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Context: Health-related quality of life (HRQOL) is a multi-dimensional construct including aspects of life quality or function that are affected by physical health and symptoms, psychosocial factors, and psychiatric conditions. HRQOL gives a broader measure of the burden of disease than physical impairment or disability levels. Purpose: To identify factors associated with HRQOL among people with multiple sclerosis (MS) utilizing the SF-8 Health Survey. Methods: Data presented in this study were collected in a survey of 1,518 people with MS living in all 50 states. The survey sample was randomly selected from the database of the National Multiple Sclerosis Society, using ZIP codes to recruit the survey sample. A multiple linear regression model was employed to analyze the survey data, with the Physical Component Summary and the Mental Component Summary of the SF-8 the dependent variables. Independent variables were demographic characteristics, MS-disease characteristics, and health services utilized. Findings: People with MS in rural areas tended to report lower physically related HRQOL. Worsening MS symptoms were associated with reduced physical and mental dimensions of HRQOL. In addition, people with MS who received a diagnosis of depression tended to have reduced physical and mental dimensions of HRQOL. Receiving MS care at an MS clinic was associated with better physically related HRQOL, while having a neurologist as principal care physician was associated with better mental-related HRQOL. Conclusion: The challenge is to increase the access that people living with MS in rural areas have to MS-focused specialty care.

The Cognitive Function Study Group of the National Multiple Sclerosis Society has highlighted the problems with assessing affective disorders in patients with multiple sclerosis. It has been said that no single physical symptom of MS is as common as defects in mood and expression and control of emotion. These aspects of MS have received little attention from those involved in the care of MS patients, and doubtlessly contribute significantly to suffering. Numerous affective symptoms have been described in MS patients, including uncontrolled weeping and laughing, euphoria, depression, and mania. Unfortunately, limitations in research methods prevent comparison between published reports and a precise calculation of the prevalence and severity of these disorders. The Study Group makes recommendations for the evaluation of affective disorders in MS, which includes the recommendation for a structured interview. Although more expensive, and requiring the presence of trained personnel, the structured interview is far more reliable than self-report questionnaires for the assessment of affective disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients infected with the human immunodeficiency virus (HIV) are especially likely to have a deficiency of vitamin B12. Although this deficiency has been attributed to an abnormality of gastrointestinal function, the precise cause is not yet clear. A recent study has indicated that about 7 percent of asymptomatic HIV-infected patients have vitamin B12 deficiency, and the proportion rises to 15 percent among patients with symptomatic AIDS. Since a deficiency of vitamin B12 can adversely affect the function of the brain if the deficiency persists over time, a study was undertaken to determine the prevalence of vitamin B12 deficiency among HIV-infected patients with neurological symptoms. Forty-nine HIV-infected patients with possible neurological involvement were tested for vitamin B12 deficiency. Ten patients (20 percent of the group) were found to have some abnormality of vitamin B12 metabolism. Six had vitamin B12 levels that were less than normal. The other four patients had abnormalities on the Schilling test, which determines the absorption of vitamin B12 after the administration of an oral dose. The patients with vitamin B12 abnormalities tended to be further along in the progression of the disease and were also older than the patients with no detectable vitamin B12 abnormality. The vitamin B12 abnormality was associated with both neuropathy (disease of the nerves) and myelopathy (disease of the spinal cord). No patient without peripheral neuropathy had a vitamin B12 abnormality, and 67 percent of the patients with both neuropathy and myelopathy had this vitamin abnormality. Eight patients were treated with injections of vitamin B12, and five experienced relief of neuropathic symptoms. No relief of symptoms of myelopathy was achieved in any patient, however. The evidence indicates that vitamin B12 deficiency may be a common and treatable cause of neurologic deficits in some HIV-infected patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dr Schiffer is director of the Center for Brain Health at the Cleveland Clinic in Ohio. He reports that he has 2000 shares of stock in Pfizer and is a [...]

