% of participants were considered to have flourishing mental health, with similar proportions across disease types (MS 56.5%; IBD 58.7%; RA 59%, p=0.95). Older age was associated with a 2% increased odds of flourishing mental health per year of age (OR 1.02; 95% CI: 1.01 to 1.04). Clinically meaningful elevations in anxiety (OR 0.25; 95% CI: 0.12 to 0.51) and depressive symptoms (OR 0.074; 95% CI: 0.009 to 0.61) were associated with lower odds. Higher levels of pain, anxiety and depressive symptoms were associated with lower total Mental Health Continuum scores at the 50th quantile. CONCLUSIONS Over half of people with MS, IBD and RA reported flourishing mental health, with levels similar across the disease groups. Interventions targeting symptoms of depression and anxiety, and upper limb impairments, as well as resilience training may help a higher proportion of the IMID population achieve flourishing mental health.
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Affiliation(s)
- Shaza Almweisheer
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Department of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A Graff
- Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott B Patten
- Community Health Sciences & Psychiatry, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carol A Hitchon
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - James J Marriott
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
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Marrie RA, Fisk JD, Fitzgerald K, Kowalec K, Maxwell C, Rotstein D, Salter A, Tremlett H. Etiology, effects and management of comorbidities in multiple sclerosis: recent advances. Front Immunol 2023; 14:1197195. [PMID: 37325663 PMCID: PMC10266935 DOI: 10.3389/fimmu.2023.1197195] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023] Open
Abstract
Comorbid conditions commonly affect people with multiple sclerosis (MS). Population-based studies indicate that people with MS have an increased incidence of ischemic heart disease, cerebrovascular disease, peripheral vascular disease, and psychiatric disorders as compared to people without MS. People with MS from underrepresented minority and immigrant groups have higher comorbidity burdens. Comorbidities exert effects throughout the disease course, from symptom onset through diagnosis to the end of life. At the individual level, comorbidity is associated with higher relapse rates, greater physical and cognitive impairments, lower health-related quality of life, and increased mortality. At the level of the health system and society, comorbidity is associated with increased health care utilization, costs and work impairment. A nascent literature suggests that MS affects outcomes from comorbidities. Comorbidity management needs to be integrated into MS care, and this would be facilitated by determining optimal models of care.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kathryn Fitzgerald
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kaarina Kowalec
- College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Dalia Rotstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- St. Michael’s Hospital, Toronto, ON, Canada
| | - Amber Salter
- Department of Neurology, UT Southwestern, Dallas, TX, United States
| | - Helen Tremlett
- Department of Medicine (Neurology) and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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Patel R, Marrie RA, Bernstein CN, Bolton JM, Graff LA, Marriott JJ, Figley CR, Kornelsen J, Mazerolle EL, Uddin MN, Fisk JD. Vascular comorbidity is associated with decreased cognitive functioning in inflammatory bowel disease. Sci Rep 2023; 13:4317. [PMID: 36922532 PMCID: PMC10017678 DOI: 10.1038/s41598-023-31160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Reports of cognitive impairment in inflammatory bowel disease (IBD) have been mixed. IBD and cardiovascular disease are often co-morbid, yet it remains unknown whether vascular comorbidity confers a risk for decreased cognitive functioning, as observed in other populations. Participants with IBD were recruited from a longitudinal study of immune-mediated disease. Participants were administered a standardized neuropsychological test protocol, evaluating information processing speed, verbal learning and memory, visual learning and memory, and verbal fluency/executive function. Cognitive test scores were standardized using local regression-based norms, adjusting for age, sex, and education. Vascular risk was calculated using a modified Framingham Risk Score (FRS). We tested the association between FRS and cognitive test scores using a quantile regression model, adjusting for IBD type. Of 84 IBD participants, 54 had ulcerative colitis and 30 had Crohn's disease; mean (SD) age was 53.36 (13.95) years, and a high proportion were females (n = 58). As the risk score (FRS) increased, participants demonstrated lower performance in information processing speed (β = - 0.12; 95% CI - 0.24, - 0.006) and verbal learning (β = - 0.14; 95% CI - 0.28, - 0.01) at the 50th percentile. After adjusting for IBD type and disease activity, higher FRS remained associated with lower information processing speed (β = - 0.14; 95% CI - 0.27, - 0.065). Vascular comorbidity is associated with lower cognitive functioning in persons with IBD, particularly in the area of information processing speed. These findings suggest that prevention, identification, and treatment of vascular comorbidity in IBD may play a critical role for improving functional outcomes in IBD.
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Affiliation(s)
- Ronak Patel
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, PZ350-771 Bannatyne Ave., Winnipeg, MB, R3E 3N4, Canada.
| | - Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, PZ350-771 Bannatyne Ave., Winnipeg, MB, R3E 3N4, Canada
| | - James J Marriott
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R Figley
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.,Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.,Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Erin L Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Md Nasir Uddin
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
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Calocer F, Ng HS, Zhu F, Zhao Y, Dejardin O, Leray E, Defer G, Evans C, Fisk JD, Marrie RA, Tremlett H. Low socioeconomic status was associated with a higher mortality risk in multiple sclerosis. Mult Scler 2023; 29:466-470. [PMID: 36281835 DOI: 10.1177/13524585221129963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relationship between socioeconomic status (SES) and mortality among persons with multiple sclerosis (PwMS) is poorly understood. OBJECTIVE To investigate the association between SES and mortality risk in PwMS. METHODS From health-administrative data, we identified 12,126 incident MS cases with a first demyelinating event (MS 'onset') occurring between 1994 and 2017. Cox proportional hazard model assessed the association between socioeconomic status quintiles (SES-Qs) at MS onset and all-cause mortality. RESULTS Lower SES-Qs were associated with higher mortality risk; adjusted hazard ratios: SES-Q1 (most deprived) =1.61 (95% confidence interval (CI) = 1.36-1.91); SES-Q2 = 1.26 (95% CI = 1.05-1.50); SES-Q3 = 1.22 (95% CI = 1.02-1.46); SES-Q4 = 1.13 (95% CI = 0.94-1.35) versus SES-Q5 (least deprived). CONCLUSION A lower SES was associated with higher mortality risk in PwMS.
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Affiliation(s)
- Floriane Calocer
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, UBC Hospital, Vancouver, BC, Canada
| | - Huah Shin Ng
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, UBC Hospital, Vancouver, BC, Canada
| | - Feng Zhu
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, UBC Hospital, Vancouver, BC, Canada
| | - Yinshan Zhao
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, UBC Hospital, Vancouver, BC, Canada
| | - Olivier Dejardin
- UNICAEN, CHU de Caen, INSERM U1086 ANTICIPE, Pôle de Recherche, Normandie University, Caen, France
| | - Emmanuelle Leray
- EHESP Rennes, Sorbonne Paris Cité, Rennes, France; CIC-P 1414, CHU Rennes, West Neuroscience Network of Excellence (WENNE), Rennes, France
| | - Gilles Defer
- UNICAEN, CHU de Caen Normandie Department of Neurology, MS Expert Center, Normandie University, Caen, France; Réseau Bas-Normand Pour la Prise en Charge de la SEP, Caen, France
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, UBC Hospital, Vancouver, BC, Canada
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Hanly JG, Robertson JW, Legge A, Kamintsky L, Aristi G, Friedman A, Beyea SD, Fisk JD, Omisade A, Calkin C, Bardouille T, Bowen C, Matheson K, Hashmi JA. Resting state functional connectivity in SLE patients and association with cognitive impairment and blood-brain barrier permeability. Rheumatology (Oxford) 2023; 62:685-695. [PMID: 35699463 PMCID: PMC9891437 DOI: 10.1093/rheumatology/keac343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Extensive blood-brain barrier (BBB) leakage has been linked to cognitive impairment in SLE. This study aimed to examine the associations of brain functional connectivity (FC) with cognitive impairment and BBB dysfunction among patients with SLE. METHODS Cognitive function was assessed by neuropsychological testing (n = 77). Resting-state FC (rsFC) between brain regions, measured by functional MRI (n = 78), assessed coordinated neural activation in 131 regions across five canonical brain networks. BBB permeability was measured by dynamic contrast-enhanced MRI (n = 61). Differences in rsFC were compared between SLE patients with cognitive impairment (SLE-CI) and those with normal cognition (SLE-NC), between SLE patients with and without extensive BBB leakage, and with healthy controls. RESULTS A whole-brain rsFC comparison found significant differences in intra-network and inter-network FC in SLE-CI vs SLE-NC patients. The affected connections showed a reduced negative rsFC in SLE-CI compared with SLE-NC and healthy controls. Similarly, a reduced number of brain-wide connections was found in SLE-CI patients compared with SLE-NC (P = 0.030) and healthy controls (P = 0.006). Specific brain regions had a lower total number of brain-wide connections in association with extensive BBB leakage (P = 0.011). Causal mediation analysis revealed that 64% of the association between BBB leakage and cognitive impairment in SLE patients was mediated by alterations in FC. CONCLUSION SLE patients with cognitive impairment had abnormalities in brain rsFC which accounted for most of the association between extensive BBB leakage and cognitive impairment.
