Prevalence of and risk factors for severe cognitive and sleep symptoms in ME/CFS and MS, 2017, Nacul et al

Andy

Andy

Retired committee member
From Jun 2017
Abstract
BACKGROUND:
There are considerable phenotypic and neuroimmune overlaps between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and multiple sclerosis (MS). While the precise aetiologies of both MS and ME/CFS are unclear, evidence suggests that deterioration in cognitive function is widely prevalent in patients with either condition. Little is known about differing risk factors or exposures, which may lead to severe cognitive or sleep symptoms. This study aims to gauge the extent of cognitive and sleep symptoms in ME/CFS and MS patients participating in the UK ME/CFS Biobank and identify the characteristics of those experiencing severe symptoms.

METHODS:
This was a cross-sectional study of 395 UK ME/CFS Biobank participants, recruited from primary care and the community, using similar standardised protocols, and matched by age, sex and geographical area. Data were collected from participants using a standardized written questionnaire at clinical visits. Cognitive symptoms included problems with short-term memory, attention, and executive function. Sleep symptoms included unrefreshing sleep and poor quality or inadequate duration of sleep. All participants reported symptoms based on an ordinal severity scale. Multivariable logistic regression was carried out in the ME/CFS group to investigate socio-demographic factors associated with severe symptoms.

RESULTS:
All cognitive and sleep symptoms were more prevalent in the ME/CFS group, with 'trouble concentrating' (98.3%) the most commonly reported symptom. Severe symptoms were also more commonly reported in the ME/CFS group, with 55% reporting 'severe, unrefreshing sleep'. Similarly, in the MS group, the most commonly reported severe symptoms were sleep-related. Logistic regression analysis revealed that ME/CFS patients aged over 50 years were more than three times as likely to experience severe symptoms than those younger than 30 (OR 3.23, p = 0.031). Current smoking was associated with severe symptoms, increasing the risk by approximately three times (OR 2.93, p = 0.003) and those with household incomes of more than £15,000 per year were less likely to experience severe symptoms compared to those earning less than this (OR 0.31, p = 0.017).

CONCLUSIONS:
Cognitive and sleep symptoms are more common in ME/CFS patients than in MS patients and healthy controls, providing further support for existing evidence of central nervous system abnormalities in ME/CFS. Our findings suggest that people with ME/CFS who are smokers, or have a low income, are more likely to report severe cognitive and sleep symptoms. Future research should aim to develop strategies to prevent the progression of severe cognitive and sleep symptoms through early interventions that prioritise patients identified as being at highest risk.
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Full text at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477754/
 
The high prevalence of cognitive and sleep symptoms in ME/CFS highlights the need for improved strategies to combat their effects. Unlike MS, the severity of these symptoms seems to be unrelated to depression, and might reflect more generalised and subtle abnormalities in the CNS.
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Alis said:
'those with household incomes of more than £15,000 per year were less likely to experience severe symptoms than those with less than this'
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Does anyone else think the researchers' interpretation is backwards? Instead, perhaps they should have stated that those who experience severe symptoms were less likely to have household incomes of more than £15,000.
 
MsUnderstood said:
Does anyone else think the researchers' interpretation is backwards? Instead, perhaps they should have stated that those who experience severe symptoms were less likely to have household incomes of more than £15,000.
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They have to state it the way the analysis was made. There is no interpretation. Which is what is good about the paper. They are not drawing any conclusions, just giving us facts. That can seem boring but it allows us to do our own interpretations.
 
"Our findings suggest that people with ME/CFS who are smokers, or have a low income, are more likely to report severe cognitive and sleep symptoms."

How is smoking relevant?
 
Mij said:
"Our findings suggest that people with ME/CFS who are smokers, or have a low income, are more likely to report severe cognitive and sleep symptoms."

How is smoking relevant?
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Smoking turns out to be relevant to a remarkable range of diseases. We were very surprised when it became clear that smoking increases both risk of and severity of rheumatoid arthritis, which was supposed to be a purely immune disease. Button course smoking is likely to correlate non-causally with all sorts of things.
 
strategist said:
Reversing the association, why are cognitive issues and poor sleep risk factors for smoking? Is there an interpretation that involves nicotine and the nervous system?
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I think in this sort of context 'risk factor' just means a predictor of an association. No causal link is presumed either way. If there is a time sequence that may be relevant at least in excluding a backwards causation.
 
The association could "merely" be that poor/disadvantaged people are more likely to smoke. As severity level of ME increases, I would imagine the vast majority of patients would feel greater financial pressure.

Tobacco and poverty have become linked in a vicious circle, through which tobacco exacerbates poverty and poverty is also associated with higher prevalence of tobacco use. Several studies from different parts of the world have shown that smoking and other forms of tobacco use are much higher among the poor. For example, in Poland, the contribution of smoking to the risk of premature death among males at ages 35-69 varies by education level; in 1996, the risk of death during middle age was 5% among higher educated people, while it nearly doubles (9%) among persons with only primary and secondary education levels.
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http://www.who.int/tobacco/research/economics/rationale/poverty/en/

The proportion who smoke cigarettes was higher amongst unemployed people, people working in routine and manual occupations and those with lower level educational qualifications. These are all factors associated with poverty
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https://www.ons.gov.uk/peoplepopula...15-03-19/adultsmokinghabitsingreatbritain2013
 
Alis said:
'those with household incomes of more than £15,000 per year were less likely to experience severe symptoms than those with less than this'
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Simply giving more money to people in poverty (regardless of the cause) solves an incredible amount of problems. In this case I suspect it leads to better health care and access to general symptomatic treatments not easily available from the NHS for ME/CFS patients. Money might mean less reliance on sleep-hygiene advice and more practical solutions involving meds, supplements, etc.

And having a higher income often gives people the option to live in a quieter environment. Sharing a flat/apartment on a noisy city street must be pretty hellish, and would certainly impact sleep. Similarly, more money could mean an extra room is affordable, so partners can sleep separately and avoid disturbances from snoring and movement.
 
Valentijn said:
Simply giving more money to people in poverty (regardless of the cause) solves an incredible amount of problems. In this case I suspect it leads to better health care and access to general symptomatic treatments not easily available from the NHS for ME/CFS patients. Money might mean less reliance on sleep-hygiene advice and more practical solutions involving meds, supplements, etc.

And having a higher income often gives people the option to live in a quieter environment. Sharing a flat/apartment on a noisy city street must be pretty hellish, and would certainly impact sleep. Similarly, more money could mean an extra room is affordable, so partners can sleep separately and avoid disturbances from snoring and movement.
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I think the latter more than the former. But I live in a country where healthcare is generally affordable (free if declared low income).
Having control over more of your life (where you live, noise, timing, stresses both social and physical etc).
I note the threshold they mention is not wealth but absence of financial difficulty.
Andy said:
From Jun 2017

Full text at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477754/
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What are these early interventions they mention? Do they exist?
 
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