Objective To evaluate dextromethorphan combined with ultra low-dose quinidine (DMq) for treating pseudobulbar affect (PBA) in patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). Methods In a 12-week randomized, double-blind trial, ALS and MS patients with clinically significant PBA (a baseline score ≥13 on the Center for Neurologic Studies-Lability Scale [CNS-LS]) were maintained, twice daily, on placebo, DMq at 30/10mg (DMq-30), or DMq at 20/10mg (DMq-20). Results In 326 randomized patients (of whom 283, or 86.8%, completed the study), the PBA-episode daily rate was 46.9% ( p < 0.0001) lower for DMq-30 than for placebo and 49.0% ( p < 0.0001) lower for DMq-20 than for placebo by longitudinal negative binomial regression, the prespecified primary analysis. Mean CNS-LS scores decreased by 8.2 points for DMq-30 and 8.2 for DMq-20, vs 5.7 for placebo ( p= 0.0002 and p= 0.0113, respectively). Other endpoints showing statistically significant DMq benefit included, for both dosage levels, the likelihood of PBA remission during the final 14 days and, for the higher dosage, improvement on measures of social functioning and mental health. Both dosages were safe and well tolerated. Interpretation DMq markedly reduced PBA frequency and severity, decreasing the condition's detrimental impact on a patient's life, with satisfactory safety and high tolerability. The findings expand the clinical evidence that DMq may be an important treatment for patients suffering from the socially debilitating symptoms of PBA. Ann Neurol 2010 [ABSTRACT FROM AUTHOR]

The article discusses the association between depression and Alzheimer's disease (AD). It states that depression and depressive symptoms are common in individuals with AD. It is generally accepted that between 30%-50% of patients with AD experienced symptoms of depression during its course. Moreover, the aspects that gives a brief explanation of the possible connection between depression and AD are discussed.

Despite the rapidly growing nature of the Mexican American population in the United States, relatively little is known regarding cognitive aging among this minority group compared to non-Hispanic, white individuals. The current study was conducted to describe the nature of cognitive and affective characteristics of Mexican American patients with dementia or other cognitive disorders on initial presentation to a Memory Disorder Clinic. Archival data were reviewed from this specialty clinic for 219 patients who were evaluated for the first time over a 2-year period. Twenty-two Mexican American patients were identified, and a sample of 22 matched non-Hispanic white patients was derived for comparison. When compared to non-Hispanic white patients, Mexican Americans were found in fewer numbers, reported higher levels of anxiety and depression, and produced lower scores on neurocognitive assessments. Results support the notion that Mexican American patients present for cognitive assessment and treatment at a greater stage of impairment severity as compared to non-Hispanic whites. [ABSTRACT FROM AUTHOR]

In response to citizen concerns in 5 small Illinois towns, community-based case-finding determined the prevalence of multiple sclerosis (MS). Potential cases were identified through town meetings, publicity, advocacy groups and local volunteer outreach coordinators. Estimated prevalence based on available medical records for self-identifying individuals for 3 of the 5 communities was high (218–231 per 100,000 population) compared to other studies. Scanning databases in medical offices used in many other studies may miss MS cases; yet tracking medical records is labor-intensive and sometimes restricted by privacy guidelines. MS registries could improve case-finding accuracy and efficiency. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background. In January 2002 the New York City Chapter of the National Multiple Sclerosis Society convened a panel of experts to review the issue of depressive affective disorders associated with multiple sclerosis (MS). This Consensus Conference was supported by a grant from the Goldman family of New York City. Results. The panel reviewed summaries of current epidemiologic, neurobiologic, and therapeutic studies having to do with depressive disorders among MS patient populations. Depressive disorders occur at high rates among patients with MS, and there is reason to believe that the immunopathology of the disease is involved in the clinical expression of affective disorders. The depressive syndromes of MS have a major, negative impact on quality of life for MS sufferers, but are treatable. At the present time, most MS patients with depression do not receive adequate recognition and treatment. Conclusions. The Goldman Consensus Conference Study Group provides recommendations for improved screening, diagnosis, and clinical management for depressive affective disorders among patients suffering from MS. [ABSTRACT FROM AUTHOR]

In a double-blind clinical trial involving 28 patients with multiple sclerosis and major depressive disorder, 14 patients were randomly assigned to a 5-week trial of desipramine and individual psychotherapy and 14 to placebo plus psychotherapy. Clinical judgments indicated that patients treated with desipramine improved significantly more than the placebo group. This was confirmed by scores on the Hamilton Rating Scale for Depression but not by Beck Depression Inventory scores. Side effects limited desipramine dosage in half of the treated patients. The authors conclude that desipramine has a modest beneficial effect in serious depression associated with multiple sclerosis but that side effects may be more of a limiting factor than in patients without medical or neurologic disease. [ABSTRACT FROM AUTHOR]

The Research Diagnostic Criteria were applied to 16 depressed patients with Parkinson's disease and 20 depressed multiple sclerosis patients. Diagnoses of anxiety and panic disorder were significantly more frequent among the patients with Parkinson's disease. These patients may experience atypical depression. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The Evolving Subspecialization of Psychiatry: Implications for the Profession," by Joel Yager and Donald G. Langsley.