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Affiliation(s)
- John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Jason W Robertson
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Nova Scotia Health Authority
| | - Alexandra Legge
- Division of Rheumatology, Department of Medicine, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Lyna Kamintsky
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guillermo Aristi
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Nova Scotia Health Authority
| | - Alon Friedman
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Departments of Cognitive and Brain Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Steven D Beyea
- Biomedical Translational Imaging Centre (BIOTIC), QEII Health Sciences Centre, and Department of Diagnostic Radiology
| | - John D Fisk
- Nova Scotia Health Authority, Halifax, Canada and the Departments of Psychiatry, Psychology & Neuroscience and Medicine, Dalhousie University
| | - Antonina Omisade
- Acquired Brain Injury (Epilepsy Program), Nova Scotia Health Authority
| | - Cynthia Calkin
- Department of Psychiatry and Department of Medical Neuroscience
| | | | - Chris Bowen
- Biomedical Translational Imaging Centre (BIOTIC), QEII Health Sciences Centre, and Department of Diagnostic Radiology
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Javeria A Hashmi
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Nova Scotia Health Authority
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21
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Marrie RA, Fisk JD, Walld R, Bolton JM, Sareen J, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Marriott JJ, Bernstein CN. Prescription opioid use in multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:167-169. [PMID: 36028309 PMCID: PMC9872229 DOI: 10.1136/jnnp-2022-329508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/17/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada .,Department of Community Health Sciences, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - John D Fisk
- Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, CAN, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Scott B Patten
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Department of Community Health Sciences, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, CAN, Winnipeg, Manitoba, Canada.,Department of Family Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - James J Marriott
- Department of Internal Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
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22
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Stewart SA, Pimer L, Fisk JD, Rusak B, Leslie RA, Eskes G, Schoffer K, McKelvey JR, Rolheiser T, Khan MN, Robertson H, Good KP. Olfactory Function and Diffusion Tensor Imaging as Markers of Mild Cognitive Impairment in Early Stages of Parkinson's Disease. Clin EEG Neurosci 2023; 54:91-97. [PMID: 34841903 PMCID: PMC9693894 DOI: 10.1177/15500594211058263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that is typified by motor signs and symptoms but can also lead to significant cognitive impairment and dementia Parkinson's Disease Dementia (PDD). While dementia is considered a nonmotor feature of PD that typically occurs later, individuals with PD may experience mild cognitive impairment (PD-MCI) earlier in the disease course. Olfactory deficit (OD) is considered another nonmotor symptom of PD and often presents even before the motor signs and diagnosis of PD. We examined potential links among cognitive impairment, olfactory functioning, and white matter integrity of olfactory brain regions in persons with early-stage PD. Cognitive tests were used to establish groups with PD-MCI and with normal cognition (PD-NC). Olfactory functioning was examined using the University of Pennsylvania Smell Identification Test (UPSIT) while the white matter integrity of the anterior olfactory structures (AOS) was examined using magnetic resonance imaging (MRI) diffusion tensor imaging (DTI) analysis. Those with PD-MCI demonstrated poorer olfactory functioning and abnormalities based on all DTI parameters in the AOS, relative to PD-NC individuals. OD and microstructural changes in the AOS of individuals with PD may serve as additional biological markers of PD-MCI.
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Affiliation(s)
| | - Laura Pimer
- 3688Dalhousie University, Halifax, NS, Canada
| | - John D Fisk
- 432234Nova Scotia Health, Halifax, NS, Canada
| | | | | | - Gail Eskes
- 3688Dalhousie University, Halifax, NS, Canada
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23
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Yusuf FLA, Wijnands JMA, Karim ME, Kingwell E, Zhu F, Evans C, Fisk JD, Zhao Y, Marrie RA, Tremlett H. Sex and age differences in the Multiple Sclerosis prodrome. Front Neurol 2022; 13:1017492. [PMID: 36408518 PMCID: PMC9668896 DOI: 10.3389/fneur.2022.1017492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/04/2022] [Indexed: 08/12/2023] Open
Abstract
Background and objectives Little is known of the potential sex and age differences in the MS prodrome. We investigated sex and age differences in healthcare utilization during the MS prodrome. Methods This was a population-based matched cohort study linking administrative and clinical data from British Columbia, Canada (population = 5 million). MS cases in the 5 years preceding a first demyelinating event ("administrative cohort;" n = 6,863) or MS symptom onset ("clinical cohort;" n = 966) were compared to age-, sex- and geographically-matched controls (n = 31,865/4,534). Negative binomial and modified Poisson models were used to compare the rates of physician visits and hospitalizations per international classification of diseases chapter, and prescriptions filled per drug class, between MS cases and controls across sex and age-groups (< 30, 30-49, ≥50 years). Results In the administrative cohort, males with MS had a higher relative rate for genitourinary-related visits (males: adjusted Rate Ratio (aRR) = 1.65, females: aRR = 1.19, likelihood ratio test P = 0.02) and antivertigo prescriptions (males: aRR = 4.72, females: aRR = 3.01 P < 0.01). Injury and infection-related hospitalizations were relatively more frequent for ≥50-year-olds (injuries < 30/30-49/≥50: aRR = 1.16/1.39/2.12, P < 0.01; infections 30-49/≥50: aRR = 1.43/2.72, P = 0.03), while sensory-related visits and cardiovascular prescriptions were relatively more common in younger persons (sensory 30-49/≥50: aRR = 1.67/1.45, P = 0.03; cardiovascular < 30/30-49/≥50: aRR = 1.56/1.39/1.18, P < 0.01). General practitioner visits were relatively more frequent in males (males: aRR = 1.63, females: aRR = 1.40, P < 0.01) and ≥50-year-olds (< 30/≥50: aRR = 1.32/1.55, P = 0.02), while differences in ophthalmologist visits were disproportionally larger among younger persons, < 50-years-old (< 30/30-49/≥50: aRR = 2.25/2.20/1.55, P < 0.01). None of the sex and age-related differences in the smaller clinical cohort reached significance (P ≥ 0.05). Discussion Sex and age-specific differences in healthcare use were observed in the 5 years before MS onset. Findings demonstrate fundamental heterogeneity in the MS prodromal presentation.
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Affiliation(s)
- Fardowsa L. A. Yusuf
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - José M. A. Wijnands
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Elaine Kingwell
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Feng Zhu
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D. Fisk
- Nova Scotia Health and the Department of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Yinshan Zhao
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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24
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Ng HS, Zhu F, Kingwell E, Yao S, Ekuma O, Evans C, Fisk JD, Marrie RA, Zhao Y, Tremlett H. Disease-Modifying Drugs for Multiple Sclerosis and Association With Survival. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/5/e200005. [PMID: 35701187 PMCID: PMC9210547 DOI: 10.1212/nxi.0000000000200005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/22/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES We examined the association between the disease-modifying drugs (DMDs) for multiple sclerosis (MS) and survival in a multiregion population-based study. METHODS We accessed multiple administrative health databases from 4 Canadian provinces. Persons with MS were identified and followed from the most recent of the first MS or demyelinating event or January 1, 1996 (index date), until death, emigration, or December 31, 2017. Association between the first-generation and second-generation DMDs and all-cause mortality was examined using stratified Cox proportional hazard models, reported as adjusted hazard ratios (aHRs). Timing of DMD initiation was explored, with findings reported at 2, 5, or 10 years postindex date, representing very early, early, or late initiation. RESULTS We identified 35,894 persons with MS; 72% were female. The mean age at index date was 44.5 years (SD = 13.6). The total person-years of follow-up while DMD-exposed was 89,180, and total person-years while unexposed was 342,217. Compared with no exposure, exposure to any DMD or to any first-generation DMD was associated with a 26% lower hazard of mortality (both aHRs 0.74; 95% CI 0.56-0.98), while any second-generation DMD exposure was associated with a 33% lower hazard (aHR 0.67; 95% CI 0.46-0.98). Earlier DMD initiation (beta-interferon or glatiramer acetate vs no exposure) was associated with a significant mortality effect (p < 0.05), while later initiation was not (95% CIs included 1). However, the survival advantage with earlier initiation diminished over time, no longer reaching statistical significance at 15 years postindex date. DISCUSSION Our study demonstrates an association between the DMDs for MS and improved survival in the real-world setting.
