Introduction: Depression and cognitive impairment are the most frequent mental disorders in multiple sclerosis (MS) and represent an important cause of morbidity and mortality. The aim of the study was to analyse the main determinants of depression in multiple sclerosis. Materials and methods: Thirty-two patients with relapsing remitting multiple sclerosis (RRMS), treated with Interferon Beta 1a, without relapses and corticosteroid treatment in the last 30 days, were included in the study. The mean age of the patients was 35.4±9.2 years, M/F ratio 0.33. Depression level was evaluated by the Romanian version of Beck Depression Inventory (BDI) and the cognitive function with Paced Auditory Serial Addition Test 3 (PASAT 3), Symbol Digit Modalities Test (SDMT). The functional status and disability level of the patients were evaluated with Multiple Sclerosis Functional Composite and Expanded Disability Status Scale. In all patients a cerebral MRI with intravenous contrast administration was performed using a 1.5T MRI device. Results: Twenty-three patients were free of depression (score 1-10), 4 patients presented mild mood disturbance (score 11-16), 3 borderline clinical depression (score 17-20) and 2 moderate depression (score 21-30). The mean BDI score was 8.71±7.16. BDI score correlated significantly with EDSS (R=0.38, p=0.03), PASAT 3 (R=-0.42, p=0.01), SDMT (R=-0.58, p=0.0007), Timed 25-Foot Walk (R=0.43, p=0.01) and 9-Hole Peg Test (R=0.45, p=0.008). From the EDSS functional scores, significant correlations were found with the urinary score (R=0.4, p=0.01) and sensitive score (R=0.49, p=0.004). BDI score correlated significantly with the total number of T2 lesions (R=0.31, p=0.05) while there was no correlation with the number of active lesions. Conclusions: The main determinants of depression in RRMS patients are the cognitive impairment, the affection of fine hand movements (9-HP), gait impairment (T25FT) and bladder and sensitive dysfunction.
The aim of the present study was to assess the prevalence of depression in a large multiple sclerosis (MS) patient group and to analyse the physical and psycho-socio-economic factors that influence its frequency and severity. In total, 351 consecutive patients with a diagnosis of MS were included in this study. All the patients completed a survey about their demographic characteristics, marital status, presence of children, employment status, educational level, duration of disease, disease course, duration of treatment and type of disease modifying therapies (DMT). Their disability level was evaluated using the Expanded Disability Status Scale (EDSS). Their depression level was evaluated using the Romanian Version (2012) of the Beck Depression Inventory-II (BDI-II). There was a significant positive correlation between the BDI-II score and the actual age of the patients, their disease duration, EDSS and the number of total relapses. From the EDSS functional scores, only the pyramidal score and the sensitive score presented a significant association with BDI-II in the logistic regression analysis. The BDI-II values decreased significantly with increasing education level. In the case of the retired patients, the BDI-II values were significantly higher. The BDI-II scores were also higher in widowers and divorced patients and in patients with children. There was no significant difference in the BDI-II values between different DMT groups. The main physical and psycho-socio-economic determinants of depression in patients with MS are the physical disability, disease duration, number of relapses, marital status, education level, employment status, and the presence of children, but many unsolved questions remain about the interrelations and relative contributions of these factors, which necessitates further research. The DMTs did not significantly influence the depression level.
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