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BACKGROUND: Current guidance on the selection of appropriate contraception for people with multiple sclerosis (PwMS) is lacking. OBJECTIVE: To address this gap, an expert-led consensus program developed recommendations to support clinicians in discussing family planning and contraception with women and men with multiple sclerosis (MS). METHODS: A multidisciplinary steering committee (SC) of 13 international clinical experts led the program, supported by an extended faculty of 32 experts representing 18 countries. A modified Delphi methodology was used for decision-making and consensus-building. The SC drafted 15 clinical questions focused on patient-centered care, selection of contraception, and timing of stopping/starting contraception and disease-modifying therapies (DMTs). Statements addressing each question were drafted based on evaluation of published evidence and the experts clinical experience. Consensus was reached if ⩾75% of respondents agreed (scoring 7-9 on a 9-point scale) with each recommendation. RESULTS: Consensus was reached on 24 of 25 proposed recommendations, including how and when to discuss contraception, types and safety of contraceptives, and how to evaluate the most appropriate contraceptive options for specific patient groups, including those with significant disability or being treated with DMTs. CONCLUSION: These expert recommendations provide the first practical, relevant, and comprehensive guidance for clinicians on the selection of contraception in PwMS.

IntroductionMethodsResultsConclusionsApathy is one of the common neuropsychiatric symptoms in people with dementia (PwD). The aim of this study is to determine the impact of apathy on the patient's quality of life (QoL) and caregiver's burden among PwD.Sample of this cross-sectional descriptive study consisted of 88 PwD attending the outpatient clinic of a university hospital in Istanbul and their family caregivers. The evaluation battery included Apathy Evaluation Scale (AES), Caregiver Burden Inventory (CBI) and Quality of Life in Alzheimer's Disease Scale (QoL-AD).The mean age of the patients was 73.1 ± 11.7, and the time since diagnosis was 3.9 ± 3.1 years; 64.8% had Alzheimer's type dementia, and 53.4% (n = 47) had mild dementia. The mean AES-C score was 52.9 ± 10.2, QoL-AD score was 28.4 ± 5.6 and CBI score 32.6 ± 25.9. Apathy was associated with medical comorbidity, stage of dementia, neuropsychiatric symptoms, functional status and depression. Apathy was found to be predictor of the QoL-AD and also related with CBI.In dementia patients, apathy was associated with patients’ functional status, quality of life, and caregiver burden. It is recommended that patients be evaluated for apathy and its impact on activities of daily living, quality of life and caregiver burden. [ABSTRACT FROM AUTHOR]

BACKGROUND: We aimed to evaluate the validity and reliability of the Turkish version of the Patient-Reported Impact of Spasticity Measure (PRISM-TR). METHODS: Expert opinions and the forward-back translation method were used for linguistic validation. Cronbach α and test-retest analysis were performed for reliability analysis. Correlations between the PRISM-TR and the Modified Ashworth Scale (MAS), the Numerical Rating Scale (NRS), and the Expanded Disability Status Scale (EDSS) were assessed. RESULTS: A total of 206 individuals with multiple sclerosis (MS; 139 women; mean age, 47.7 ± 11.3 years; mean EDSS score, 5.2 ± 1.5) who had not had a relapse in the previous 3 months were included in the study. Test-retest correlation coefficients were high for all subdimensions of the scale (0.95-0.99). All Cronbach α values for the PRISM-TR subdimensions, except for Positive Impact, were likewise quite high (0.85-0.94). PRISM-TR subscale scores were correlated with MAS, NRS, and EDSS scores (P < .001). CONCLUSIONS: PRISM-TR is a valid and reliable scale for use with Turkish individuals with MS. It is simple to use in the clinic and can be helpful in detecting patients' spasticity early in the disease course. [ABSTRACT FROM AUTHOR]