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25
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Tittle JM, Schwark DG, Biddle W, Schmitt MA, Fisk JD. Impact of queuosine modification of endogenous E. coli tRNAs on sense codon reassignment. Front Mol Biosci 2022; 9:938114. [PMID: 36120552 PMCID: PMC9471426 DOI: 10.3389/fmolb.2022.938114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
The extent to which alteration of endogenous tRNA modifications may be exploited to improve genetic code expansion efforts has not been broadly investigated. Modifications of tRNAs are strongly conserved evolutionarily, but the vast majority of E. coli tRNA modifications are not essential. We identified queuosine (Q), a non-essential, hypermodified guanosine nucleoside found in position 34 of the anticodons of four E. coli tRNAs as a modification that could potentially be utilized to improve sense codon reassignment. One suggested purpose of queuosine modification is to reduce the preference of tRNAs with guanosine (G) at position 34 of the anticodon for decoding cytosine (C) ending codons over uridine (U) ending codons. We hypothesized that introduced orthogonal translation machinery with adenine (A) at position 34 would reassign U-ending codons more effectively in queuosine-deficient E. coli. We evaluated the ability of introduced orthogonal tRNAs with AUN anticodons to reassign three of the four U-ending codons normally decoded by Q34 endogenous tRNAs: histidine CAU, asparagine AAU, and aspartic acid GAU in the presence and absence of queuosine modification. We found that sense codon reassignment efficiencies in queuosine-deficient strains are slightly improved at Asn AAU, equivalent at His CAU, and less efficient at Asp GAU codons. Utilization of orthogonal pair-directed sense codon reassignment to evaluate competition events that do not occur in the standard genetic code suggests that tRNAs with inosine (I, 6-deaminated A) at position 34 compete much more favorably against G34 tRNAs than Q34 tRNAs. Continued evaluation of sense codon reassignment following targeted alterations to endogenous tRNA modifications has the potential to shed new light on the web of interactions that combine to preserve the fidelity of the genetic code as well as identify opportunities for exploitation in systems with expanded genetic codes.
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26
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Uddin MN, Figley TD, Kornelsen J, Mazerolle EL, Helmick CA, O'Grady CB, Pirzada S, Patel R, Carter S, Wong K, Essig MR, Graff LA, Bolton JM, Marriott JJ, Bernstein CN, Fisk JD, Marrie RA, Figley CR. The comorbidity and cognition in multiple sclerosis (CCOMS) neuroimaging protocol: Study rationale, MRI acquisition, and minimal image processing pipelines. Front Neuroimaging 2022; 1:970385. [PMID: 37555178 PMCID: PMC10406313 DOI: 10.3389/fnimg.2022.970385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/29/2022] [Indexed: 08/10/2023]
Abstract
The Comorbidity and Cognition in Multiple Sclerosis (CCOMS) study represents a coordinated effort by a team of clinicians, neuropsychologists, and neuroimaging experts to investigate the neural basis of cognitive changes and their association with comorbidities among persons with multiple sclerosis (MS). The objectives are to determine the relationships among psychiatric (e.g., depression or anxiety) and vascular (e.g., diabetes, hypertension, etc.) comorbidities, cognitive performance, and MRI measures of brain structure and function, including changes over time. Because neuroimaging forms the basis for several investigations of specific neural correlates that will be reported in future publications, the goal of the current manuscript is to briefly review the CCOMS study design and baseline characteristics for participants enrolled in the three study cohorts (MS, psychiatric control, and healthy control), and provide a detailed description of the MRI hardware, neuroimaging acquisition parameters, and image processing pipelines for the volumetric, microstructural, functional, and perfusion MRI data.
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Affiliation(s)
- Md Nasir Uddin
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Teresa D. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Department of Physiology and Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Erin L. Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Carl A. Helmick
- Division of Geriatric Medicine, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Christopher B. O'Grady
- Department of Anesthesia and Biomedical Translational Imaging Centre, Dalhousie University, Halifax, NS, Canada
| | - Salina Pirzada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Department of Physiology and Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sean Carter
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Kaihim Wong
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Marco R. Essig
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Lesley A. Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M. Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J. Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N. Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - John D. Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
- Department of Physiology and Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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27
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Marrie RA, Patel R, Figley CR, Kornelsen J, Bolton JM, Graff LA, Mazerolle EL, Helmick C, Uddin MN, Figley TD, Marriott JJ, Bernstein CN, Fisk JD. Effects of Vascular Comorbidity on Cognition in Multiple Sclerosis Are Partially Mediated by Changes in Brain Structure. Front Neurol 2022; 13:910014. [PMID: 35685743 PMCID: PMC9170886 DOI: 10.3389/fneur.2022.910014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 01/09/2023] Open
Abstract
ObjectiveVascular comorbidities are associated with reduced cognitive performance and with changes in brain structure in people with multiple sclerosis (MS). Understanding causal pathways is necessary to support the design of interventions to mitigate the impacts of comorbidities, and to monitor their effectiveness. We assessed the inter-relationships among vascular comorbidity, cognition and brain structure in people with MS.MethodsAdults with neurologist-confirmed MS reported comorbidities, and underwent assessment of their blood pressure, HbA1c, and cognitive functioning (i.e., Symbol Digit Modalities Test, California Verbal Learning Test, Brief Visuospatial Memory Test-Revised, and verbal fluency). Test scores were converted to age-, sex-, and education-adjusted z-scores. Whole brain magnetic resonance imaging (MRI) was completed, from which measures of thalamic and hippocampal volumes, and mean diffusivity of gray matter and normal-appearing white matter were converted to age and sex-adjusted z-scores. Canonical correlation analysis was used to identify linear combinations of cognitive measures (cognitive variate) and MRI measures (MRI variate) that accounted for the most correlation between the cognitive and MRI measures. Regression analyses were used to test whether MRI measures mediated the relationships between the number of vascular comorbidities and cognition measures.ResultsOf 105 participants, most were women (84.8%) with a mean (SD) age of 51.8 (12.8) years and age of symptom onset of 29.4 (10.5) years. Vascular comorbidity was common, with 35.2% of participants reporting one, 15.2% reporting two, and 8.6% reporting three or more. Canonical correlation analysis of the cognitive and MRI variables identified one pair of variates (Pillai's trace = 0.45, p = 0.0035). The biggest contributors to the cognitive variate were the SDMT and CVLT-II, and to the MRI variate were gray matter MD and thalamic volume. The correlation between cognitive and MRI variates was 0.50; these variates were used in regression analyses. On regression analysis, vascular comorbidity was associated with the MRI variate, and with the cognitive variate. After adjusting for the MRI variate, vascular comorbidity was not associated with the cognitive variate.ConclusionVascular comorbidity is associated with lower cognitive function in people with MS and this association is partially mediated via changes in brain macrostructure and microstructure.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Ruth Ann Marrie
| | - Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - James M. Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A. Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Erin L. Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Carl Helmick
- Department of Psychiatry and Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Md Nasir Uddin
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Neurology, University of Rochester, Rochester, New York, NY, United States
| | - Teresa D. Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J. Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N. Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
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Marrie RA, Fisk JD, Walld R, Bolton JM, Sareen J, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Marriott JJ, Bernstein CN. Use of Benzodiazepines and Z-Drugs in Multiple Sclerosis. Front Neurol 2022; 13:874724. [PMID: 35493810 PMCID: PMC9049992 DOI: 10.3389/fneur.2022.874724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Use of benzodiazepines and Z-drugs (non-benzodiazepine sedative hypnotics) is controversial due to adverse health outcomes in the general population. However, little is known about their use in people with multiple sclerosis (MS). We estimated the incidence and prevalence of benzodiazepine and Z-drug use (jointly BZD) in the MS population as compared to an age-, sex- and geographically-matched population without MS, and examined the association of mood/anxiety disorders with the use of BZD over a twenty-year period. Methods Using administrative data from Manitoba, Canada, we identified 2,985 persons with incident MS and 14,891 persons without MS matched 5:1 on sex, birth year and region. We applied validated case definitions to identify persons with any mood/anxiety disorder. Dispensations of BZD were identified. To assess the association between MS, mood/anxiety disorders and BZD use we constructed generalized linear models adjusting for age, sex, index year, socioeconomic status, urban/rural residence, physical comorbidities, and health care use. We also examined patterns of BZD use. Results In 2016, the crude incidence of benzodiazepine use in the MS cohort was 2.10% (95%CI: 1.43–2.98%), 1.49-fold higher than in the non-MS cohort (1.41%; 95%CI: 1.18–1.67%). The crude incidence of Z-drug use in the MS cohort was 1.77% (95%CI: 1.20–2.51%), 1.78-fold higher than in the non-MS cohort (0.99%; 95%CI: 0.81–1.21%). After adjusting for covariates, among individuals without an active mood/anxiety disorder, the MS cohort had a 39% increased incidence rate of benzodiazepine use and a 72% increased incidence rate of Z-drug use as compared to the non-MS cohort. Among individuals with an active mood/anxiety disorder, the incidence of BZD use did not differ between the MS and non-MS cohorts. A higher proportion of people with MS used BZD for ≥6 months than people without MS. Conclusion Use of BZD is more common in people with MS than in general population controls, and use of these agents is in persons with MS is often chronic.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Ruth Ann Marrie
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M. Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carol A. Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Anesthesiology, Perioperative Medicine and Pain, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alan Katz
- Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J. Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N. Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Graf J, Ng HS, Zhu F, Zhao Y, Wijnands JM, Evans C, Fisk JD, Marrie RA, Tremlett H. Emergency department use by persons with MS: A population-based descriptive study with a focus on infection-related visits. Mult Scler 2022; 28:1825-1828. [PMID: 35232298 PMCID: PMC9442277 DOI: 10.1177/13524585221078497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We described emergency department (ED) visits (all visits and infection-related)
by persons with multiple sclerosis (MS) in British Columbia, Canada (1 April
2012 to 31 December 2017). We identified 15,350 MS cases using health
administrative data; 73.4% were women, averaging 51.4 years at study entry. Over
4.9 years of follow-up (mean), 56.0% of MS cases visited an ED (mean = 0.6
visits/person/year; total = 37,072 visits). A diagnosis was documented for
25,698 (69.3%) ED visits, and 18.4% (4725/25,698) were infection-related.
