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Modifiable Comorbidities and Disability in Multiple Sclerosis

  • Demyelinating Disorders (DN Bourdette and V Yadav, Section Editors)
  • Published:
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Abstract

Multiple sclerosis is a common neurological disease that results in disability in early adulthood that may progress through a relatively normal lifespan. Other comorbid health conditions can increase the likelihood of progression of MS and independently contribute to limitations in activities and social participation. We examine common modifiable health conditions and behaviors, including hypertension, obesity, diabetes mellitus, alcohol, and smoking to determine their impacts on MS and disability. Appropriate identification and treatment can improve health status, diminish disability, and improve quality of life.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Dean G. How many people in the world have multiple sclerosis? Neuroepidemiology. 1994;13:1–7.

    Article  PubMed  CAS  Google Scholar 

  2. Weinshenker BG. Epidemiology of multiple sclerosis. Neurol Clin. 1996;14:291–308.

    Article  PubMed  CAS  Google Scholar 

  3. Ebers GC. Natural history of multiple sclerosis. J Neurol Neurosurg Psychiatry. 2001;71 Suppl 2:16–9.

    Google Scholar 

  4. Weinshenker BG, Bass B, Rice GP, et al. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain. 1989;112(Pt 1):133–46.

    Article  PubMed  Google Scholar 

  5. Marrie RA, Horwitz RI, Cutter G, et al. Association between comorbidity and clinical characteristics of MS. Acta Neurol Scand. 2011;124:135–41.

    Article  PubMed  CAS  Google Scholar 

  6. • Marrie RA, Horwitz RI. Emerging effects of comorbidities on multiple sclerosis. Lancet Neurol. 2010;9:820–8. The authors broadly identify which comorbidities occur in patients with MS, which are most common, and whether they occur with greater or less frequency than in the general population. They found that an increasing amount of evidence suggests that comorbidities and lifestyle factors might affect the diagnostic delay between MS onset and diagnosis, the clinical phenotype of MS, disability progression, health-related quality of life, and treatment decisions. Further research is needed to answer many questions about comorbidities associated with MS, including the best way to measure and analyze comorbidities to understand these associations.

    Article  PubMed  Google Scholar 

  7. • Marrie RA, Rudick R, Horwitz R, et al. Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis. Neurology. 2010;74:1041–7. The authors discussed the results of the October 2006 NARCOMS Registry survey on comorbidities, including the year of diagnosis. They linked this information to demographic and clinical information related to MS disability progression. They demonstrated that the presence of vascular comorbidities led to more rapid disability progression and the need for assistive walking devices.

    Article  PubMed  CAS  Google Scholar 

  8. Obisesan TO. Hypertension and cognitive function. Clin Geriatr Med. 2009;25:259–88.

    Article  PubMed  Google Scholar 

  9. Tall MW, Chertow GM, Marsden PA, et al., editors. Brenner & Rector's the kidney. Philadelphia: Saunders/Elsevier; 2011.

    Google Scholar 

  10. Centers for Disease Control and Prevention. Prevalence of disability and associated health conditions, US 1991–1992. MMWR Morb Mortal Wkly Rep. 1994;40:730–9.

    Google Scholar 

  11. Rosano C, Longstreth Jr WT, Boudreau R, et al. High blood pressure accelerates gait slowing in well-functioning older adults over 18-years of follow-up. J Am Geriatr Soc. 2011;59:390–7.

    Article  PubMed  Google Scholar 

  12. Hajjar I, Quach L, Yang F, et al. Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study. Circulation. 2011;123:858–65.

    Article  PubMed  Google Scholar 

  13. Kang JH, Chen YH, Lin HC. Comorbidities amongst patients with multiple sclerosis: a population-based controlled study. Eur J Neurol. 2010;17:1215–9.

    Article  PubMed  Google Scholar 

  14. Marrie RA, Cutter G, Tyry T. Substantial adverse association of visual and vascular comorbidities on visual disability in multiple sclerosis. Mult Scler. 2011;17:1464–71.

    Article  PubMed  Google Scholar 

  15. Dallmeijer AJ, Beckerman H, de Groot V, et al. Long-term effect of comorbidity on the course of physical functioning in patients after stroke and with multiple sclerosis. J Rehabil Med. 2009;41:322–6.