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Objective: In the COVID-19 pandemic period, the effect of COVID-19 fear on quality of life was uncertain. This present study examined the effect of fear of COVID-19 on quality of life in patients with epilepsy through anxiety and depression. Methods: This single-center, cross-sectional study was conducted with a total of 319 adult patients with epilepsy. The mean age of the patients was 36.0 (± 11.1) years, and 53% were male. The mean duration of diagnosis was 16.0 (± 10.6) years, and more than half of the patients (52.4%) were using two and more antiepileptic drugs. Data were collected online between 15 December 2020 and 5 January 2021. COVID-19 Fear Scale, Beck Depression Inventory, Worry and Anxiety Questionnaire, and Epilepsy Quality of Life Scale-10 were used for data collection. Serial mediation analysis was conducted to determine the effect of COVID-19 fear on quality of life. Results: Although there was a significant correlation between them, the fear of COVID-19 did not directly affect the quality of life. The fear of COVID-19 increased anxiety and depression respectively, the increase in the mediators also decreased the quality of life. Conclusion: The fear of COVID-19 experienced by patients with epilepsy did not have a significant direct effect on the quality of life. However, it was found that it had an indirect effect on the quality of life by increasing mental health problems such as anxiety and depression, the indirect effect was mostly on anxiety. [ABSTRACT FROM AUTHOR]

Background & Objectives: This study was carried out to evaluate the effects of discharge training on quality of life and self-efficacy in stroke patients and their informal caregivers; and reintegration to normal living in patients only. Methods: In this randomized, controlled trial, 59 patients and their caregivers were randomly allocated to receive discharge with education (via a webpage or booklet) or a standard of care discharge without intervention (i.e. an additional training). The 12-Item Short-Form Health Survey (SF-12), the General Self-Efficacy Scale (GSES) were applied to patients and caregivers and the Reintegration to Normal Living Index (RNLI) were applied to patients only, before discharge and 3 months after discharge. Results: It was found that, although the quality of life improved by the trainings in the patient intervention groups, compared with the control group (p<0.05); there was no change in self-efficacy parameter (p>0.05). Both self-efficacy and quality of life of the caregivers improved or maintained by the interventions, compared with the controls (p<0.05). In general, there was no significant difference between training methods (webpage versus booklet) (p>0.05). Lastly, the impact of discharge trainings on reintegration to normal living which was assessed in the patients only, was found to be limited. Conclusion: Although discharge training improved the quality of life in both patients and informal caregivers, its effect on self-efficacy in both populations and reintegration to normal living in patients was found to be limited. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate caregiver burden and quality of life (QoL) and their predictors in family caregivers of dementia patients. A descriptive cross-sectional survey was carried out with a sample of 102 patients and their family caregivers. The Caregiver Burden Inventory (CBI) and Short Form-12 (SF-12) were used to collect data. CBI mean score was 37.97 ± 21.30. Mean scores of SF-12 sub-domains varied between 36.02 and 77.94 and were significantly lower as compared to normative means of the general population, excluding only the physical health subdomain. Among several patient and caregiver-related correlations, the number of medications and worse cognitive function of the patient, caregiver's age and having limited space at home were found as predictors of burden, whereas caregiver's chronic disease and having a limited space were predictors of QoL. Also, the burden and QoL were correlated. This study demonstrated a high burden and low QoL in dementia caregivers. In societies where caregivers are mostly informal such as that in Turkey, supportive systems should be established. [ABSTRACT FROM AUTHOR]

