The impact of smoking on cognition and brain atrophy in patients with multiple sclerosis in a large clinical cohort
ECTRIMS Online Library. Alshehri E. Sep 11, 2019; 278821; P461
Ebtesam Alshehri
Ebtesam Alshehri
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Abstract

Abstract: P461

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Comorbidity

E. Alshehri1, K. Nakamura2, L. Baldassari1, M. McGinley1, G. Macaron1, B. Moss1, M. Weber1, R. Bermel1, J. Cohen1, D. Ontaneda1, D. Conway1

1Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, 2Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States

Background: Smoking has been linked to an increased risk of multiple sclerosis (MS) and faster disability accumulation. The magnitude of effect of smoking on cognition and brain atrophy remains uncertain. Our center employs the Processing Speed Test (PST), an electronic adaptation of the Symbol Digit Modalities Test, to assess cognitive functioning at each clinical encounter.
Objectives: To quantify the impact of smoking on cognition and brain atrophy in patients with MS using clinical and magnetic resonance imaging (MRI) outcomes.
Methods: Patients who underwent quantitative MRI within 90 days of PST evaluation were identified. Demographics, disease characteristics, and smoking historywere collected. The relationship between smoking status, Processing Speed Test (PST) and brain atrophy as measured with whole brain fraction (WBF) were assessed using univariable and multivariable linear regression.
Results: The analysis included 997 patients with a mean age of 47.7 years, and mean disease duration of 12.4 years. The cohort included 520 never smokers (52.2%), 335 former smokers (33.6%), and 142 current smokers (14.2%). In the univariable analysis, former smokers had WBFthat was 0.0081% less than never smokers (p=0.0004), and current smokers had WBFthat was 0.0083% less than never smokers (p=0.0076). In the model with WBFas the dependent variable, and smoking status, age, race, disease duration, and MS disease course as independent variables, smoking status remained a significant predictor of WBF. In the model with PST as the dependent variable and adjusting for age, race, and disease duration, smoking status was again a significant predictor of PST score. Former smokers scored 3.6 points lower than non-smokers (p< 0.0001) and current smokers scored 5.9 points lower than non-smokers (p< 0.0001).
Conclusions: Our data indicate that smoking has an adverse influence on both cognition and brain atrophy. This emphasizes the critical need for smoking cessation counseling as part of MS management.
Disclosure: Dr. Ebtesam Alshehri reports no disclosures. Dr. Kunio Nakamura has received personal fees for consulting from NeuroRx Research, speaking from Sanofi Genzyme, and license from Biogen Idec. He has received research support from NIH NINDS, NMSS, DOD, Biogen Idec, Sanofi Genzyme, and Novartis. Dr. 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). Dr. Laura Baldassari receives funding via a Sylvia Lawry Physician Fellowship Grant through the National Multiple Sclerosis Society (#FP-1606-24540). She has received personal fees for serving on a scientific advisory board for Teva. Dr. Gabrielle Macaron receives fellowship funding from Biogen Idec (#6873-P-FEL) and a National Multiple Sclerosis Society Institutional Clinician Training Award (ICT 0002). Dr. Brandon Moss has received funding from a National Multiple Sclerosis Society Institutional Clinician Training Award (ICT 0002). Ms. Malory Weber reports no disclosures. Dr. Robert Bermel has served as a consultant for Biogen Idec, Genzyme, Genentech, and Novartis. He receives research support from Biogen Idec and Genentech.Dr. 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. Dr. 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. Dr. Devon Conway has received research support paid to his institution by Novartis Pharmaceuticals. He has received personal compensation for consulting for Novartis Pharmaceuticals, Arena Pharmaceuticals, and Tanabe Laboratories.

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