    Article  PubMed  Google Scholar 

  16. Ranadive SM, Yan H, Weikert M, et al. Vascular dysfunction and physical activity in multiple sclerosis. Med Sci Sports Exerc. 2012;44:238–43.

    Article  PubMed  CAS  Google Scholar 

  17. Fjeldstad AS, McDaniel J, Witman MA, et al. Vascular function and multiple sclerosis. J Neurol. 2011;258:2036–42.

    Article  PubMed  CAS  Google Scholar 

  18. Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378:31–40.

    Article  PubMed  CAS  Google Scholar 

  19. Centers for Disease Control and Prevention. general information and national estimates on diabetes in the United States, 2007: U.S. Department of Health and Human Services; 2008.

  20. De Souza CT, Araujo EP, Bordin S, et al. Consumption of a fat-rich diet activates a proinflammatory response and induces insulin resistance in the hypothalamus. Endocrinology. 2005;146:4192–9.

    Article  PubMed  Google Scholar 

  21. Barcellos LF, Kamdar BB, Ramsay PP, et al. Clustering of autoimmune diseases in families with a high-risk for multiple sclerosis: a descriptive study. Lancet Neurol. 2006;5:924–31.

    Article  PubMed  CAS  Google Scholar 

  22. Dorman JS, Steenkiste AR, Burke JP, Songini M. Type 1 diabetes and multiple sclerosis: together at last. Diabetes Care. 2003;26:3192–3.

    Article  PubMed  Google Scholar 

  23. Watson GS, Craft S. Insulin resistance, inflammation, and cognition in Alzheimer's disease: lessons for multiple sclerosis. J Neurol Sci. 2006;245:21–33.

    Article  PubMed  CAS  Google Scholar 

  24. Resnick HE, Stansberry KB, Harris TB, et al. Diabetes, peripheral neuropathy, and old age disability. Muscle Nerve. 2002;25:43–50.

    Article  PubMed  Google Scholar 

  25. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–41.

    Article  PubMed  CAS  Google Scholar 

  26. Maffei M, Halaas J, Ravussin E, et al. Leptin levels in human and rodent: measurement of plasma leptin and ob RNA in obese and weight-reduced subjects. Nat Med. 1995;1:1155–61.

    Article  PubMed  CAS  Google Scholar 

  27. Matarese G, Carrieri PB, La Cava A, et al. Leptin increase in multiple sclerosis associates with reduced number of CD4(+)CD25+ regulatory T cells. Proc Natl Acad Sci U S A. 2005;102:5150–5.

    Article  PubMed  CAS  Google Scholar 

  28. Mohamed-Ali V, Goodrick S, Rawesh A, et al. Subcutaneous adipose tissue releases interleukin-6, but not tumor necrosis factor-alpha, in vivo. J Clin Endocrinol Metab. 1997;82:4196–200.

    Article  PubMed  CAS  Google Scholar 

  29. De Rosa V, Procaccini C, Cali G, et al. A key role of leptin in the control of regulatory T cell proliferation. Immunity. 2007;26:241–55.

    Article  PubMed  Google Scholar 

  30. Pasare C, Medzhitov R. Toll pathway-dependent blockade of CD4 + CD25+ T cell-mediated suppression by dendritic cells. Science. 2003;299:1033–6.

    Article  PubMed  CAS  Google Scholar 

  31. Munger KL, Chitnis T, Ascherio A. Body size and risk of MS in two cohorts of US women. Neurology. 2009;73:1543–50.

    Article  PubMed  Google Scholar 

  32. Khurana SR, Bamer AM, Turner AP, et al. The prevalence of overweight and obesity in veterans with multiple sclerosis. Am J Phys Med Rehabil. 2009;88:83–91.

    Article  PubMed  Google Scholar 

  33. Malnick SD, Knobler H. The medical complications of obesity. QJM. 2006;99:565–79.

    Article  PubMed  CAS  Google Scholar 

  34. Bombardier CH, Blake KD, Ehde DM, et al. Alcohol and drug abuse among persons with multiple sclerosis. Mult Scler. 2004;10:35–40.

    Article  PubMed  CAS  Google Scholar 

  35. Marrie R, Horwitz R, Cutter G, et al. High frequency of adverse health behaviors in multiple sclerosis. Mult Scler. 2009;15:105–13.

