Multiple Sclerosis in Mongolia; the First Study Exploring Predictors of Disability and Depression in Mongolian MS Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Setting, Participants, and Questionnaire
2.2. EDSS and the 9-Item Patient Health Questionnaire (PHQ-9)
2.3. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CNS | Central nervous system |
DMD | Disease-modifying drug |
EAE | Experimental autoimmune encephalomyelitis |
EDSS | Expanded disability status scale |
MNUMS | Mongolian National University of Medical Sciences |
MS | Multiple sclerosis |
PHQ-9 | 9-item patient health questionnaire |
PP | Primary progressive |
RR | Relapsing-remitting |
SP | Secondary progressive |
UV | Ultraviolet |
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Variable | Number | Percentage (%) |
---|---|---|
Education Level | ||
high school | 9 | 33.3 |
university | 18 | 66.7 |
Marital Status | ||
married | 22 | 81.5 |
single | 4 | 14.8 |
divorced/widowed | 1 | 3.7 |
Employment Status | ||
government organization | 1 | 3.7 |
own business | 7 | 25.9 |
retired/disability | 19 | 70.4 |
Accomodation | ||
apartment | 15 | 55.6 |
house | 8 | 29.6 |
ger * | 4 | 14.8 |
Lifestyle | ||
smoking | ||
Yes | 5 | 18.5 |
No | 22 | 81.5 |
alcohol consumption | ||
Yes | 2 | 7.4 |
No | 25 | 92.6 |
Religion | ||
Buddhism | 12 | 44.4 |
Shamanism | 6 | 22.2 |
none | 9 | 33.3 |
Ethnicity | ||
Khalkh | 24 | 88.9 |
Buryat | 2 | 7.4 |
other | 1 | 3.7 |
Variable | Number | Disability Level * | p Value | ||
---|---|---|---|---|---|
Mild | Moderate/Severe | ||||
Age group | 20–29 | 1 | 0 (0) | 1 (4.2) | |
30–39 | 3 | 1 (33.3) | 2 (8.3) | ||
40–49 | 9 | 0 (0) | 9 (37.5) | ||
>50 | 14 | 2 (66.7) | 12 (50) | <0.01 | |
MS onset age | 20–29 | 8 | 1 (33.3) | 7 (29.2) | 0.962 |
30–39 | 11 | 1 (33.3) | 10 (41.7) | ||
40–49 | 8 | 1 (33.3) | 7 (29.2) | ||
Family member with MS | Yes | 4 | 0 (0) | 14 (14.8) | 0.444 |
No | 23 | 3 (100) | 20 (85.2) | ||
MS disease duration | 0–5 years | 6 | 1 (33.3) | 5 (20.8) | 0.885 |
6–10 years | 11 | 1 (33.3) | 10 (41.7) | ||
>11 years | 10 | 1 (33.3) | 9 (37.5) | ||
MS treatment duration | 0–5 months | 9 | 1 (33.3) | 8 (33.3) | 0.869 |
6–12 months | 6 | 1 (33.3) | 5 (20.8) | ||
>1 years | 12 | 1 (33.3) | 11 (45.8) | ||
Treatment | |||||
Corticosteroid (oral) | Yes | 13 | 2 (67.7) | 11 (45.8) | 0.496 |
No | 14 | 1 (33.3) | 13 (54.2) | ||
Methotrexate (2.5 mg/day) | Yes | 5 | 2 (40) | 1 (20) | 0.381 |
No | 5 | 2 (40) | 1 (20) | ||
History/comorbidity (%) | |||||
diabetes mellitus | Yes | 1 | 0 (0) | 1 (4.2) | 0.719 |
No | 26 | 3 (12) | 23 (95.8) | ||
cardiovascular disease | Yes | 5 | 0 (0) | 5 (20.8) | 0.381 |
No | 22 | 3 (14.2) | 19 (79.2) | ||
ophthalmic disease | Yes | 6 | 1 (33.3) | 5 (20.8) | 0.623 |
No | 21 | 2 (66.7) | 19 (79.2) | ||
rheumatic disease | Yes | 13 | 1 (33.3) | 12 (50) | 0.586 |
No | 14 | 2 (66.7) | 12 (50) | ||
Neurological sign/symptom | |||||
abnormal deep tendon reflex | Yes | 5 | 0 (0) | 5 (20.8) | 0.381 |
No | 22 | 3 (100) | 19 (79.2) | ||
vision problem | Yes | 23 | 2 (67.7) | 21 (87.5) | <0.05 |
No | 4 | 1 (33.3) | 3 (12.5) | ||
pyramidal sign | Yes | 18 | 2 (11.1) | 16 (88.9) | 0.721 |
No | 9 | 1 (88.9) | 8 (11.1) | ||
Brainstorm sign/symptom | Yes | 3 | 0 (0) | 3 (12.5) | 0.516 |
No | 24 | 3 (100) | 21 (87.5) | ||
sensation problem | Yes | 17 | 2 (67.7) | 15 (62.5) | 0.888 |
No | 10 | 1 (33.3) | 9 (37.5) | ||
disequilibrium | Yes | 23 | 1 (4.3) | 22 (95.7) | <0.01 |
No | 4 | 2 (95.7) | 2 (4.3) | ||
urination problem | Yes | 14 | 1 (67.7) | 13 (54.2) | 0.681 |
