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Influence of depression on subjective rating of physical disability in a large clinical cohort
Author(s): ,
E. Alshehri
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
,
M. Brandon
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
,
K. Nakamura
Affiliations:
Biomedical Engineering, Cleveland Clinic Foundation Lerner Research Institute
,
D. Miller
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
,
A. Sullivan
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
,
M. McGinley
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
,
G. Macaron
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
,
L. Baldassari
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
,
H.L. Li
Affiliations:
Quantitive Statistic, Cleveland Clinic Foundation, Cleveland, OH, United States
,
M. Weber
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
,
D. Ontaneda
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
,
J. Cohen
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
R. Bermel
Affiliations:
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Neurological Institute
ECTRIMS Online Library. Alshehri E. Oct 12, 2018; 228887
Ebtesam Alshehri
Ebtesam Alshehri
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Abstract: P1046

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Comorbidity

Background: The prevalence of depression among multiple sclerosis (MS) patients is higher than the general population. Patient Health Questionnaire (PHQ9) is a validated depression measure.
Objectives: To assess the prevalence of depression and its association with neuroperformance measures and patient-reported outcomes (PROs) in a large clinical cohort.
Methods: Demographics, disease history, technology-enabled neuroperformance assessments via iPad® application, and PROs were collected from the MS population at a single site. Spearman correlation coefficients were used to correlate PHQ9 with demographics and disease measures; significance was set at p< 0.001 to account for multiple comparisons. Linear regression models were built to explore the contribution of PHQ9 score to Neurology Quality of Life (NQoL) domains after adjusting for age, sex, race, disease duration, fatigue, and the corresponding disability measure. Linear regression models also explored the contribution of demographics, disease characteristics, and disability to PHQ9.
Results: Depression severity (n=949) was mild 29.1%, moderate 15.0%, moderate-severe 5.6%, and severe 3.5%. PHQ9 correlated strongly with the NQoL domains of depression (ρ=0.77), anxiety (ρ=0.73), cognition (ρ=0.74), emotional dyscontrol (ρ=0.68), fatigue (ρ=0.76), sleep (ρ=0.77), and social satisfaction (ρ=0.63); and correlated moderately with NQoL hand function (ρ=0.48) and mobility (ρ=0.46). PHQ9 correlated weakly with neuroperformance tests: walking speed (WST) (ρ=0.35), manual dexterity (MDT) (ρ=0.31), and processing speed (PST) (ρ=0.26). PHQ9 significantly predicted self-reported disability for cognition, mobility, and hand function after adjusting for demographics, disease duration, and the corresponding disability measures including PST, WST, and MDT. PHQ9 scores explained more of the variance in the model for self-reported cognition than hand function and mobility. A linear regression model was also run to investigate the impact of demographics, disease duration, neuroperformance measures on PHQ9. Although age and PST were significant predictors, the model only explained 14% of the variance in scores.
Conclusions: Depression severity correlates better with subjective vs. objective physical disability. It accounts for the most variability in self-rated cognition and less variability in self-rated hand function and mobility. Depression needs be considered when interpreting PROs.
Disclosure: Ebtesam Alshehri: Nothing to disclose
Laura Baldassari has received personal fees for serving on a scientific advisory board for Teva, and receives funding via a Sylvia Lawry Physician Fellowship Grant through the National Multiple Sclerosis Society (#FP-1606-24540).
Kunio Nakamura has received personal fees for consulting from NeuroRx Research, speaking from Sanofi Genzyme, and license from Biogen. He has received research support from NIH NINDS, NMSS, DOD, Biogen, Sanofi Genzyme, and Novartis.
Deborah Miller has received consulting fees from Hoffman-Roche, Ltd.
Amy Sullivan has received fees as a speaker for Novartis pharmaceuticals.
Marisa McGinley has served on scientific advisory boards for Genzyme and Genentech, and receives funding via a Sylvia Lawry Physician Fellowship Grant through the National Multiple Sclerosis Society (#FP-1506-04742).
Gabrielle Macaron receives fellowship funding from Biogen Idec (#6873-P-FEL).Brandon Moss is supported by National Multiple Sclerosis Society Institutional Clinician Training Award ICT 0002.
Hong Li: Nothing to disclose
Malory Weber: Nothing to disclose
Robert Bermel has served as a consultant for Biogen, Genzyme, Genentech, and Novartis. He receives research support from Biogen and Genentech.
Daniel Ontaneda has received research support from National Multiple Sclerosis Society, National Institutes of Health, Patient Centered Research Institute, Race to Erase MS Foundation, Genentech, and Genzyme. He has also received consulting fees from Biogen Idec, Genentech/Roche, Genzyme, and Merck.
Jeffrey Cohen has received personal fees for consulting from Adamas, Celgene, Convelo, EMD Serono, Novartis, and PendoPharm; speaking for Mylan; and serving as Co-Editor of Multiple Sclerosis Journal - Experimental, Translational and Clinical.

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