MS Speaks

]SUMMARY AND COMMENT | PSYCHIATRY, NEUROLOGY
Anxiety and Depression Contribute to Cognitive Problems in Multiple Sclerosis and Other Immune-Mediated Diseases

Jonathan Silver, MD reviewing Whitehouse CE et al. Neurology 2019 Jan 11

Multiple sclerosis (MS) is associated with depression and cognitive deficits. The cognitive problems are assumed to be related to brain pathology, but the role of anxiety and depression is unclear. These investigators assessed the relationship between anxiety and depression and cognitive impairment in patients with MS and other immune-mediated disorders (IMDs) that do not directly affect the central nervous system.

Study participants were 255 patients with MS, 247 patients with inflammatory bowel disease, 154 with rheumatoid arthritis, and 308 patients with DSM-IV anxiety and depressive disorders but no IMD. Evaluation included structured psychiatric interviews, measures of anxiety and depression severity, and assessments of cognition.

Across the IMD groups, prevalence of a current anxiety disorder ranged from 12.5% to 17.4%; prevalence of current major depression ranged from 8.5% to 11.0%. Compared with norms in the general population, impairments in processing speed, verbal learning, and delayed recall memory were common in all IMD patients, and such impairments were relatively common among the MS patients without anxiety or depressive symptoms. The presence of clinically meaningful anxiety symptoms, but not depressive symptoms, was associated with impaired cognitive test performance and working memory. The diagnosis of an anxiety disorder, but not major depression, was associated with reduced processing speed.

COMMENT

Beyond confirming the presence of anxiety and depression in MS and other IMDs, these findings highlight the additive detrimental effect of anxiety in particular on cognition. We also need to be aware that patients with other disorders associated with anxiety (e.g., concussion) may have cognitive deficits as a result of anxiety and not just the concussion. Although these authors do not address the effects on cognition of anxiety and depression treatment, these conditions require active treatment to improve cognition.