Inpatient admissions were reported for 20.4% (5238/25,698) of all and 29.2%
(1380/4725) of infection-related ED visits. Findings suggest that the ED plays a
substantial role in MS healthcare and infection management.
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Affiliation(s)
- Jonas Graf
- Division of Neurology, Department of Medicine, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Huah Shin Ng
- Division of Neurology, Department of Medicine, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Feng Zhu
- Division of Neurology, Department of Medicine, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Yinshan Zhao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - José Ma Wijnands
- Division of Neurology, Department of Medicine, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
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Ng HS, Graf J, Zhu F, Kingwell E, Aktas O, Albrecht P, Hartung HP, Meuth SG, Evans C, Fisk JD, Marrie RA, Zhao Y, Tremlett H. Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population. Front Immunol 2022; 12:794075. [PMID: 35095869 PMCID: PMC8792855 DOI: 10.3389/fimmu.2021.794075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background Evidence regarding the efficacy or effectiveness of the disease-modifying drugs (DMDs) in the older multiple sclerosis (MS) population is scarce. This has contributed to a lack of evidence-based treatment recommendations for the ageing MS population in practice guidelines. We examined the relationship between age (<55 and ≥55 years), DMD exposure and health service use in the MS population. Methods We conducted a population-based observational study using linked administrative health data from British Columbia, Canada. We selected all persons with MS and followed from the most recent of their first MS or demyelinating event, 18th birthday or 01-January-1996 (index date) until the earliest of emigration, death or 31-December-2017 (study end). We assessed DMD exposure status over time, initially as any versus no DMD, then by generation (first or second) and finally by each individual DMD. Age-specific analyses were conducted with all-cause hospitalizations and number of physician visits assessed using proportional means model and negative binomial regression with generalized estimating equations. Results We included 19,360 persons with MS (72% were women); 10,741/19,360 (56%) had ever reached their 55th birthday. Person-years of follow-up whilst aged <55 was 132,283, and 93,594 whilst aged ≥55. Any DMD, versus no DMD in the <55-year-olds was associated with a 23% lower hazard of hospitalization (adjusted hazard ratio, aHR0.77; 95%CI 0.72-0.82), but not in the ≥55-year-olds (aHR0.95; 95%CI 0.87-1.04). Similar patterns were observed for the first and second generation DMDs. Exposure to any (versus no) DMD was not associated with rates of physician visits in either age group (<55 years: adjusted rate ratio, aRR1.02; 95%CI 1.00-1.04 and ≥55 years: aRR1.00; 95%CI 0.96-1.03), but variation in aRR was observed across the individual DMDs. Conclusion Our study showed beneficial effects of the DMDs used to treat MS on hospitalizations for those aged <55 at the time of exposure. In contrast, for individuals ≥55 years of age exposed to a DMD, the hazard of hospitalization was not significantly lowered. Our study contributes to the broader understanding of the potential benefits and risks of DMD use in the ageing MS population.
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Affiliation(s)
- Huah Shin Ng
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Jonas Graf
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Feng Zhu
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Elaine Kingwell
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.,Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, Palacky University in Olomouc, Olomouc, Czechia
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Yinshan Zhao
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Helen Tremlett
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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Biddle W, Schwark DG, Schmitt MA, Fisk JD. Directed Evolution Pipeline for the Improvement of Orthogonal Translation Machinery for Genetic Code Expansion at Sense Codons. Front Chem 2022; 10:815788. [PMID: 35252113 PMCID: PMC8891652 DOI: 10.3389/fchem.2022.815788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/24/2022] [Indexed: 12/30/2022] Open
Abstract
The expansion of the genetic code beyond a single type of noncanonical amino acid (ncAA) is hindered by inefficient machinery for reassigning the meaning of sense codons. A major obstacle to using directed evolution to improve the efficiency of sense codon reassignment is that fractional sense codon reassignments lead to heterogeneous mixtures of full-length proteins with either a ncAA or a natural amino acid incorporated in response to the targeted codon. In stop codon suppression systems, missed incorporations lead to truncated proteins; improvements in activity may be inferred from increased protein yields or the production of downstream reporters. In sense codon reassignment, the heterogeneous proteins produced greatly complicate the development of screens for variants of the orthogonal machinery with improved activity. We describe the use of a previously-reported fluorescence-based screen for sense codon reassignment as the first step in a directed evolution workflow to improve the incorporation of a ncAA in response to the Arg AGG sense codon. We first screened a library with diversity introduced into both the orthogonal Methanocaldococcus jannaschii tyrosyl tRNA anticodon loop and the cognate aminoacyl tRNA synthetase (aaRS) anticodon binding domain for variants that improved incorporation of tyrosine in response to the AGG codon. The most efficient variants produced fluorescent proteins at levels indistinguishable from the E. coli translation machinery decoding tyrosine codons. Mutations to the M. jannaschii aaRS that were found to improve tyrosine incorporation were transplanted onto a M. jannaschii aaRS evolved for the incorporation of para-azidophenylalanine. Improved ncAA incorporation was evident using fluorescence- and mass-based reporters. The described workflow is generalizable and should enable the rapid tailoring of orthogonal machinery capable of activating diverse ncAAs to any sense codon target. We evaluated the selection based improvements of the orthogonal pair in a host genomically engineered for reduced target codon competition. Using this particular system for evaluation of arginine AGG codon reassignment, however, E. coli strains with genomes engineered to remove competing tRNAs did not outperform a standard laboratory E. coli strain in sense codon reassignment.
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Wan A, Bernstein CN, Graff LA, Patten SB, Sareen J, Fisk JD, Bolton JM, Hitchon C, Marriott JJ, Marrie RA. Childhood Maltreatment and Psychiatric Comorbidity in Immune-Mediated Inflammatory Disorders. Psychosom Med 2022; 84:10-19. [PMID: 34654023 DOI: 10.1097/psy.0000000000001025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether childhood maltreatment is associated with immune-mediated inflammatory disorders (IMIDs; multiple sclerosis [MS], inflammatory bowel disease [IBD], and rheumatoid arthritis [RA]). We further aimed to determine the relationship between maltreatment and psychiatric comorbidity in IMIDs and whether these relationships differed across IMID. METHODS Six hundred eighty-one participants (MS, 232; IBD, 216; RA, 130; healthy controls, 103) completed a structured psychiatric interview to identify psychiatric disorders, and the Childhood Trauma Questionnaire to evaluate five types of maltreatment: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. We evaluated associations between maltreatment, IMID, and psychiatric comorbidity using multivariable logistic regression models. RESULTS The prevalence of having ≥1 maltreatment was similar across IMID but higher than in controls (MS, 63.8%; IBD, 61.6%; RA, 62.3%; healthy controls, 45.6%). Emotional abuse was associated with having an IMID (adjusted odds ratio [aOR] = 2.37; 1.15-4.89). In the sex-specific analysis, this association was only present in women. History of childhood maltreatment was associated with a lifetime diagnosis of a psychiatric disorder in the IMID cohort (OR = 2.24; 1.58-3.16), but this association did not differ across diseases. In those with IMID, total types of maltreatments (aOR = 1.36; 1.17-1.59) and emotional abuse (aOR = 2.64; 1.66-4.21) were associated with psychiatric comorbidity. CONCLUSIONS Childhood maltreatment is more common in IMID than in a healthy population and is associated with psychiatric comorbidity. Given the high burden of psychiatric disorders in the IMID population, clinicians should be aware of the contribution of maltreatment and the potential need for trauma-informed care strategies.
