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The influence of depression and anxiety on cognition in people with multiple sclerosis: a cross-sectional analysis

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Abstract

There are conflicting findings about the relationships between depression, anxiety, and cognitive dysfunction in people with multiple sclerosis (MS), and a paucity of research has examined the cumulative influence on cognition of depression plus anxiety. This study aimed to determine whether elevated symptoms of depression and anxiety alone or in combination are associated with worse cognition in people with MS. In this cross-sectional analysis, people with MS consecutively seen at a tertiary neuropsychiatry clinic completed the Hospital Anxiety and Depression Scale for symptoms of depression (HADS-D) and anxiety (HADS-A), and the Minimal Assessment of Cognitive Function in MS for cognitive indices. Accounting for covariates, regression models predicted cognitive indices from scores for HADS-D, HADS-A, and the interaction. Of 831 people with MS, 72% were female, mean age was 43.2 years, and median Expanded Disability Status Scale score was 2.0. Depressive symptoms were independently predictive of lower verbal fluency (Controlled Oral Word Association Test, p < 0.01), verbal learning (California Verbal Learning Test-II (CVLT-II) total learning, p = 0.02), verbal delayed recall (CVLT-II delayed recall, p < 0.01), and processing speed (Symbol Digit Modalities Test, p < 0.01; three-second Paced Auditory Serial Addition Test (PASAT), p = 0.05; two-second PASAT, p = 0.01). Anxiety in people with depression predicted decreased visuospatial function (Judgment of Line Orientation, p = 0.05), verbal learning (p < 0.01), verbal delayed recall (p < 0.01), visuospatial recall (Brief Visuospatial Memory Test-Revised, p = 0.02), and executive function (Delis-Kaplan Executive Function System, p < 0.01). Anxiety alone was not independently predictive of cognition. In conclusion, depression, especially with comorbid anxiety, is associated with cognitive dysfunction in people with MS.

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Funding

No funding was received to assist with the preparation of this manuscript or for conducting this study.

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Authors and Affiliations

  1. Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada

    David E. Freedman & Anthony Feinstein

  2. Division of Neurology, Department of Medicine, Temerty Faculty of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Jiwon Oh

  3. Evaluative Clinical Sciences, Department of Health Policy, Management and Evaluation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada

    Alex Kiss

  4. Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada

    Juliana Puopolo, Margaret Wishart, Cecilia Meza & Anthony Feinstein

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  1. David E. Freedman
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  2. Jiwon Oh
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Contributions

David E. Freedman, Jiwon Oh, Alex Kiss, and Anthony Feinstein contributed to the study conception and design. Data collection and analysis were performed by David E. Freedman, Alex Kiss, Juliana Puopolo, Margaret Wishart, Cecilia Meza, and Anthony Feinstein. The first draft of the manuscript was written by David E. Freedman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to David E. Freedman.

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Conflicts of interest

Dr. Oh has received grants from Biogen-Idec, Roche, and EMD-Serono; consulting fees from Biogen-Idec, EMD-Serono, BMS, Novartis, Eli-Lilly, Sanofi, and Roche; payment or honoraria from EMD-Serono, Biogen-Idec, Novartis, Roche, and Sanofi; participation on a Data Safety Monitoring or Advisory Board for Biogen-Idec, EMD-Serono, Roche, Novartis, and Sanofi; and leadership or fiduciary role as Chair of Medical Advisory Committee for MS Society of Canada during the conduct of this study. Dr. Feinstein has received grants from MS Society of Canada, CIHR, and Bristol Myers Squibb; royalties from Johns Hopkins University Press and Cambridge University Press; and honoraria from Novartis during the conduct of this study. All other authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This retrospective chart review study involving human participants was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Research Ethics Board at Sunnybrook Health Sciences Centre, affiliated to the University of Toronto (Date: December 30, 2021/No. 5263).

Informed consent

Data were collected as part of a retrospective chart review and a waiver of consent was obtained as part of the research ethics board approval process.

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Disclaimers: The views expressed in the submitted article are our own and not an official position of the associated institutions.

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Freedman, D.E., Oh, J., Kiss, A. et al. The influence of depression and anxiety on cognition in people with multiple sclerosis: a cross-sectional analysis. J Neurol (2024). https://doi.org/10.1007/s00415-024-12409-x

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