Whitehouse Christiane E, Fisk John D, Bernstein Charles N, Berrigan Lindsay I, Bolton James M, Graff Lesley A, Hitchon Carol A, Marriott James J, Peschken Christine A, Sareen Jitender, Walker John R, Stewart Sherry H, Marrie Ruth Ann
From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada.
Neurology. 2019 Jan 28;92(5):e406-e417. doi: 10.1212/WNL.0000000000006854.
To determine whether anxiety and depression are associated with cognition in multiple sclerosis (MS), and whether these associations are similar in other immune-mediated inflammatory diseases (IMID; including inflammatory bowel disease [IBD] and rheumatoid arthritis [RA]) and in anxious/depressed individuals (ANX/DEP) without an IMID.
Participants (MS: n = 255; IBD: n = 247; RA: n = 154; ANX/DEP: n = 308) completed a structured psychiatric interview, the Hospital Anxiety and Depression Scale, and cognitive testing, including the Symbol Digit Modalities Test, the California Verbal Learning Test, and Letter Number Sequencing test. Test scores were converted to age-, sex-, and education-adjusted scores. We evaluated associations of anxiety and depression with the cognitive scores using multivariate linear models, adjusting for disease cohort.
All cohorts exhibited higher rates of impairment (i.e., less than or equal to -1.5) in the domains of processing speed, verbal learning, and delayed recall memory relative to general population norms. Higher levels of anxiety symptoms were associated with slower processing speed, lower verbal learning, and lower working memory performance (all < 0.001); higher levels of depression symptoms were associated with slower processing speed. These associations did not differ across cohorts.
Anxiety and depression are associated with lower cognitive function in MS, with a similar pattern observed in persons with other IMID, including IBD and RA, and persons without an IMID. Managing symptoms of anxiety and of depression in MS, as well as other IMIDs, is important to mitigate their effect on cognition.
确定焦虑和抑郁是否与多发性硬化症（MS）的认知相关，以及这些关联在其他免疫介导的炎症性疾病（IMID；包括炎症性肠病[IBD]和类风湿性关节炎[RA]）以及无IMID的焦虑/抑郁个体（ANX/DEP）中是否相似。
参与者（MS：n = 255；IBD：n = 247；RA：n = 154；ANX/DEP：n = 308）完成了结构化精神科访谈、医院焦虑抑郁量表以及认知测试，包括符号数字模式测试、加利福尼亚言语学习测试和字母数字排序测试。测试分数被转换为经年龄、性别和教育程度调整后的分数。我们使用多变量线性模型评估焦虑和抑郁与认知分数的关联，并对疾病队列进行了校正。
相对于一般人群标准，所有队列在处理速度、言语学习和延迟回忆记忆领域的损伤率（即小于或等于-1.5）均较高。较高水平的焦虑症状与较慢的处理速度、较低的言语学习能力和较低的工作记忆表现相关（均P < 0.001）；较高水平的抑郁症状与较慢的处理速度相关。这些关联在各队列之间没有差异。
焦虑和抑郁与MS患者较低的认知功能相关，在其他IMID患者（包括IBD和RA）以及无IMID的个体中也观察到类似模式。控制MS以及其他IMID患者的焦虑和抑郁症状对于减轻其对认知的影响很重要。
