Interplay Between Cognitive and Bowel/Bladder Function in Multiple Sclerosis

Abstract

Purpose: to evaluate the prevalence of bowel/bladder dysfunction in multiple sclerosis (MS) and the association with cognitive impairment. Methods:We prospectively enrolled 150 MS patients. Patients were administered the Symbol Digit Modality Test (SDMT), and filled the Neurogenic Bowel Dysfunction Score (NBDS) and the Actionable Bladder Symptom Screening Tool (ABSST). Association between bowel/bladder dysfunction and cognitive function was assessed through hierarchical regression models using SDMT and clinic-demographic features as independent variables and NBDS or ABSST score as dependent variables.Results: Prevalence for bowel/bladder deficit was 44.7%, with 26 patients (17.3%) suffering from bowel deficits and 60 patients (40%) from bladder deficits. Total NBDS and ABSST correlated with SDMT (coeff. = -0.10, p<0.001 and coeff. = -0.03, p=0.04, respectively) after correction for demographic features and physical disability.Conclusions: Bowel/bladder disorders are common in MS and are associated with both physical and cognitive disability burden. As SDMT is embedded into routine clinical assessment, a lower score may warrant investigating bowel/bladder dysfunction due their strong interplay.

A multiscale assessment of bowel impairment in an Italian multiple sclerosis cohort

“…Both scores were associated with disease duration, clinical disability and disease severity. Furthermore, they were closely associated with each other and with NBDS, which has been repeatedly used in MS 6 , 17 .…”

“…Another strength of our study resides in the use of Wexner scores for incontinence and constipation to separately assess the two main problems related to bowel dysfunctions. The aforementioned scales have been widely applied and validated in different settings, they are quick and easy to use and overcome one of the major limitations of several studies, in that constipation and fecal incontinence were not separately analyzed 6 , 17 .…”

“…Despite their negative role on the well-being of pwMS, sphincter-related symptoms have typically been inadequately investigated by clinicians and are under-reported by patients, leading to an underestimation of their actual prevalence 4 . The strong association between bowel dysfunctions and physical and mental health as well as with the level of satisfaction with life situation 2 , fatigue 5 and cognitive disability further underline the need to carefully assess this aspect in pwMS 6 . The relevance of sphincter dysfunctions in MS is related also to socio-economic factors: significantly higher costs for medicines for constipation in MS as well as inpatient costs related to urinary tract infections, which are often an indirect consequence of bowel dysfunction 7 .…”

Bowel dysfunctions after acquired brain injury: a scoping review

“…A broad spectrum of conditions has been extensively studied in NBD epidemiology, including Parkinson’s disease ( Stocchi et al, 2000 ; Awad, 2011 ), multiple sclerosis ( Preziosi et al, 2018 ; Carotenuto et al, 2021 ), spinal cord injury (SCI; Emmanuel, 2019 ; Johns et al, 2021 ), spina bifida ( Emmanuel, 2019 ), stroke ( Harari et al, 2003 ; Li et al, 2017 ), and cerebral palsy ( Wright et al, 2016 ).…”