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Affiliation(s)
- Anthony Wan
- From the Max Rady College of Medicine (Wan) and Departments of Internal Medicine (Bernstein, Hitchon, Marriott, Marrie) and Clinical Health Psychology (Graff), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Departments of Community Health Sciences and Psychiatry (Patten), Cumming School of Medicine, University of Calgary, Calgary; Department of Psychiatry (Sareen, Bolton), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health Authority (Fisk), Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax; and Department of Community Health Sciences (Bolton), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Landrigan J, Bessenyei K, Leitner D, Yakovenko I, Fisk JD, Prentice JL. A systematic review of the effects of cannabis on cognition in people with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103338. [DOI: 10.1016/j.msard.2021.103338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
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Ng HS, Zhu F, Kingwell E, Zhao Y, Yao S, Ekuma O, Svenson LW, Evans C, Fisk JD, Marrie RA, Tremlett H. Disease-modifying drugs for multiple sclerosis and subsequent health service use. Mult Scler 2021; 28:583-596. [PMID: 34949130 PMCID: PMC8958569 DOI: 10.1177/13524585211063403] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective: We assessed the relationship between the multiple sclerosis (MS) disease-modifying drugs (DMDs) and healthcare use. Methods: Persons with MS (aged ⩾18 years) were identified using linked population-based health administrative data in four Canadian provinces and were followed from the most recent of their first MS/demyelinating event or 1 January 1996 until the earliest of death, emigration, or study end (31 December 2017 or 31 March 2018). Prescription records captured DMD exposure, examined as any DMD, then by generation (first-generation (the injectables) or second-generation (orals/infusions)) and individual DMD. The associations with subsequent all-cause hospitalizations and physician visits were examined using proportional means model and negative binomial regression. Results: Of 35,894 MS cases (72% female), mean follow-up was 12.0 years, with person-years of DMD exposure for any, or any first- or second-generation DMD being 63,290, 54,605 and 8685, respectively. Any DMD or any first-generation DMD exposure (versus non-exposure) was associated with a 24% lower hazard of hospitalization (adjusted hazard ratio, aHR: 0.76; 95% confidence intervals (CIs): 0.71–0.82), rising to 29% for the second-generation DMDs (aHR: 0.71; 95% CI: 0.58–0.88). This ranged from 18% for teriflunomide (aHR: 0.82; 95% CI: 0.67–1.00) to 44% for fingolimod (aHR: 0.56; 95% CI: 0.36–0.87). In contrast, DMD exposure was generally not associated with substantial differences in physician visits. Conclusion: Findings provide real-world evidence of a beneficial relationship between DMD exposure and hospitalizations.
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Affiliation(s)
- Huah Shin Ng
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Feng Zhu
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Elaine Kingwell
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada/Research Department of Primary Care & Population Health, University College London, London, UK
| | - Yinshan Zhao
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Shenzhen Yao
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada/Health Quality Council, Saskatoon, SK, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence W Svenson
- Alberta Health, Edmonton, AB, Canada/Division of Preventive Medicine & School of Public Health, University of Alberta, Edmonton, AB, Canada/Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada/Division of Neurology, Department of Medicine, Faculty of Medicine, UBC Hospital, Vancouver, BC, Canada
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Maxwell SP, Cash MK, Rockwood K, Fisk JD, Darvesh S. A Canadian cohort with the IVS10+14
MAPT
mutation. Alzheimers Dement 2021. [DOI: 10.1002/alz.054597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Sultan Darvesh
- Dalhousie University Halifax NS Canada
- Mount Saint Vincent University Halifax NS Canada
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Parks NE, Andreou P, Marrie RA, Fisk JD, Bhan V, Kirkland SA. Comorbidity and persistence of disease-modifying therapy use in relapsing remitting multiple sclerosis. Mult Scler Relat Disord 2021; 56:103249. [PMID: 34517192 DOI: 10.1016/j.msard.2021.103249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/29/2021] [Accepted: 09/01/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Comorbidity decreases the likelihood of initiating disease-modifying therapy (DMT) for multiple sclerosis (MS). Our objective was to characterize the relationship between comorbidity and initial DMT persistence along with reasons for DMT discontinuation. METHODS We identified individuals with relapsing remitting MS or clinically isolated syndrome starting a platform DMT (interferon-β, glatiramer acetate, dimethyl fumarate, teriflunomide) as initial therapy in the Canadian province of Nova Scotia from 2001 to 2016. Cases were identified using a clinic database for the only clinic providing specialty MS care in a province with universal publicly-funded health care. Comorbidity was determined by linkage of MS cases to provincial health administrative data using validated case definitions for mental health disorder, hypertension, hyperlipidemia, diabetes, chronic lung disease, ischemic heart disease, epilepsy, and inflammatory bowel disease. Cox proportional hazards models explored the relationship between comorbidity, as a count or individual comorbidities, and time to discontinuation of initial DMT. Logistic regression models explored reasons for DMT discontinuation. RESULTS Among 1464 individuals starting platform therapy as initial DMT, the median duration on first DMT was 4 years (95% CI 4 - 4). Comorbidity count (0, 1, ≥2) was not associated with time to discontinuation of initial DMT. However, the presence of a mental health disorder was associated with an increased hazard of discontinuing DMT (hazard ratio 1.22, 95% CI 1.03-1.44). Comorbidity count was not associated with discontinuation for lack of efficacy or lack of tolerability after adjusting for covariates. CONCLUSION Individuals with mental health comorbidity may have unique challenges that affect persistence on DMT after treatment initiation.
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Affiliation(s)
- Natalie E Parks
- Division of Neurology, Halifax Infirmary, Dalhousie University, 1796 Summer St, Room 3832, Halifax, NS B3H 3A7, Canada; Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada.
| | - Pantelis Andreou
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Health Sciences Centre, University of Manitoba, GF 543-820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience and Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Virender Bhan
- Division of Neurology, University of British Columbia, 3935 Kincaid St, Burnaby, BC V5G 2J6, Canada
| | - Susan A Kirkland
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada
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Marrie RA, Walld R, Bolton JM, Sareen J, Patten SB, Singer A, Lix LM, Hitchon CA, Marriott JJ, El-Gabalawy R, Katz A, Fisk JD, Bernstein CN. Effect of comorbid mood and anxiety disorders on breast and cervical cancer screening in immune-mediated inflammatory disease. PLoS One 2021; 16:e0249809. [PMID: 34351924 PMCID: PMC8341605 DOI: 10.1371/journal.pone.0249809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
We aimed to examine rates of breast and cervical cancer screening in women with immune-mediated inflammatory diseases (IMID), including inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) versus a matched cohort with IMID; and examine the association of psychiatric comorbidity with screening in these populations. We conducted a retrospective cohort study in Manitoba, Canada using administrative data. We identified women with IBD, MS and RA, and controls without these IMID matched on age and region. Annually, we identified individuals with any active mood/anxiety disorder. Using physician claims, we determined the proportion of each cohort who had cervical cancer screening within three-year intervals, and mammography screening within two-year intervals. We modeled the difference in the proportion of the IMID and matched cohorts who underwent mammography; and pap tests using log-binomial regression with generalized estimating equations, adjusting for sociodemographics, comorbidity and immune therapy use. We tested for additive interactions between cohort and mood/anxiety disorder status. During 2006–2016, we identified 17,230 women with IMID (4,623 with IBD, 3,399 with MS, and 9,458 with RA) and 85,349 matched controls. Having an IMID was associated with lower (-1%) use of mammography; however, this reflected a mixture of more mammography in the IBD cohort (+2.9%) and less mammography in the MS (-4.8 to -5.2%) and RA (-1.5%) cohorts. Within the IBD, MS and RA cohorts, having an active mood/anxiety disorder was associated with more mammography use than having an inactive mood/anxiety disorder. The MS and RA cohorts were less likely to undergo Pap testing than their matched cohorts. In the absence of an active mood/anxiety disorder, the IBD cohort was more likely to undergo Pap testing than its matched cohort; the opposite was true when an active mood/anxiety disorder was present. Among women with an IMID, mood/anxiety disorder influence participation in cancer screening.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James J Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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MacDonald TM, Fisk JD, Bernstein CN, El-Gabalawy R, Hitchon CA, Kornelsen J, Patten SB, Tisseverasinghe A, Marrie RA. The association between childhood maltreatment and pain catastrophizing in individuals with immune-mediated inflammatory diseases. J Psychosom Res 2021; 145:110479. [PMID: 33814193 DOI: 10.1016/j.jpsychores.2021.110479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Childhood maltreatment is associated with pain catastrophizing. Both childhood maltreatment and pain catastrophizing are prevalent in certain immune-mediated inflammatory disease (IMID) populations. However, it is unknown whether childhood maltreatment contributes to the high rates of pain catastrophizing in IMID cohorts. We assessed the relationship between childhood maltreatment and pain catastrophizing in individuals with IMID, and whether this differed across IMID. METHODS Between November 2014 and July 2016 we recruited individuals with multiple sclerosis (MS), inflammatory bowel disease (IBD), and rheumatoid arthritis (RA). Participants completed the Childhood Trauma Questionnaire-Short Form, the Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. We tested the association between childhood maltreatment and pain catastrophizing using multivariable logistic regression. RESULTS We included 577 individuals with IMID (MS: 232, IBD: 215, RA: 130). Overall, 265 (46%) participants with IMID reported any childhood maltreatment, with the most common type of maltreatment being emotional neglect. Childhood maltreatment was associated with pain catastrophizing (OR 3.32; 95% CI 1.89-5.85) independent of other risk factors, including sociodemographics and symptoms of anxiety and depression. CONCLUSION Pain catastrophizing is highly prevalent in our IMID population, and strongly associated with childhood maltreatment in this population. Interventions that consider childhood maltreatment and pain catastrophizing should be incorporated into the clinical management of IMID patients.
