Polypharmacy in multiple sclerosis: Relationship with fatigue, perceived cognition, and objective cognitive performance

Thelen, Joanie; Lynch, Sharon G.; Bruce, Amanda S.; Hancock, Laura M.; Bruce, Jared M.

doi:10.1016/j.jpsychores.2014.02.013

Cited by 54 publications

(46 citation statements)

References 42 publications

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“…The authors did not detect any signal of an association of DMD use with disability reduction in those on longer term DMDs, although the lack of longitudinal data on disease outcomes precludes any meaningful conclusion from this finding. The authors confirmed previous concerns about polypharmacy for the QOL of PwMS 33 and raise concerns about higher relapse rates and more disability.…”

Section: Discussionsupporting

confidence: 78%

“… 31 This contrasts with the strong associations found between healthy lifestyle choices and reduced fatigue in this same cohort described elsewhere. 32 Given previous data suggesting worse fatigue and cognitive deficit in those PwMS on multiple pharmacological agents, 33 the extent of polypharmacy in this cohort was of concern, with over one-third of the cohort taking three or more over the counter, prescription or herbal agents for symptom management, and ∼15% taking five or more, excluding their use of DMDs.…”

Section: Discussionmentioning

confidence: 93%

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Medication use in a large international sample of people with multiple sclerosis: associations with quality of life, relapse rate and disability

Jelinek

Weiland

Hadgkiss

et al. 2015

Neurological Research

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Objectives:To examine associations between medication use and health-related quality of life (HRQOL), relapse rate and disability in an international cohort of people with multiple sclerosis (PwMS).Methods:Using Web 2.0 platforms, the authors recruited PwMS who completed survey items on demographics, medication use, HRQOL, relapse rate and disability.Results:Of 2276 respondents from 56 countries, approximately half were taking a disease-modifying drug (DMD), most commonly glatiramer acetate or an interferon. Use of DMDs was not consistently associated with HRQOL. Individually, glatiramer acetate was associated with better HRQOL when compared with other DMDs or no DMD use. Overall, DMD use was neither associated with disability nor lower relapse rate, although those taking a DMD >12 months had 23.9% fewer relapses than those not taking a DMD. Polypharmacy, defined as those taking five or more over the counter, prescription or herbal medications, irrespective of DMD use, was associated with markedly worse HRQOL across all domains.Discussion:There was no consistent association of DMD use with better health outcomes in this large international \sample of PwMS, although relapse rate appears lower for those taking a DMD for >12 months. Glatiramer acetate had associations with better HRQOL compared with other DMDs.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 93%

Medication use in a large international sample of people with multiple sclerosis: associations with quality of life, relapse rate and disability

Jelinek

Weiland

Hadgkiss

et al. 2015

Neurological Research

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“…Moreover, subjective baseline measures of cognitive dysfunction in MDD do not correlate with objective measures of cognitive function [12]. Notwithstanding the lack of baseline correlation, results in multiple sclerosis populations indicate that changes in objective cognitive measures highly correlate with changes in subjective measures of cognitive function [28,29]. This latter observation suggests that subjective and objective measures may be evaluating overlapping yet discrete phenomena.…”

Section: Measuring Cognitive Functionmentioning

confidence: 96%

The Prevalence, Measurement, and Treatment of the Cognitive Dimension/Domain in Major Depressive Disorder