    Article  PubMed  Google Scholar 

  36. Quesnel S, Feinstein A. Multiple sclerosis and alcohol: a study of problem drinking. Mult Scler. 2004;10:197–201.

    Article  PubMed  Google Scholar 

  37. Turner AP, Hawkins EJ, Haselkorn JK, Kivlahan DR. Alcohol misuse and multiple sclerosis. Arch Phys Med Rehabil. 2009;90:842–8.

    Article  PubMed  Google Scholar 

  38. Nortvedt MW, Riise T, Maeland JG. Multiple sclerosis and lifestyle factors: the Hordaland Health Study. Neurol Sci. 2005;26:334–9.

    Article  PubMed  CAS  Google Scholar 

  39. National Institute on Alcohol Abuse and Alcoholism. State of the science report on the effects of moderate drinking: US Department of Health and Human Services; 2003.

  40. Bradley KA, Maynard C, Kivlahan DR, et al. The relationship between alcohol screening questionnaires and mortality among male veteran outpatients. J Stud Alcohol. 2001;62:826–33.

    PubMed  CAS  Google Scholar 

  41. Rehm J, Greenfield TK, Rogers JD. Average volume of alcohol consumption, patterns of drinking, and all-cause mortality: results from the US National Alcohol Survey. Am J Epidemiol. 2001;153:64–71.

    Article  PubMed  CAS  Google Scholar 

  42. Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337:1705–14.

    Article  PubMed  CAS  Google Scholar 

  43. Feinstein A. An examination of suicidal intent in patients with multiple sclerosis. Neurology. 2002;59:674–8.

    Article  PubMed  Google Scholar 

  44. Goodin DS. Survey of multiple sclerosis in northern California. Northern California MS Study Group. Mult Scler. 1999;5:78–88.

    PubMed  CAS  Google Scholar 

  45. D'Hooghe MB, Nagels G, Bissay V, De Keyser J. Modifiable factors influencing relapses and disability in multiple sclerosis. Mult Scler. 2010;16:773–85.

    Article  PubMed  Google Scholar 

  46. D'Hooghe MB, Haentjens P, Nagels G, De Keyser J. Alcohol, coffee, fish, smoking and disease progression in multiple sclerosis. Eur J Neurol. 2012;19:616–24.

    Article  PubMed  Google Scholar 

  47. Borzecki AM, Lee A, Kalman D, Kazis LE. Do poor health behaviors affect health-related quality of life and healthcare utilization among veterans? The Veterans Health Study. J Ambul Care Manage. 2005;28:141–56.

    PubMed  Google Scholar 

  48. Davies SJ, Pandit SA, Feeney A, et al. Is there cognitive impairment in clinically 'healthy' abstinent alcohol dependence? Alcohol Alcohol. 2005;40:498–503.

    PubMed  Google Scholar 

  49. Parsons OA, Nixon SJ. Cognitive functioning in sober social drinkers: a review of the research since 1986. J Stud Alcohol. 1998;59:180–90.

    PubMed  CAS  Google Scholar 

  50. Vik PW, Cellucci T, Jarchow A, Hedt J. Cognitive impairment in substance abuse. Psychiatr Clin North Am. 2004;27:97–109. ix.

    Article  PubMed  Google Scholar 

  51. Mangold S, Laubli T, Krueger H. Effects of a low alcohol dose on static balance, fine motor activity, and mental performance. Neurotoxicol Teratol. 1996;18:547–54.

    Article  PubMed  CAS  Google Scholar 

  52. Schweizer TA, Vogel-Sprott M, Danckert J, et al. Neuropsychological profile of acute alcohol intoxication during ascending and descending blood alcohol concentrations. Neuropsychopharmacology. 2006;31:1301–9.

    PubMed  CAS  Google Scholar 

  53. Wang MQ, Taylor-Nicholson ME, Airhihenbuwa CO, et al. Psychomotor and visual performance under the time-course effect of alcohol. Percept Mot Skills. 1992;75:1095–106.

    PubMed  CAS  Google Scholar 

  54. Centers for Disease Control and Prevention. Vital signs: current cigarette smoking among adults aged ≥18 years—United States, 2005–2010. MMWR Morb Mortal Wkly Rep. 2011;60:1207–12.