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Affiliation(s)
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry and Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Departments of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada; Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Annaliese Tisseverasinghe
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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Marrie RA, Walld R, Bolton JM, Sareen J, Patten SB, Singer A, Lix LM, Hitchon CA, Marriott JJ, El-Gabalawy R, Katz A, Fisk JD, Bernstein CN. Uptake of influenza vaccination among persons with inflammatory bowel disease, multiple sclerosis or rheumatoid arthritis: a population-based matched cohort study. CMAJ Open 2021; 9:E510-E521. [PMID: 33990365 PMCID: PMC8157981 DOI: 10.9778/cmajo.20200105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Individuals with immune-mediated inflammatory diseases, such as inflammatory bowel disease, multiple sclerosis and rheumatoid arthritis, are at increased risk for influenza and related complications. We examined and compared the uptake of influenza vaccination among people with and without these diseases, as well as the influence of psychiatric comorbidity on vaccine uptake. METHODS Using administrative data from Apr. 1, 1984, to Mar. 31, 2016, we conducted a retrospective matched cohort study in Manitoba, Canada. We matched persons 18 years of age or older who had a diagnosis of inflammatory bowel disease, multiple sclerosis or rheumatoid arthritis (the immune-mediated inflammatory disease cohorts) with persons who did not have these diagnoses (the control cohorts) on age, sex and region. We then identified cohort members with any mood or anxiety disorder (depression, anxiety disorders, bipolar disorder). We identified influenza vaccinations through billing codes. Using binomial regression, we modelled the difference in the proportion of the immune-mediated inflammatory disease and matched cohorts vaccinated annually, with adjustment for sociodemographic characteristics, comorbidity and immune therapy. We tested additive interaction effects between a person's cohort and presence of a mood or anxiety disorder. RESULTS We identified 32 880 individuals with 1 or more immune-mediated inflammatory diseases (10 148 with inflammatory bowel disease, 6158 with multiple sclerosis and 16 975 with rheumatoid arthritis) and a total of 164 152 controls. In fiscal year 2015, 8668 (41.3%, 95% confidence interval [CI] 40.6% to 42.0%) of the 20 982 persons with an immune-mediated inflammatory disease received an influenza vaccination, a rate higher than among controls (35 238 of 104 634; 33.7%, 95% CI 33.4% to 34.0%). After adjustment, participants with an immune-mediated inflammatory disease but no mood or anxiety disorder had 6.44% (95% CI 5.79% to 7.10%) greater uptake of vaccination than participants without such a disease. Among participants without an immune-mediated inflammatory disease, having a mood or anxiety disorder was associated with 4.54% (95% CI 4.20% to 4.89%) greater uptake of vaccination. However, we observed a subadditive interaction between immune-mediated inflammatory disease and psychiatric status (-1.38%, 95% CI -2.26% to -0.50%). INTERPRETATION Uptake of influenza vaccination was consistently low in populations with immune-mediated inflammatory disease, and although psychiatric morbidity is associated with greater vaccine uptake by Manitobans, it negatively interacts with these diseases to reduce uptake. Changes in care delivery are needed to mitigate this gap in care.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - Randy Walld
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - James M Bolton
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - Jitender Sareen
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - Scott B Patten
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - Alexander Singer
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - Lisa M Lix
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - Carol A Hitchon
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - James J Marriott
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - Renée El-Gabalawy
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - Alan Katz
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - John D Fisk
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
| | - Charles N Bernstein
- Department of Internal Medicine (Marrie, Hitchon, Marriott, Bernstein), Department of Community Health Sciences (Marrie, Lix, Katz), Manitoba Centre for Health Policy (Walld, Katz), Department of Psychiatry (Bolton, Sareen), Department of Family Medicine (Singer, Katz), Department of Clinical Health Psychology (El-Gabalawy) and Department of Anesthesiology and Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Patten), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Psychiatry (Fisk), of Psychology and Neuroscience (Fisk) and of Medicine (Fisk), Dalhousie University, Halifax, NS
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Cash MK, Rockwood K, Fisk JD, Darvesh S. Clinicopathological correlations and cholinesterase expression in early-onset familial Alzheimer's disease with the presenilin 1 mutation, Leu235Pro. Neurobiol Aging 2021; 103:31-41. [PMID: 33789210 DOI: 10.1016/j.neurobiolaging.2021.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 11/28/2022]
Abstract
In sporadic Alzheimer's disease (SpAD), acetylcholinesterase and butyrylcholinesterase, co-regulators of acetylcholine, are associated with β-amyloid plaques and tau neurofibrillary tangles in patterns suggesting a contribution to neurotoxicity. This association has not been explored in early-onset familial Alzheimer's disease (FAD). We investigated whether cholinesterases are observed in the neuropathological hallmarks in FAD expressing the presenilin 1 Leu235Pro mutation. Brain tissues from three FAD cases and one early-onset SpAD case were stained and analyzed for β-amyloid, tau, α-synuclein, acetylcholinesterase and butyrylcholinesterase. AD pathology was prominent throughout the rostrocaudal extent of all 4 brains but α-synuclein-positive neurites were present in only one familial case. In FAD and SpAD cases, cholinergic activity was associated with plaques and tangles but not with α-synuclein pathology. Both cholinesterases showed similar or decreased plaque staining than detected with β-amyloid immunostaining but greater plaque deposition than observed with thioflavin-S histofluorescence. Acetylcholinesterase and butyrylcholinesterase are highly associated with AD pathology in inherited disease and both may represent specific diagnostic and therapeutic targets for all AD forms.
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Affiliation(s)
- Meghan K Cash
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada
| | - John D Fisk
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sultan Darvesh
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Medicine (Neurology), Dalhousie University, Halifax, Nova Scotia, Canada.
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Kamintsky L, Beyea SD, Fisk JD, Hashmi JA, Omisade A, Calkin C, Bardouille T, Bowen C, Quraan M, Mitnitski A, Matheson K, Friedman A, Hanly JG. Response to: 'Correspondence on 'Blood-brain barrier leakage in systemic lupus erythematosus is associated with gray matter loss and cognitive impairment'' by Pamuk and Hasni. Ann Rheum Dis 2021; 82:e124. [PMID: 33622691 DOI: 10.1136/annrheumdis-2021-220057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 01/15/2023]
Affiliation(s)
- Lyna Kamintsky
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steven D Beyea
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth ll Health Sciences Centre, Halifax, Nova Scotia, Canada.,Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John D Fisk
- Psychiatry, Psychology & Neuroscience and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Javeria A Hashmi
- Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Antonina Omisade
- Acquired Brain Injury (Epilepsy Program), Nova Scotia Health Authority, Halifax, Nova Scotia, Guernsey
| | - Cynthia Calkin
- Psychiatry and Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Mood Disorders Clinic, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Tim Bardouille
- Physics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Bowen
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth ll Health Sciences Centre, Halifax, Nova Scotia, Canada.,Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maher Quraan
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth ll Health Sciences Centre, Halifax, Nova Scotia, Canada.,Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Alon Friedman
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Cognitive and Brain Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - John G Hanly
- Medicine and Pathology, Queen Elizabeth ll Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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Maxwell SP, Cash MK, Rockwood K, Fisk JD, Darvesh S. Clinical and neuropathological variability in the rare IVS10 + 14 tau mutation. Neurobiol Aging 2021; 101:298.e1-298.e10. [PMID: 33612310 DOI: 10.1016/j.neurobiolaging.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/24/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
Mutations in the microtubule-associated protein tau gene are known to cause progressive neurodegenerative disorders with variable clinical and neuropathological phenotypes, including the intronic 10 + 14 (IVS10 + 14) splice site mutation. Three families have been reported with the IVS10 + 14 microtubule-associated protein tau mutation. Here, we describe the clinical and neuropathological data from an additional family. Neuropathological data were available for 2 of the 3 cases, III-4, and III-5. While III-5 had widespread tau deposition and atrophy, III-4 exhibited more mild neuropathological changes except for the substantia nigra. The previously reported families that express the IVS10 + 14 mutation exhibited significant interfamilial heterogeneity, with symptoms including amyotrophy, dementia, disinhibition, parkinsonism, and breathing problems. In addition to expressing many of these symptoms, members of this fourth family experienced profound sensory abnormalities and sleep disturbance. Although there were probable clinicopathological correlates for the symptoms expressed by the earlier families and III-5 from our cohort, pathology in III-4 did not appear sufficient to explain symptom severity. This indicates the need to explore alternate mechanisms of tau-induced brain dysfunction.