et al. 2015

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Insufficient outcomes amongst adults with major depressive disorder (MDD) provide the impetus to identify and refine therapeutic targets that are most critical to outcome from patient, provider, and societal perspectives. Towards this aim, a pivotal shift towards the transnosological domain, cognition, is occurring in the study of MDD and other brain disorders. This paper aims to provide a framework for conceptualizing and prioritizing cognitive function amongst adults with MDD with a particular view to provide a conceptual framework for research and clinical priorities. We also summarize extant data pertaining to psychotropic effects, notably antidepressants, on the cognitive dimension/domain. This narrative review was based on articles identified through a PubMed/MEDLINE search of all English-language articles published between January 1966 and October 2014. The search words were major depressive disorder, depression, unipolar depression, cognition, cognitive dysfunction, cognitive deficit, and cognitive function. The search was supplemented with a manual review of relevant references. The selection of articles for inclusion in this review was based on overall methodological quality as well as on their pertinence to informing the framework described herein. Cognitive dysfunction in MDD is a discrete domain subserved by discrete yet overlapping substrates. There is a need to provide a glossary of terms commonly employed in the cognition literature for consensus as to the appropriate screening, measurement, and monitoring tools. The guiding principle of measurement-based care should include systematic assessment and measurement of cognition in subpopulations with MDD, as a tactic to improve outcome. Relatively few treatment strategies have demonstrated efficacy specifically for the cognitive domain in MDD. The antidepressant vortioxetine has replicated evidence of specific pro-cognitive effects in adults with MDD across multiple subdomains of cognitive function. Vortioxetine is a novel antidepressant that is hypothesized to act through a combination of direct effects on receptor activity and serotonin receptor inhibition, as well as other systems. Pro-cognitive effects for other US FDA-approved agents are suggested, but pseudospecificity has not been excluded as a possible explanation of their beneficial effects on cognitive function. A disparate assortment of other agents are currently under investigation for possible benefit in mitigating cognitive deficits and improving cognitive performance (e.g., intranasal insulin, erythropoietin, anti-inflammatory agents). Non-pharmacological approaches including, but not limited to, cognitive remediation (CR), aerobic exercise, and neuromodulation are promising.

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“…Similar to retrospective memory, people with MS are inclined to report poor PM functioning. Other investigators have assessed PM using objective measures of performance (Bravin, Kinsella, Ong, & Vowels, 2000; Rendell, Jensen, & Henry, 2007; Rendell et al, 2012; Thelen, Lynch, Bruce, Hancock, & Bruce 2014). For example, Bravin et al (2000) found that people with MS displayed poor performance on one of two PM tests and all indices of the Rey Auditory Verbal Learning Test.…”

mentioning

confidence: 99%

Pain is associated with prospective memory dysfunction in multiple sclerosis

Miller

Basso

Candilis

et al. 2014

Journal of Clinical and Experimental Neuropsychology

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Prospective memory (PM) pertains to the execution of a future goal or behavior. Initial research implies that people with multiple sclerosis (MS) are apt to show impaired prospective memory for activities of daily living (Rendell, Jensen, & Henry, 2007; Rendell et al., 2012). Yet, PM impairment does not occur in all people with MS. Thus, some other variable besides disease status alone may contribute to PM dysfunction in people with MS. Chronic pain may be such a variable. Approximately 50-70% of people with MS experience significant pain, and such pain has been thought to diminish memory function (Moore, Keogh, and Eccleston, 2009). To investigate this possibility, 96 patients with MS and 29 healthy subjects were administered the Memory for Intentions Screening Test (MIST) (Raskin, Buckheit, & Sherrod, 2010), a well-validated measure of prospective memory, and the Medical Outcomes Study Pain Effects Scale (PES) (Fischer, Rudick, Cutter, & Reingold, 1999) to assess chronic pain. After controlling for demographic variables and disability severity, subjective pain accounted for significant variance in PM, particularly for time-based intentions over sustained delay periods. These data accord well with assertions that pain may degrade ability to remember new intentions, and suggests that pain is associated with PM dysfunction in people with MS.

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Polypharmacy in multiple sclerosis: Relationship with fatigue, perceived cognition, and objective cognitive performance

Cited by 54 publications

References 42 publications

Medication use in a large international sample of people with multiple sclerosis: associations with quality of life, relapse rate and disability

Medication use in a large international sample of people with multiple sclerosis: associations with quality of life, relapse rate and disability

The Prevalence, Measurement, and Treatment of the Cognitive Dimension/Domain in Major Depressive Disorder

Pain is associated with prospective memory dysfunction in multiple sclerosis

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