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MS research update - Does smoking make MS cognitive symptoms worse? - 29 September 2014

Summary

About half of all people with MS have problems at some time with aspects of thinking such as memory, concentration or problem solving. Cognition is the term that covers all aspects of thinking and so these symptoms are referred to as cognitive problems.

Previous research has implicated smoking as a trigger for MS, as well as suggesting it can increase the number of relapses and increase disability progression. Despite the evidence for its role in influencing the course of MS, the effect of cigarette smoking on cognition has not been investigated.

72 people with MS from Turkey took part in the study. Participants were asked about their smoking habits and their cognitive function was assessed using the Brief Repeatable Battery of Neuropsychological Tests (BRB-N). These tests assess memory, attention, language function and how well the person can process information.

The study found that there were 24 non-smokers in the group and 20 heavy smokers. When the researchers compared the test scores it was found that although some of the non-smokers had cognitive problems, more of the heavy smokers had cognitive difficulties and their problems with memory and information processing were significantly worse.

The study shows that heavy smoking appeared to be related to cognitive difficulties in people with MS. The authors conclude that this study is the first to investigate the effect of smoking on cognition in people with MS, but it fits in with previous research that has shown that smoking can also make other MS symptoms worse.

Background

About half of all people with MS have problems at some time with aspects of thinking such as memory, concentration or problem solving. Cognition is the term that covers all aspects of thinking and so these symptoms are referred to as cognitive problems.

Previous research has implicated smoking as a trigger for MS, as well as suggesting it can increase the number of relapses and increase disability progression. Despite the evidence for its role in influencing the course of MS, the effect of cigarette smoking on cognition has not been investigated.

How this study was carried out

72 people with MS from Turkey took part in the study. 80% had relapsing remitting MS, 14% had secondary progressive MS and 6% primary progressive MS. The average age was 35.5 years old, on average the participants had MS for 6.5 years and the average EDSS score was 1.5 although this ranged from 1-7.5.

Participants were asked about their smoking habits and the researchers calculated how much they smoked, using the 'pack year' calculation. This is calculated by multiplying the number of packs of 20 cigarettes smoked each day by the number of years the person has smoked, therefore one pack year is the equivalent to smoking a pack of 20 cigarettes every day for one year. The researchers considered participants were heavy smokers if they had smoked for at least 10 pack years (equivalent to 20 cigarettes a day for 10 years) and were still smoking.

Cognitive function was assessed using the Brief Repeatable Battery of Neuropsychological Tests (BRB-N). These tests assess memory, attention, language function and how well the person can process information.

What was found

The study found that there were 24 non-smokers in the group, 20 heavy smokers and the remaining 28 were either ex-smokers or light smokers. The non-smokers were more likely to be women (15 out of 24) and the heavy smokers more likely to be men (13 out of 20), but both groups EDSS scores, number of years in education and number of years since MS diagnosis were all very similar.

When the researchers compared the test scores it was found that heavy smokers were more likely to have cognitive difficulties and they also had significantly greater difficulties than non-smokers. The heavy smokers had the greatest problems with working memory (short term storing and manipulating pieces of information) and how well they could process information.

What does it mean?

The study shows that heavy smoking appeared to be related to cognitive difficulties in people with MS. Although non-smokers did have cognitive problems, more of the heavy smokers had difficulties and their problems with memory and information processing were significantly worse.

The authors conclude that this study is the first to investigate the effect of smoking on cognition in people with MS, but it fits in with previous research that has shown that smoking can also make other MS symptoms worse.

Ozcan ME, Ince B, Bingöl A, et al.
Association between smoking and cognitive impairment in multiple sclerosis
Neuropsychiatr Dis Treat. 2014 Sep 10;10:1715-9.
abstract
Read the full text of this paper

More about smoking and MS

There is increasing evidence linking smoking to risk and symptoms in MS. It has been linked to an increased risk of getting MS in smokers and an increased chance of children later developing MS after being exposed to second-hand smoke. Studies have suggested that people with MS who smoke experience more relapses and a more rapid disease progression than non-smokers.

As smoking is also a risk factor for a range of other conditions such as cancers and cardiovascular disease, giving up, or at least cutting down, is recommended.

There are a range of support programmes so you could visit your GP to discuss what could work for you.

NHS Choices has more information on giving up smoking including eight suggestions of things that could help you stop.

During October the Department of Health also runs the Stoptober campaign which challenges smokers to give up cigarettes for 28 days. Evidence shows that if a smoker can quit for 28 days they are five times more likely to stop for good. Stoptober includes various motivation and support tools, including an app (phone and online), text support and a free information pack.

Cognitive symptoms

Cognitive difficulties is the term used to describe a range of problems with slowed thinking such as poor memory, attention span or concentration and difficulty following complicated instructions or problem solving. Cognitive symptoms are common in MS but may not be recognised. Management of these symptoms involves finding strategies that minimise the difficulty, for example, if you have trouble remembering where you've put your car keys, always putting them in the same place will help.