Aims: Sexual dysfunction (SD) is highly prevalent in women with multiple sclerosis (MS), however little is known about treatment options. The aim of this paper is to review the prevalence, symptomatology, and management options of sexual dysfunction in women with MS. Methods: The Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, PEDro, Database of International Rehabilitation Research, Occupational Therapy Systematic Evaluation of Evidence, ClinicalTrials.gov, and Current Controlled Trials databases were searched. No limitations were placed on the date. A critical appraisal of the literature on SD in women with MS was performed according to the PRISMA statement. Two reviewers screened and extracted data. Study quality was evaluated using a standardized tool. Results: A search of 12 databases identified 61 relevant studies (33 observational, 14 case‐control, 4 follow up, 10 interventional). Significant variability in the prevalence of SD and questionnaires used to evaluate SD were observed. The most commonly reported sexual difficulties were problems with desire, arousal, and orgasm. Different demographics and MS‐related characteristics were found to contribute to SD. Few studies have evaluated interventions for treating SD, and bias was high because of the weak quality of trial designs. Conclusions: SD in women with MS is multidimensional, comparable in prevalence with other neurological disorders and increases with advancing disease. Studies evaluating practical strategies and pharmacological interventions are few, and properly designed trials using MS‐specific validated outcome measures of SD are required to inform evidence‐based treatment options for this high impact MS‐related dysfunction. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to translate the eight‐item Actionable Bladder Symptom Screening Tool (ABSST) and determine its psychometric properties in Turkish speaking subjects. Methods: The study was conducted at the multiple sclerosis (MS) outpatient clinic of the Istanbul Faculty of Medicine, Istanbul University. First, the ABSST was translated into Turkish by an expert panel. We employed the back translation method for linguistic validation. Cronbach's α and test‐retest analysis were performed for reliability analysis. The overactive bladder‐v8 (OAB‐v8) questionnaire was also administered for concurrent validation, and expanded disability status scale (EDSS) and multiple sclerosis quality of life scale‐54 (MSQL‐54) were used to evaluate construct validity. Results: One hundred and five patients (84 females; mean age, 39.5 ± 11.6 years; mean EDSS score, 3.2 ± 1.8) participated in the study. Mean duration of MS was 9.7 ± 8.3 years, and most (n = 96; 91.5%) had relapsing‐remitting MS. The mean ABSST score was 9.7 ± 5.8 (range, 0‐21). Highest scores were obtained from urgency and frequency, and the lowest from psychosocial effects of lower urinary tract (LUT) symptoms. The Cronbach's α coefficient was 0.856, and item‐total score correlations ranged between 0.485 and 0.845. Correlations of ABSST scores with OAB‐v8, EDSS, and MSQL‐54 scales were significant (P <.001). According to the questionnaire, 38.1% (n = 40) of the patients needed a referral to a urologist or gynecologist for their LUT symptoms. Conclusions: The Turkish version of the ABSST is a valid and reliable screening tool that can be used to identify LUT symptoms in an MS clinic. [ABSTRACT FROM AUTHOR]

Background: Falling, which is common in the elderly and leads to negative consequences, can also be seen in dementia patients. The aim of this study is to determine the risk of falls in patients with dementia and to evaluate the factors associated with falls. Method: The sample of this cross‐sectional study consisted of 95 patients with a diagnosis of definite dementia who attended a dementia outpatient clinic in a university hospital in Istanbul between January and March 2020. Patients using assistive devices while walking were not included in the study. A sociodemographic form, DENN Fall Risk Assessment Scale, Mini Mental State Test (MMSE), Neuropsychiatric Inventory (NPI), Apathy Assessment Scale (AES), Clinical Dementia Rating Scale (CDR), Cornell Depression in Dementia Scale (CSDD), Lawton and Brody Instrumental Activities of Daily Living (Lawton IADL), and Katz Activities of Daily Living (Katz ADL) Scale were used for data collection. Results: It was determined that 53.7% of the patients were female and the mean age was 73.1±11.4. Most of the patients (64.2%) had Alzheimer's type dementia, 49.5% had mild or moderate dementia, 75.8% had an additional chronic disease, 22.1% were semi‐dependent in movement activity. 47.4% of the individuals had a history of fall in the last month, 48.9% had fallen at least 2 times, the average number of falls was 1.5±0.5, 70.5% of the patients had injuries after falling, and the mean DENN Fall Risk score was found to be 10.4±3.4. In the group with a history of falling non‐Alzheimer dementias were more common (p = 0.018), NPI symptom (p<0.001) and bother (p<0.001) scores were higher, Lawton IADL scores were lower (p = 0.009), AES clinician (p = 0.054) and caregiver (p = 0.052) scores and Cornell depression score (CSDD) (p = 0.005) were higher. Conclusion: Falling, which is the most common geriatric syndrome in dementia patients, can lead to negative patient outcomes. Most dementia patients have a history of falling and post‐fall injury. Factors associated with falls in dementia patients should be known, and appropriate nursing interventions should be made to prevent falls by recognizing the risk of falling. More work is needed on this subject. [ABSTRACT FROM AUTHOR]

