Etiology, effects and management of comorbidities in multiple sclerosis: recent advances

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.

Randomized Controlled Trial of Intermittent Calorie Restriction in People With Multiple Sclerosis

“…Beneficial effects of CR include improved vascular and metabolic risk factors which are associated with worse MS outcomes 42 . Our 12-week study showed no major improvement of the clinical lipid profile or glucose tolerance.…”

Association of Higher Mediterranean Diet Adherence With Lower Prevalence of Disability and Symptom Severity, Depression, Anxiety, Stress, Sleep Quality, Cognitive Impairment, and Physical Inactivity in Older Adults With Multiple Sclerosis

“…74 The present study has several strengths as it was performed in an adequate sample size of older adults with MS who had non any additional severe chronic disease except for MS. This fact has provided substantial evidence for the impact of MD against disability and symptom severity, independently of potential comorbidities, which may affect the potential beneficial effect of MD against MS. 12 A strength of our study also deals with the assessment of several sociodemographic characteristics and BMI status which may exert a confounding effect concerning the association of MD with disease disability and symptom severity as well as quality of life. Another strength of our study was the used of qualified questionnaires such as EDSS, GDS, STAI-6, PSS, MMSE, IPAQ, PSQI and MedDietScore, to assess disability and symptom severity, depression, anxiety, stress, cognitive status, physical activity, sleep quality, and MD adherence of the enrolled study population, respectively.…”

“…5,9 Changes in MS pathophysiology appear to be age dependent and several studies have identified a consistent phase of disability worsening in the later stages of the life. [10][11][12] Several clinical studies indicated significantly diminished anti-inflammatory efficacy in patients older than 40 years old. 13,14 Also, MS itself may be closely related to cognitive impairment, even though its exact etiopathogenic mechanisms remain still unclear.…”

Association of Mediterranean diet adherence with disease progression, quality of life and physical activity, sociodemographic and anthropometric parameters, and serum biomarkers in community-dwelling older adults with multiple sclerosis: a cross-sectional study

“…In fact, the epidemiology of MS has recently shifted to an older population, with a peak prevalence of the disease seen at the age group of 55–65 years [ 15 ]. Changes in MS pathophysiology appear to be age dependent and a consistent phase of disability worsening in later stages of life has been identified [ 16 ]. Older age has been related with a higher risk of adverse events, including serious infections and MS [ 17 ].…”