There is more information, tips and strategies for getting around cognitive symptoms on the StayingSmart website. StayingSmart was developed by the MS Trust in partnership with Prof Dawn Langdon, a neuropsychologist at Royal Holloway University of London. The Tips and Tricks section, which includes ideas shared by people living with cognitive symptoms, and Gadgets and Gizmos features readily available items of equipment that may be helpful.

You can also read more about cognition and MS in the A to Z of MS.

Research by topic areas...

Assessment tools

Sonder JM, Balk LJ, van der Linden FA, et al.
Toward the use of proxy reports for estimating long-term patient-reported outcomes in multiple sclerosis.
Mult Scler. 2014 Sep 25. [Epub ahead of print]
abstract

Basic research

Dickens AM, Larkin JR, Griffin JL, et al.
A type 2 biomarker separates relapsing-remitting from secondary progressive multiple sclerosis.
Neurology. 2014 Sep 24. [Epub ahead of print]
abstract

CCSVI

Jandaghi AB, Amanian D, Roudbari SA, et al.
Evaluation of hemodynamic properties of cerebral venous drainage in patients with multiple sclerosis: a case-control study.
Pol J Radiol. 2014;79:323-7.
abstract
Read the full text of this paper

Disease modifying treatments

Cocco E, Sardu C, Spinicci G, et al.
Influence of treatments in multiple sclerosis disability: a cohort study.
Mult Scler. 2014 Sep 25. [Epub ahead of print]
abstract

Limmroth V, Gerbershagen K.
Single-use autoinjector for once-weekly intramuscular injection of IFNβ-1a.
Expert Opin Drug Deliv. 2014 Sep 26:1-10. [Epub ahead of print]
abstract

Ferrè L, Moiola L, Sangalli F, et al.
Recurrence of disease activity after repeated Natalizumab withdrawals.
Neurol Sci. 2014 Sep 24. [Epub ahead of print]
abstract

Chinea Martinez AR, Correale J, Coyle PK, et al.
Efficacy and safety of Fingolimod in hispanic patients with multiple sclerosis: pooled clinical trial analyses.
Adv Ther. 2014 Sep 23. [Epub ahead of print]
abstract

Falls

Mazumder R, Murchison C, Bourdette D, et al.
Falls in people with multiple sclerosis compared with falls in healthy controls.
PLoS One. 2014;9(9):e107620.
abstract
Read the full text of this paper

Other

Aleixandre-Benavent R, Alonso-Arroyo A, González de Dios J, et al.
Bibliometric profile of the global scientific research on multiple sclerosis (2003-2012).
Mult Scler. 2014 Sep 25. [Epub ahead of print]
abstract

Physical activity

McLoughlin JV, Barr CJ, Crotty M, et al.
Six minutes of walking leads to reduced lower limb strength and increased postural sway in people with multiple sclerosis.
NeuroRehabilitation. 2014 Sep 23. [Epub ahead of print]
abstract

Psychological aspects

Samartzis L, Gavala E, Zoukos Y, et al.
Perceived cognitive decline in multiple sclerosis impacts quality of life independently of depression.
Rehabil Res Pract. 2014;2014:128751.
abstract
Read the full text of this paper

Leclercq E, Cabaret M, Guilbert A, et al.
The influence of age and illness duration on cognitive impairment in aging patients with relapsing-remitting multiple sclerosis (RR-MS).
Geriatr Psychol Neuropsychiatr Vieil. 2014 Sep 1;12(3):331-338.
abstract

Rehabilitation

Marinelli L, Mori L, Solaro C, et al.
Effect of radial shock wave therapy on pain and muscle hypertonia: a double-blind study in patients with multiple sclerosis.
Mult Scler. 2014 Sep 25. [Epub ahead of print]
abstract

Kjølhede T, Vissing K, de Place L, et al.
Neuromuscular adaptations to long-term progressive resistance training translates to improved functional capacity for people with multiple sclerosis and is maintained at follow-up.
Mult Scler. 2014 Sep 25. [Epub ahead of print]
abstract

Chisari C, Venturi M, Bertolucci F, et al.
Benefits of an intensive task-oriented circuit training in multiple sclerosis patients with mild disability.
NeuroRehabilitation. 2014 Sep 23. [Epub ahead of print]
abstract

Symptoms and symptom management

Birnbaum G, Iverson J.
Dalfampridine may activate latent trigeminal neuralgia in patients with multiple sclerosis.
Neurology. 2014 Sep 26. [Epub ahead of print]
abstract

Du Y, Li JJ, Zhang YJ, et al.
Risk factors for idiopathic optic neuritis recurrence.
PLoS One. 2014;9(9):e108580.
abstract
Read the full text of this paper

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