Depression Symptoms Moderate Link Between Infratentorial and Cervical Cord T2 Lesions on Gait Speed in Relapsing-remitting Multiple Sclerosis
Hanaan Bing-Canar1, Marwa Baalbaki1, James Sumowski1
1Neurology, Icahn School of Medicine at Mount Sinai
Objective:
To examine relationships between gait speed/endurance and depressive symptoms in relapsing-remitting multiple sclerosis (RRMS), and evaluate whether depression symptoms moderate the relationship between infratentorial / cervical cord T2 lesion burden and gait.
Background:
Gait disturbance is common in RRMS and walking speed is an important outcome in clinical care and research; however, it is unclear whether depression affects gait performance.
Design/Methods:
A yes/no cutoff for at least mild depression symptoms was established with questionnaires (Beck Depression Inventory-Fast Screen or Hospital Anxiety and Depression Scale) in 404 persons with RRMS. Timed 25-Foot Walk (T25FW) and 2-Minute Walk Test (2MWT) were adjusted for age, sex, height, and weight. T2 lesions in the pons/medulla (0, 1, 2, 3+), cerebellum (0, 1, 2, 3+), and cervical cord (0, 1, 2, 3, 4+) were summed for total infratentorial / cervical cord T2 lesion burden (0-10). Multiple regressions predicted T25FW and 2MWT with depression (yes, no) and T2 lesion burden (continuous; step one), and a depression x T2 lesion burden interaction (step two).
Results:
Positive depression screen (yes n=113, 28.0%) was associated with slower T25FW (B=0.36s [0.21, 0.51], β=0.23, p<0.001) and shorter 2MWT (B=-47.0ft [-64.9, -29.1], β=-0.25, p<0.001), and moderated the link between lesion burden and gait whereby worse lesion burden was associated with slower gait in patients with at least mild depression (T25FW r= 0.34 , 2MWT r= -0.33; Ps<0.001) but not patients without depression (T25FW r= 0.09; 2MWT r= -0.08; Ps>0.10). T2 lesion burden was unrelated to depression (p>0.10).
Conclusions:
Depression was linked to slower gait in RRMS, and was associated with much greater impact of infratentorial / cervical cord disease burden on gait function. Findings highlight even mild depression symptoms as a modifiable contributor to gait disturbance in clinical practice, and inform research (especially clinical trials) utilizing gait speed as a proxy of MS-related disability.