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MSWA Bulletin Magazine Spring 2019

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RESEARCH Quick test

RESEARCH Quick test could help detect changes in thinking and memory Up to 65% of people with MS report difficulties with thinking and memory, but cognitive tests can cause anxiety, and require resources to administer them to people. Australian researchers have performed the first-ever study of a brief web-based cognitive test and found that it was reliable, sensitive and that participants were happy to complete it. Since it is web-based, it can be completed at home or in the clinic and would also benefit people who have lower mobility or live in regional areas. Early detection of changes in thinking and memory will lead to better long-term outcomes for people with MS. People with MS report cognitive symptoms including difficulties with memory, problem-solving and the speed at which they can think. These symptoms can affect their employment, social lives and daily activities. Finding ways to test for changes early in the disease and ongoing is important. Many tests used for cognition aren’t sensitive enough to detect changes in cognition early in the disease course. Mr Daniel Merlo from Monash University was funded through MSRA to implement web-based tests looking for changes in thinking functions in people with MS. The aim of this research is to implement a brief, interesting and self-administered test for cognition. The researchers tested 450 people, mainly with RRMS, both in the clinic and at home. The test focused on three cognitive functions – processing speed, visual attention and memory. The study involved an initial test followed by further tests at the clinic every six months. Participants could also do home-based testing every one to three months. Surveys on the acceptability of the test, quality of life, depression and anxiety were also completed by participants. Researchers found the test became more reliable after two or three tests. Scores in the clinic were similar to those at home, suggesting this could be used to test people more frequently to pick up small changes in cognition. The researchers also found MSReactor scores were similar to a written and oral cognitive measurement tool commonly used in clinical practice. These new findings show that MSReactor is a brief, reliable and acceptable test for cognitive screening in MS. As it is web-based, easy to use and not stressful, it can be completed regularly, allowing for the detection of small changes in cognition. It would also benefit people who have lower mobility or living in rural areas. Further testing will now be done on people with CIS. Read more msra.org.au/news/ detect-changes-thinking-memory MS SOCIETY OF CANADA Smoking is a modifiable risk factor of MS The relationship between cigarette smoke and MS risk before disease onset has been established, while the effect of quitting smoking and disability progression in people diagnosed with MS has been less studied. 1. A UK study, led by Dr. Radu Tanasescu of the University of Nottingham, included 1270 people with RRMS who answered questions related to their smoking habits, including when they started smoking, the age they stopped smoking (if applicable), and a rough estimate of the number of cigarettes smoked per day. The study showed that each ’smoke-free’ year was associated with a decreased risk of reaching an Expanded Disability Status Score (EDSS) of 4.0 and 6.0. The researchers gave the following example: “an individual with MS who is an ex-smoker and curbed the habit 10 years prior has a 33% lower risk of reaching an EDSS score of 4.0 and 26% reduced risk of reaching EDSS 6.0 compared with an individual with MS who has continued to smoke throughout that 10 year span”. 2. Researchers from Case Western Research University in Ohio conducted a study of 1000 people with MS self-reporting their smoking habits. This randomly selected cohort was drawn from the North American Research Committee on Multiple Sclerosis (NARCOMS) registry that comprises more than 38,000 people with MS. The majority included in the study had RRMS and SPMS. Active smokers experienced diminished health-related quality of life and increased reported disease activity. When their performance on numerous physical and functional scales was assessed, smokers scored worse overall compared to non-smokers. Read more mssociety.ca/hot-topics/ risk-and-prognostic-factors 10

RESEARCH OILY FISH CONSUMPTION MAY PROTECT AGAINST DEVELOPING MS Recent findings from two MS studies suggest that higher fish consumption may protect against developing MS. We used diet information from two separate studies investigating environmental risk factors for MS: the 2003-2006 Ausimmune Study (Australia) and the 2011- 2014 MS Sunshine Study (USA). In the Ausimmune Study, consuming around two weekly servings of fish was linked to an 18 percent reduced risk of MS [1]. The effect was highest for consumption of tinned fish, which is primarily oily (eg salmon, tuna, mackerel and sardines). Consuming around two weekly servings of tinned (oily) fish was linked to a 41 percent reduced risk of MS. In the MS Sunshine Study, consuming fish or seafood at least once a week, or regular fish oil supplement use, was linked to a 44 percent reduced risk of MS (unpublished results). These findings agree with the few previous studies investigating fish consumption and risk of MS [2-4]. It has previously been suggested that vitamin D might explain the link between higher fish consumption and lower risk of MS [2, 3]. Indeed, oily fish is high in vitamin D and some white fish species contain small amounts of vitamin D. However, our studies contradict this hypothesis, since we found no evidence that fish consumption compensated for vitamin D deficiency. In contrast, we suggest that the link between higher fish consumption and lower risk of MS is due to the high content of omega-3 fatty acids in oily fish. Omega-3 fatty acids, particularly the very long chain omega-3 fatty acids (EPA, DHA and DPA), which are found in oily fish but not plants, are vital for healthy brain structure and function. Our findings are relevant for those who are at high risk of developing MS. However, our findings do not indicate whether fish consumption might have a role in slowing disease progression. There have been several omega-3 supplementation studies conducted in people with MS, with inconclusive results. We are currently investigating the links between fish consumption and disease progression in follow-up studies of the Ausimmune Study. Until we have stronger evidence for any link between fish consumption and MS development and progression, the best dietary advice is to follow the Australian Dietary Guidelines (www.eatforhealth.gov.au), which recommend two servings of oily fish per week. DR LUCINDA BLACK, SENIOR RESEARCH FELLOW, SCHOOL OF PUBLIC HEALTH, CURTIN UNIVERSITY Acknowledgement This research was funded by MSWA through a Postdoctoral Research Fellowship (Dr Lucinda Black). References 1. Black LJ, Zhao Y, Peng YC, Sherriff JL, Lucas RM, van der Mei I et al. Higher fish consumption and lower risk of central nervous system demyelination. European Journal of Clinical Nutrition. 2019: doi: 10.1038/ s41430-41019-40476-z. 2. Baarnhielm M, Olsson T, Alfredsson L. Fatty fish intake is associated with decreased occurrence of multiple sclerosis. Multiple Sclerosis Journal. 2014; 20(6): 726-732. 3. Kampman MT, Wilsgaard T, Mellgren SI. Outdoor activities and diet in childhood and adolescence relate to MS risk above the Arctic Circle. Journal of Neurology 2007; 254(4): 471-477. 4. Ghadirian P, Jain M, Ducic S, Shatenstein B, Morisset R. Nutritional factors in the aetiology of multiple sclerosis: a casecontrol study in Montreal, Canada. International Journal of Epidemiology 1998; 27(5): 845-852. 11

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