    Google Scholar 

  55. The health consequences of smoking: a report of the Surgeon General. Washington DC: Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.

  56. Healy BC, Ali EN, Guttmann CR, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol. 2009;66:858–64.

    Article  PubMed  Google Scholar 

  57. Hedstrom AK, Baarnhielm M, Olsson T, Alfredsson L. Tobacco smoking, but not Swedish snuff use, increases the risk of multiple sclerosis. Neurology. 2009;73:696–701.

    Article  PubMed  Google Scholar 

  58. Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. Smoking among veterans with multiple sclerosis: prevalence correlates, quit attempts, and unmet need for services. Arch Phys Med Rehabil. 2007;88:1394–9.

    Article  PubMed  Google Scholar 

  59. Antonovsky A, Leibowitz U, Smith HA, et al. Epidemiologic study of multiple sclerosis in Israel: I. An overall review of methods and findings. Arch Neurol. 1965;13:183–93.

    Article  PubMed  CAS  Google Scholar 

  60. Villard-Mackintosh L, Vessey MP. Oral contraceptives and reproductive factors in multiple sclerosis incidence. Contraception. 1993;47:161–8.

    Article  PubMed  CAS  Google Scholar 

  61. Thorogood M, Hannaford PC. The influence of oral contraceptives on the risk of multiple sclerosis. Br J Obstet Gynaecol. 1998;105:1296–9.

    Article  PubMed  CAS  Google Scholar 

  62. Hernan MA, Olek MJ, Ascherio A. Cigarette smoking and incidence of multiple sclerosis. Am J Epidemiol. 2001;154:69–74.

    Article  PubMed  CAS  Google Scholar 

  63. Carlens C, Hergens MP, Grunewald J, et al. Smoking, use of moist snuff, and risk of chronic inflammatory diseases. Am J Respir Crit Care Med. 2010;181:1217–22.

    Article  PubMed  Google Scholar 

  64. Pekmezovic T, Drulovic J, Milenkovic M, et al. Lifestyle factors and multiple sclerosis: a case–control study in Belgrade. Neuroepidemiology. 2006;27:212–6.

    Article  PubMed  Google Scholar 

  65. Zorzon M, Zivadinov R, Nasuelli D, et al. Risk factors of multiple sclerosis: a case–control study. Neurol Sci. 2003;24:242–7.

    Article  PubMed  CAS  Google Scholar 

  66. Riise T, Nortvedt MW, Ascherio A. Smoking is a risk factor for multiple sclerosis. Neurology. 2003;61:1122–4.

    Article  PubMed  Google Scholar 

  67. Handel AE, Williamson AJ, Disanto G, et al. Smoking and multiple sclerosis: an updated meta-analysis. PLoS One. 2011;6:e16149.

    Article  PubMed  CAS  Google Scholar 

  68. Hawkes CH. Smoking is a risk factor for multiple sclerosis: a metanalysis. Mult Scler. 2007;13:610–5.

    Article  PubMed  CAS  Google Scholar 

  69. Hedstrom AK, Baarnhielm M, Olsson T, Alfredsson L. Exposure to environmental tobacco smoke is associated with increased risk for multiple sclerosis. Mult Scler. 2011;17:788–93.

    Article  PubMed  CAS  Google Scholar 

  70. Hernan MA, Jick SS, Logroscino G, et al. Cigarette smoking and the progression of multiple sclerosis. Brain. 2005;128:1461–5.

    Article  PubMed  Google Scholar 

  71. Pittas F, Ponsonby AL, van der Mei IA, et al. Smoking is associated with progressive disease course and increased progression in clinical disability in a prospective cohort of people with multiple sclerosis. J Neurol. 2009;256:577–85.

    Article  PubMed  Google Scholar 

  72. Sundstrom P, Nystrom L. Smoking worsens the prognosis in multiple sclerosis. Mult Scler. 2008;14:1031–5.

    Article  PubMed  CAS  Google Scholar 

  73. Zivadinov R, Weinstock-Guttman B, Hashmi K, et al. Smoking is associated with increased lesion volumes and brain atrophy in multiple sclerosis. Neurology. 2009;73:504–10.

    Article  PubMed  CAS  Google Scholar 

  74. Koch M, van Harten A, Uyttenboogaart M, De Keyser J. Cigarette smoking and progression in multiple sclerosis. Neurology. 2007;69:1515–20.

