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MS in the Bedroom

DALLAS — Cognitive dysfunction was an independent risk factor for sexual dysfunction in multiple sclerosis (MS), according to results of a prospective cohort study presented here.

Sexual dysfunction was 1.5 times more common in MS patients with perceived cognitive impairment, reported Jing Wu, a graduate student at Karolinska Institute in Stockholm, and George Jelinek, MD, of the University of Melbourne in Australia, and co-authors at the 2019 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) forum.

Prior studies have shown that people with MS often experience sexual dysfunction, at rates of 40% to 80%. Sexual problems exact a toll on patients’ well-being: a survey of 6,183 patients in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry found that sexual dysfunction had a much larger detrimental impact on the mental health aspects of health-related quality of life in MS patients than severity of physical disability.

Last year, a study at Mellen Center for Multiple Sclerosis at the Cleveland Clinic in Ohio showed that 64.2% of patients reported sexual dysfunction; those patients also showed significantly worse average depressive symptom scores.

Depressive and anxiety symptoms also have been associated with reduced cognitive functioning in MS. Despite the prevalence of both sexual and cognitive dysfunction in MS patients, there has been little research about the relationship between the two until now, said Wu.

“There’s evidence that disability and fatigue are significantly associated with sexual dysfunction in MS,” Wu told MedPage Today. While other studies have shown cognitive impairment is correlated with sexual dysfunction, its relationship with incident sexual dysfunction had not been assessed, she added.

In this analysis, researchers looked at participants with diagnosed MS in the HOLISM (Health Outcomes and Lifestyle in a Sample of People with Multiple Sclerosis) international online study. In total, 1,959 participants provided cognitive and sexual function data at baseline, and 1,127 did so at 2.5-year follow-up.

The researchers assessed disability with the Patient-Determined MS Severity Score (P-MSSS) and depression with the Patient Health Questionnaire-212 (PHQ-2). At each review, participants completed the MSQOL-54, which included assessments of cognitive function and sexual function. Perceived cognitive impairment was defined as MSQOL-54 cognitive function subscore ≤66.7%, and perceived sexual dysfunction was defined as MSQOL-54 sexual function subscore ≤66.7%.

At baseline, the prevalence of perceived cognitive impairment was 45.6% and the prevalence of perceived sexual dysfunction was 45.5%. Of participants who reported no sexual dysfunction at baseline, 23.4% went on to develop sexual dysfunction during the 2.5 year follow-up period.

Incident sexual dysfunction was significantly higher among people with cognitive impairment (RR 1.53, 95% CI 1.13-2.06), and among those who became cognitively impaired during follow-up. The relationship was still significant after adjusting for age, sex, P-MSSS, PHQ-2, marital status, physical activity, and the number of comorbidities.

There was no difference in the cognitive impairment-sexual dysfunction association by sex, but non-partnered patients with cognitive impairment had a 2-fold greater risk of sexual dysfunction.

“Our results indicate that cognitive dysfunction is a risk factor for sexual dysfunction in people with MS,” Wu said. “This is another way MS may adversely affect patients’ quality of life. It’s important for clinicians to be aware of this and focus not only on the treatment of multiple sclerosis, but on the whole person.”

This study had several limitations, including the fact that all data were self-reported. Perceived sexual dysfunction and perceived cognitive dysfunction were determined by categorizing participants in groups depending on their responses on the MSQOL-54; this method has not been validated.

The work was funded by the Bloom Foundation, Wal Pisciotta, the Horne Family Charitable Trust, and the Royal Australian and New Zealand College of Psychiatrists.