Background: Apathy is one of the most common neuropsychiatric symptoms in dementia. The aim of this study is to evaluate apathy and its relationships with activities of daily living, quality of life and caregiver burden in patients with dementia. Method: The research was conducted in a descriptive analytic type. The sample consisted of 88 patients with a definite diagnosis of dementia attending outpatient clinic of a university hospital in Istanbul between October 2019‐March 2020 and their family caregivers. Depressive patients (assessed by Cornell Scale) and paid caregivers were not included. Apathy Evaluation Scale‐Clinician (AES‐C) and Informant (AES‐I) Forms, Neuropsychiatric Inventory (NPI), Mini Mental Test (MMSE), Quality of Life in Alzheimer's Disease Scale (QoL‐AD), Lawton Instrumental (Lawton IADL) and the Katz Activities of Daily Living Scale (Katz ADL) were used for patients and Caregiver Burden Inventory (CBI) was used for caregivers. Results: The mean age of the patients was 73.11±11.68, and diagnosis duration was 3.9±3.1 years, 64.8% had Alzheimer's type dementia and 53.4% (n = 47) had mild‐1 dementia. The mean MMSE score was 16.4±6.6, NPI‐Symptom score was 16.6±13.7, AES‐C score was 52.9±10.2. The QoL‐AD score was 28.8±6.1 in patient evaluation and 27.6±6.4 in caregiver evaluation. The AES‐C scores were correlated with NPI, MMSE, ADL, Cornell, QoL‐AD, and CBI. Apathy was found to be an important predictor of both the patient's QoL and CBI. Conclusion: In dementia patients, apathy was found to be associated with patient's activities of daily living, quality of life, and caregiver burden. It is recommended that patients be evaluated for apathy. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterial and methodsResultsConclusions\nSHORT CONDENSATIONMultiple sclerosis (MS) is often diagnosed in people of reproductive age. However, family planning counselling is not always integrated within MS care. Decisions on family planning can be further complicated by potential side effects associated with several disease-modifying therapies. While neurologists may lack training in contraceptive use and family planning counselling, obstetricians and gynaecologists (OB-GYNs) and other health care professionals involved in reproductive life planning (RHCPs) may lack detailed knowledge and experience around the use of contemporary MS treatments.Through a modified Delphi consensus programme, a multidisciplinary steering committee of 13 international experts developed practical clinical recommendations on contraceptive use and family planning for people with MS (PwMS). This article offers insights to help OB-GYNs and RHCPs implement these recommendations, focusing on contraceptive decision-making and MS medications.The perspectives discussed emphasise providing education on MS to OB-GYNs and other RHCPs, enabling informed counselling for PwMS and their partners regarding contraception and family planning. Close collaboration among the multidisciplinary team, including neurologists, is crucial in providing reproductive care for PwMS.The detailed perspectives provided aim to enable OB-GYNs and other RHCPs to provide informed counselling for PwMS and their partners regarding contraception and family planning.Multiple sclerosis (MS) onset often coincides with reproductive age, but family planning counselling is not standard in MS care. The detailed perspectives provided here aim to enable health care professionals involved in reproductive life planning to provide informed counselling for people with MS and their partners. [ABSTRACT FROM AUTHOR]