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Affiliation(s)
- Selena P Maxwell
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Meghan K Cash
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Department of Medicine (Division of Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Medicine (Division of Neurology), Dalhousie University, Halifax, Nova Scotia, Canada
| | - John D Fisk
- Department of Medicine (Division of Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sultan Darvesh
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Medicine (Division of Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Medicine (Division of Neurology), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Chemistry and Physics, Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
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Schwark DG, Schmitt MA, Fisk JD. Directed Evolution of the Methanosarcina barkeri Pyrrolysyl tRNA/aminoacyl tRNA Synthetase Pair for Rapid Evaluation of Sense Codon Reassignment Potential. Int J Mol Sci 2021; 22:E895. [PMID: 33477414 PMCID: PMC7830368 DOI: 10.3390/ijms22020895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/20/2022] Open
Abstract
Genetic code expansion has largely focused on the reassignment of amber stop codons to insert single copies of non-canonical amino acids (ncAAs) into proteins. Increasing effort has been directed at employing the set of aminoacyl tRNA synthetase (aaRS) variants previously evolved for amber suppression to incorporate multiple copies of ncAAs in response to sense codons in Escherichia coli. Predicting which sense codons are most amenable to reassignment and which orthogonal translation machinery is best suited to each codon is challenging. This manuscript describes the directed evolution of a new, highly efficient variant of the Methanosarcina barkeri pyrrolysyl orthogonal tRNA/aaRS pair that activates and incorporates tyrosine. The evolved M. barkeri tRNA/aaRS pair reprograms the amber stop codon with 98.1 ± 3.6% efficiency in E. coli DH10B, rivaling the efficiency of the wild-type tyrosine-incorporating Methanocaldococcus jannaschii orthogonal pair. The new orthogonal pair is deployed for the rapid evaluation of sense codon reassignment potential using our previously developed fluorescence-based screen. Measurements of sense codon reassignment efficiencies with the evolved M. barkeri machinery are compared with related measurements employing the M. jannaschii orthogonal pair system. Importantly, we observe different patterns of sense codon reassignment efficiency for the M. jannaschii tyrosyl and M. barkeri pyrrolysyl systems, suggesting that particular codons will be better suited to reassignment by different orthogonal pairs. A broad evaluation of sense codon reassignment efficiencies to tyrosine with the M. barkeri system will highlight the most promising positions at which the M. barkeri orthogonal pair may infiltrate the E. coli genetic code.
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Affiliation(s)
| | | | - John D. Fisk
- Department of Chemistry, University of Colorado Denver, Campus Box 194, P.O. Box 173364, Denver, CO 80217-3364, USA; (D.G.S.); (M.A.S.)
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Marrie RA, Whitehouse CE, Patel R, Figley CR, Kornelsen J, Bolton JM, Graff LA, Mazerolle EL, Marriott JJ, Bernstein CN, Fisk JD. Performance of Regression-Based Norms for Cognitive Functioning of Persons With Multiple Sclerosis in an Independent Sample. Front Neurol 2021; 11:621010. [PMID: 33519702 PMCID: PMC7840703 DOI: 10.3389/fneur.2020.621010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Cognitive impairment is common in multiple sclerosis (MS). Interpretation of neuropsychological tests requires the use of normative data. Traditionally, normative data have been reported for discrete categories such as age. More recently continuous norms have been developed using multivariable regression equations that account for multiple demographic factors. Regression-based norms have been developed for use in the Canadian population for tests included in the MACFIMS and BICAMS test batteries. Establishing the generalizability of these norms is essential for application in clinical and research settings. Objectives: We aimed to (i) test the performance of previously published Canadian regression-based norms in an independently collected sample of Canadian healthy controls; (ii) compare the ability of Canadian and non-Canadian regression-based norms to discriminate between healthy controls and persons with MS; and (iii) develop regression-based norms for several cognitive tests drawn from batteries commonly used in MS that incorporated race/ethnicity in addition to age, education, and sex. Methods: We included 93 adults with MS and 96 healthy adults in this study, with a replication sample of 104 (MS) and 39 (healthy adults). Participants reported their sociodemographic characteristics, and each was administered the oral Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test (CVLT-II), and the Brief Visuospatial Memory Test-Revised (BVMT-R). From the healthy control data, we developed regression-based norms incorporating race, age, education and sex. We then applied existing discrete norms and regression-based norms for the cognitive tests to the healthy controls, and generated z-scores which were compared using Spearman rank and concordance coefficients. We also used receiver operating characteristic (ROC) curves to compare the ability of each set of norms to discriminate between participants with and without MS. Within the MS samples we compared the ability of each set of norms to discriminate between differing levels of disability and employment status using relative efficiency. Results: When we applied the published regression norms to our healthy sample, impairment classification rates often differed substantially from expectations (7%), even when the norms were derived from a Canadian (Ontario) population. Most, but not all of the Spearman correlations between z-scores based on different existing published norms for the same cognitive test exceeded 0.90. However, concordance coefficients were often lower. All of the norms for the SDMT reliably discriminated between the MS and healthy control groups. In contrast, none of the norms for the CVLT-II or BVMT-R discriminated between the MS and healthy control groups. Within the MS population, the norms varied in their ability to discriminate between disability levels or employment status; locally developed norms for the SDMT and CVLT-II had the highest relative efficiency. Conclusion: Our findings emphasize the value of local norms when interpreting the results of cognitive tests and demonstrate the need to consider and assess the performance of regression-based norms developed in other populations when applying them to local populations, even when they are from the same country. Our findings also strongly suggest that the development of regression-based norms should involve larger, more diverse samples to ensure broad generalizability.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Ronak Patel
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R Figley
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.,Neuroscience Research Program, Winnipeg Health Sciences Centre, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.,Neuroscience Research Program, Winnipeg Health Sciences Centre, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Erin L Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - James J Marriott
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - John D Fisk
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada.,Departments of Psychiatry, and Medicine, Dalhousie University, Halifax, NS, Canada
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Marrie RA, Graff LA, Fisk JD, Patten SB, Bernstein CN. The Relationship Between Symptoms of Depression and Anxiety and Disease Activity in IBD Over Time. Inflamm Bowel Dis 2021; 27:1285-1293. [PMID: 33393632 PMCID: PMC8314114 DOI: 10.1093/ibd/izaa349] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 02/06/2023]
Abstract
BRACKGROUND We aimed to examine associations between elevated symptoms of depression and anxiety and disease activity in inflammatory bowel disease (IBD). Previous findings have been inconsistent and have not accounted for variability in the courses of these conditions over time. METHODS We followed 247 participants with IBD (153 Crohn's disease [CD], 94 ulcerative colitis [UC]) for 3 years. Annually, participants underwent an abdominal examination, reported therapies used for IBD, and completed the Hospital Anxiety and Depression Scale (HADS) questionnaire. We evaluated associations of elevated symptoms (scores ≥11) of anxiety (HADS-A) and depression (HADS-D) with the presence of active IBD as measured using the Powell Tuck Index for UC and the Harvey-Bradshaw Disease Activity Index for CD. We employed logistic regression with generalized estimating equations, simultaneously estimating between-person and within-person effects. RESULTS Of 247 participants, 15 (6.1%) had elevated symptoms of depression (HADS-D ≥11) at enrollment, 41 (16.6%) had elevated symptoms of anxiety (HADS-A ≥11), and 101 (40.9%) had active IBD. On average, individuals with elevated symptoms of depression (odds ratio [OR], 6.27; 95% CI, 1.39-28.2) and anxiety (OR, 2.17; 95% CI, 1.01-4.66) had increased odds of active IBD. Within individuals, elevations in symptoms of depression over time were associated with increased odds of active IBD (OR, 2.70; 95% CI, 1.15-6.34), but elevated symptoms of anxiety were not. After adjustment for covariates (including disease activity), elevated symptoms of depression were also associated with increased odds of biologic therapy use (OR, 2.02; 95% CI, 1.02-4.00). CONCLUSION Symptoms of depression and anxiety are associated with disease activity in IBD over time. Reducing these symptoms should be incorporated into the management of IBD.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CANADA,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CANADA,University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, CANADA
| | - Lesley A Graff
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, CANADA,Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CANADA
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Nova Scotia, CANADA
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CANADA
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CANADA,University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, CANADA,Address correspondence to: Charles N. Bernstein, MD, 804F-715 McDermot Avenue, University of Manitoba, Winnipeg, Manitoba, Canada R3E3P4. E-mail:
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Ng HS, Zhu F, Kingwell E, Zhao Y, Yao S, Ekuma O, Svenson LW, Evans C, Fisk JD, Marrie RA, Tremlett H. Characteristics of a population-based multiple sclerosis cohort treated with disease-modifying drugs in a universal healthcare setting. Expert Rev Neurother 2020; 21:131-140. [PMID: 33146570 DOI: 10.1080/14737175.2021.1847085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Relatively little is known about the use of disease-modifying drugs (DMDs) for multiple sclerosis (MS) in the population-based universal healthcare setting. This study aimed to describe the characteristics of a population-based cohort with MS and their DMD exposure in four Canadian provinces. Methods: We identified all adults (aged ≥18 years) with MS using linked population-based health administrative data. Individuals were followed from the most recent of their first MS or demyelinating event or 1 January 1996(study entry), to the earliest of death, emigration, or 31 March 2018(study end). Cohort characteristics examined included sex, age, socioeconomic status, and comorbidity burden. Results: Overall, 10,418/35,894 (29%) of MS cases filled a DMD prescription during the 22-year study period. Most were women (n = 7,683/10,418;74%), and 17% (n = 1,745/10,418) had some comorbidity (Charlson Comorbidity Index≥1) at study entry. Nearly 20% (n = 1,745/10,418) were aged ≥50 when filling their first DMD; the mean age was 39.6 years. Conclusions: Almost 1 in 6 people with MS had at least some comorbidity, and nearly 1 in 6 were ≥50 years old at the time of their first DMD. As these individuals are typically excluded from clinical trials, findings illustrate the need to understand the harms and benefits of DMD use in these understudied groups.