    Article  PubMed  Google Scholar 

  75. van der Mei IA, Simpson Jr S, Stankovich J, Taylor BV. Individual and joint action of environmental factors and risk of MS. Neurol Clin. 2011;29:233–55.

    Article  PubMed  Google Scholar 

  76. Simon KC, van der Mei IA, Munger KL, et al. Combined effects of smoking, anti-EBNA antibodies, and HLA-DRB1*1501 on multiple sclerosis risk. Neurology. 2010;74:1365–71.

    Article  PubMed  CAS  Google Scholar 

  77. • Hedstrom AK, Sundqvist E, Baarnhielm M, et al. Smoking and two human leukocyte antigen genes interact to increase the risk for multiple sclerosis. Brain. 2011;134:653–64. The authors conducted a population-based case–control study involving incident cases of multiple sclerosis in Sweden. Cases and controls were classified according to their smoking status and human leukocyte antigen DRB1, as well as human leukocyte antigen A genotypes. Subjects with different genotypes and smoking habits were compared with regard to incidence of multiple sclerosis. Smokers, nonsmokers with genetic risk factors, and smokers with genetic risk factors had progressively increasing risks of developing MS. The authors assert that the risk of developing MS associated with human leukocyte antigen genotypes may be strongly influenced by smoking status and that priming of the immune response in the lungs may subsequently lead to multiple sclerosis in genetically susceptible people.

    Article  PubMed  Google Scholar 

  78. • Aveyard P, Begh R, Parsons A, West R. Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction. 2012;107:1066–73. The authors conducted a review of studies examining brief opportunistic physician advice and assistance to stop smoking. Providing advice to quit on medical grounds increased the frequency of quit attempts. Providing support in the form of behavioral counseling or nicotine replacement therapy generated more quit attempts than did advice alone. Intervention increased the likelihood of success from a quit attempt. The authors concluded that physicians may be more effective in promoting attempts to stop smoking by offering assistance to all smokers than by advising smokers to quit and then offering assistance only to those who express an interest in doing so.

    Article  PubMed  Google Scholar 

  79. Vogt F, Hall S, Marteau TM. General practitioners' and family physicians' negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review. Addiction. 2005;100:1423–31.

    Article  PubMed  Google Scholar 

  80. Whitlock EP, Polen MR, Green CA, et al. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:557–68.

    PubMed  Google Scholar 

  81. Treating tobacco use and dependence. Quick Reference Guide for Clinicians. Washington, DC: US Public Health Service; 2008.

  82. National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: a clinician’s guide. Washington, DC: US Public Health Services; 2005.

    Google Scholar 

  83. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775–9.

    Article  PubMed  Google Scholar 

  84. Wagner EH, Austin BT, Von Korff M. Improving outcomes in chronic illness. Manag Care Q. 1996;4(2):12–25.

    PubMed  CAS  Google Scholar 

  85. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74:511–44.

    Article  PubMed  CAS  Google Scholar 

  86. Wagner EH. The role of patient care teams in chronic disease management. BMJ. 2000;320:569–72.

    Article  PubMed  CAS  Google Scholar 

  87. Bombardier CH, Cunniffe M, Wadhwani R, et al. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89:1849–56.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Portland VA Medical Center, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA

    Shannon Overs

  2. Rehabilitation Care Service, S-117-RCS, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA

    Christina M. Hughes, Jodie K. Haselkorn & Aaron P. Turner

  3. Department of Rehabilitation Medicine, University of Washington, Box 359612, Seattle, WA, 98105, USA

    Christina M. Hughes, Jodie K. Haselkorn & Aaron P. Turner

  4. Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98105, USA

    Jodie K. Haselkorn

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  1. Shannon Overs
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  2. Christina M. Hughes
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  3. Jodie K. Haselkorn
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  4. Aaron P. Turner
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Correspondence to Aaron P. Turner.

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Overs, S., Hughes, C.M., Haselkorn, J.K. et al. Modifiable Comorbidities and Disability in Multiple Sclerosis. Curr Neurol Neurosci Rep 12, 610–617 (2012). https://doi.org/10.1007/s11910-012-0293-4

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  • DOI: https://doi.org/10.1007/s11910-012-0293-4

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