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Affiliation(s)
- Huah Shin Ng
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
| | - Feng Zhu
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
| | - Elaine Kingwell
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
| | - Yinshan Zhao
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
| | - Shenzhen Yao
- College of Pharmacy and Nutrition, University of Saskatchewan , Saskatoon, SK, Canada.,Health Quality Council , Saskatoon, SK, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, MB, Canada
| | - Lawrence W Svenson
- Alberta Health , Edmonton, AB, Canada.,Division of Preventive Medicine & School of Public Health, University of Alberta , Edmonton, AB, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary , Calgary, AB, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan , Saskatoon, SK, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University , Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, MB, Canada
| | - Helen Tremlett
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
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Bernstein CN, Hitchon CA, Walld R, Bolton JM, Lix LM, El-Gabalawy R, Sareen J, Singer A, Katz A, Marriott J, Fisk JD, Patten SB, Marrie RA. The Impact of Psychiatric Comorbidity on Health Care Utilization in Inflammatory Bowel Disease: A Population-based Study. Inflamm Bowel Dis 2020; 27:1462-1474. [PMID: 33274369 PMCID: PMC8376123 DOI: 10.1093/ibd/izaa310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with an increase in psychiatric comorbidity (PC) compared with the general population. We aimed to determine the impact of PC on health care utilization in persons with IBD. METHODS We applied a validated administrative definition of IBD to identify all Manitobans with IBD from April 1, 2006, to March 31, 2016, and a matched cohort without IBD. A validated definition for PC in IBD population was applied to both cohorts; active PC status meant ≥2 visits for psychiatric diagnoses within a given year. We examined the association of active PC with physician visits, inpatient hospital days, proportion with inpatient hospitalization, and use of prescription IBD medications in the following year. We tested for the presence of a 2-way interaction between cohort and PC status. RESULTS Our study matched 8459 persons with IBD to 40,375 controls. On crude analysis, IBD subjects had ≥3.7 additional physician visits, had >1.5 extra hospital days, and used 2.1 more drug types annually than controls. Subjects with active PC had >10 more physician visits, had 3.1 more hospital days, and used >6.3 more drugs. There was a synergistic effect of IBD (vs no IBD) and PC (vs no PC) across psychiatric disorders of around 4%. This synergistic effect was greatest for anxiety (6% [2%, 9%]). After excluding psychiatry-related visits and psychiatry-related hospital stays, there remained an excess health care utilization in persons with IBD and PC. CONCLUSION Inflammatory bowel disease with PC increases health care utilization compared with matched controls and compared with persons with IBD without PC. Active PC further increases health care utilization.
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Affiliation(s)
- Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Address correspondence to Charles N. Bernstein, MD, 804F-715 McDermot Avenue, University of Manitoba, Winnipeg, Manitoba, Canada R3E3P4. E-mail:
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Departments of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexander Singer
- Department Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Department Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Marrie RA, Walld R, Bolton JM, Sareen J, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Fisk JD, Marriott JJ, Bernstein CN. Effect of mood and anxiety disorders on health care utilization in multiple sclerosis. Mult Scler 2020; 27:1411-1420. [PMID: 33045925 PMCID: PMC8358559 DOI: 10.1177/1352458520963880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Little is known about the effects of changes in the presence or absence of psychiatric disorders on health care utilization in multiple sclerosis (MS). Objective: To evaluate the association between “active” mood and anxiety disorders (MAD) and health care utilization in MS. Methods: Using administrative data from Manitoba, Canada, we identified 4748 persons with MS and 24,154 persons without MS matched on sex, birth year, and region. Using multivariable general linear models, we evaluated the within-person and between-person effects of any “active” MAD on annual physician visits, hospital days, and number of drug classes dispensed in the following year. Results: Annually, the MS cohort had an additional two physician visits, two drug classes, and nearly two more hospital days versus the matched cohort. Individuals with any MAD had more physician visits, had hospital days, and used more drug classes than individuals without a MAD. Within individuals, having an “active” MAD was associated with more utilization for all outcomes than not having an “active” MAD, but the magnitude of this effect was much smaller for visits and drugs than the between-person effect. Conclusion: Within individuals with MS, changes in MAD activity are associated with changes in health services use.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada/Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada/Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada/Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada/ Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada/Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - James J Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Kamintsky L, Beyea SD, Fisk JD, Hashmi JA, Omisade A, Calkin C, Bardouille T, Bowen C, Quraan M, Mitnitski A, Matheson K, Friedman A, Hanly JG. Blood-brain barrier leakage in systemic lupus erythematosus is associated with gray matter loss and cognitive impairment. Ann Rheum Dis 2020; 79:1580-1587. [PMID: 33004325 DOI: 10.1136/annrheumdis-2020-218004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine the association between blood-brain barrier (BBB) integrity, brain volume and cognitive dysfunction in adult patients with systemic lupus erythematosus (SLE). METHODS A total of 65 ambulatory patients with SLE and 9 healthy controls underwent dynamic contrast-enhanced MRI scanning, for quantitative assessment of BBB permeability. Volumetric data were extracted using the VolBrain pipeline. Global cognitive function was evaluated using a screening battery consisting of tasks falling into five broad cognitive domains, and was compared between patients with normal versus extensive BBB leakage. RESULTS Patients with SLE had significantly higher levels of BBB leakage compared with controls (p=0.04). Extensive BBB leakage (affecting over >9% of brain volume) was identified only in patients with SLE (16/65; 24.6%), who also had smaller right and left cerebral grey matter volumes compared with controls (p=0.04). Extensive BBB leakage was associated with lower global cognitive scores (p=0.02), and with the presence of impairment on one or more cognitive tasks (p=0.01). CONCLUSION Our findings provide evidence for a link between extensive BBB leakage and changes in both brain structure and cognitive function in patients with SLE. Future studies should investigate the mechanisms underlying BBB-mediated cognitive impairment, validate the diagnostic utility of BBB imaging, and determine the potential of targeting the BBB as a therapeutic strategy in patients with SLE.
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Affiliation(s)
- Lyna Kamintsky
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steven D Beyea
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth ll Health Sciences Centre, Halifax, Nova Scotia, Canada.,Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John D Fisk
- Psychiatry, Psychology & Neuroscience and Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Javeria A Hashmi
- Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Antonina Omisade
- Acquired Brain Injury (Epilepsy Program), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Cynthia Calkin
- Psychiatry and Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Mood Disorders Clinic, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Tim Bardouille
- Physics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Bowen
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth ll Health Sciences Centre, Halifax, Nova Scotia, Canada.,Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maher Quraan
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth ll Health Sciences Centre, Halifax, Nova Scotia, Canada.,Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Alon Friedman
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Cognitive and Brain Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - John G Hanly
- Medicine and Pathology, Queen Elizabeth ll Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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Wallace LMK, Theou O, Darvesh S, Bennett DA, Buchman AS, Andrew MK, Kirkland SA, Fisk JD, Rockwood K. Neuropathologic burden and the degree of frailty in relation to global cognition and dementia. Neurology 2020; 95:e3269-e3279. [PMID: 32989103 DOI: 10.1212/wnl.0000000000010944] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To test the hypothesis that degree of frailty and neuropathologic burden independently contribute to global cognition and odds of dementia. METHODS This was a secondary analysis of a prospective cohort study of older adults living in Illinois. Participants underwent an annual neuropsychological and clinical evaluation. We included 625 participants (mean age 89.7 ± 6.1 years; 67.5% female) who died and underwent autopsy. We quantified neuropathology using an index measure of 10 neuropathologic features: β-amyloid deposition, hippocampal sclerosis, Lewy bodies, tangle density, TDP-43, cerebral amyloid angiopathy, arteriolosclerosis, atherosclerosis, and gross and chronic cerebral infarcts. Clinical consensus determined dementia status, which we coded as no cognitive impairment, mild cognitive impairment, or dementia. A battery of 19 tests spanning multiple domains quantified global cognition. We operationalized frailty using a 41-item frailty index. We employed regression analyses to model relationships between neuropathology, frailty, and dementia. RESULTS Both frailty and a neuropathology index were independently associated with global cognition and dementia status. These results held after controlling for traditional pathologic measures in a sample of participants with Alzheimer clinical syndrome. Frailty improved the fit of the model for dementia status (χ2[2] 72.64; p < 0.0001) and explained an additional 11%-12% of the variance in the outcomes. CONCLUSION Dementia is a multiply determined condition, to which both general health, as captured by frailty, and neuropathology significantly contribute. This integrative view of dementia and health has implications for prevention and therapy; specifically, future research should evaluate frailty as a means of dementia risk reduction.
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Affiliation(s)
- Lindsay M K Wallace
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Olga Theou
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Sultan Darvesh
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - David A Bennett
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Aron S Buchman
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Melissa K Andrew
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Susan A Kirkland
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - John D Fisk
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Kenneth Rockwood
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.
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