No | 12 | 1 (33.3) | 11 (45.8) | ||
Depression level (PHQ-9 score) | mild (5–9) | 12 | 2 (66.3) | 10 (41.7) | 0.282 |
moderate (10–14) | 11 | 0 (0) | 11 (45.8) | ||
severe (>15) | 4 | 1 (33.3) | 3 (12.5) |
Variables | Number | Depression Level *: Number (%) | p Value ** | |||
---|---|---|---|---|---|---|
Mild | Moderate | Severe | ||||
Age group | 20–29 | 1 | 0 (0) | 1 (9.1) | 0 (0) | 0.132 |
30–39 | 3 | 0 (0) | 2 (18.2) | 1 (25) | ||
40–49 | 9 | 3 (25) | 3 (27.3) | 3 (75) | ||
>50 | 14 | 9 (75) | 5 (2) | 0 (0) | ||
MS onset age | 20–29 | 8 | 5 (41.7) | 1 (9.1) | 2 (50) | 0.942 |
30–39 | 11 | 4 (33.3) | 5 (45.5) | 2 (50) | ||
40–49 | 8 | 3 (25) | 5 (45.5) | 0 (0) | ||
Family member with MS | Yes | 4 | 1 (8.3) | 3 (27.3) | 0 (0) | 0.294 |
No | 23 | 11 (91.7) | 8 (72.7) | 4 (100) | ||
MS disease duration | 0–5 years | 6 | 1 (8.3) | 4 (36.4) | 1 (25) | 0.156 |
6–10 years | 11 | 4 (33.3) | 4 (36.4) | 3 (75) | ||
>11 years | 10 | 7 (58.3) | 3 (27.3) | 0 (0) | ||
MS treatment duration | 0–5 months | 9 | 2 (16.7) | 6 (54.5) | 1 (25) | 0.408 |
6–12 months | 6 | 3 (25) | 2 (18.2) | 1 (25) | ||
>1 years | 12 | 7 (58.3) | 3 (27.3) | 2 (50) | ||
Treatment | ||||||
Corticosteroid (oral) | Yes | 13 | 6 (50) | 3 (27.3) | 4 (100) | <0.05 |
No | 14 | 6 (50) | 8 (72.7) | 0 (0) | ||
Methotrexate (2.5 mg/day) | Yes | 5 | 2 (16.7) | 2 (18.2) | 1 (25) | 0.933 |
No | 22 | 10 (83.3) | 9 (81.8) | 3 (75) | ||
History/comorbidity (%) | ||||||
diabetes mellitus | Yes | 1 | 0 (0) | 0 (0) | 1 (25) | 0.051 |
No | 26 | 12 (100) | 11 (100) | 3 (75) | ||
cardiovascular disease | Yes | 5 | 4 (33.3) | 0 (0) | 1 (25) | 0.113 |
No | 21 | 8 (66.7) | 11 (100) | 3 (75) | ||
ophthalmic disease | Yes | 6 | 2 (16.7) | 4 (36.6) | 0 (0) | 0.268 |
No | 21 | 10 (83.3) | 7 (63.4) | 4 (100) | ||
rheumatic disease | Yes | 13 | 7 (58.3) | 6 (54.6) | 0 (0) | 0.111 |
No | 14 | 5 (41.7) | 5 (45.4) | 4 (100) | ||
Neurological sign/symptom | ||||||
abnormal deep tendon reflex | Yes | 5 | 3 (25) | 1 (9.1) | 1 (25) | 0.579 |
No | 22 | 9 (75) | 10 (90.9) | 3 (75) | ||
vision problem | Yes | 23 | 11 (91.7) | 9 (81.8) | 3 (75) | 0.661 |
No | 4 | 1 (8.3) | 2 (18.2) | 1 (25) | ||
pyramidal sign | Yes | 12 | 9 (50) | 6 (54.5) | 3 (75) | 0.541 |
No | 9 | 3 (33.3) | 5 (55.5) | 1 (25) | ||
brainstem sign/symptom | Yes | 3 | 1 (8.3) | 1 (9.1) | 1 (25) | 0.631 |
No | 24 | 11(91.7) | 10 (90.9) | 3 (75) | ||
sensation problem | Yes | 17 | 7 (58.3) | 6 (54.5) | 4 (100) | 0.297 |
No | 10 | 5 (41.7) | 5 (45.5) | 0 (0) | ||
disequilibrium | Yes | 23 | 10 (83.3) | 10 (90.9) | 3 (75) | 0.724 |
No | 4 | 2 (16.7) | 1 (9.1) | 1 (25) | ||
Urination problem | Yes | 15 | 7 (58.3) | 4 (36.4) | 4 (100) | 0.087 |
No | 12 | 5(41.7) | 7 (63.6) | 0 (0) | ||
EDSS score | <5 | 3 | 2 (16.7) | 0 (0) | 1 (25) | 0.282 |
≥5 | 24 | 10 (83.3) | 11 (100) | 3 (75) |
Variable | Unit/Category | Unadjusted | Age-Adjusted | ||||
---|---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | ||
age | year | 1.00 | 1.00–1.34 | <0.001 | - | - | - |
gender | female/male | 1.03 | 1.02–1.18 | 0.707 | 1.00 | 1.00–1.17 | 0.743 |
MS onset age | year | 1.50 | 1.21–4.75 | <0.001 | 1.50 | 1.02–4.39 | <0.001 |
MS treatment duration | year | 1.18 | 1.30–4.60 | <0.05 | 1.02 | 1.00–1.17 | <0.01 |
depression severity | score | 1.00 | 0.78–1.27 | 0.88 | 1.30 | 0.19–4.64 | 0.786 |
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Jaalkhorol, M.; Dulamsuren, O.; Dashtseren, A.; Byambajav, E.-A.; Khaidav, N.; Bat-Orgil, B.; Bold, A.; Amgalan, E.; Chuluunbaatar, A.; Tsunoda, I. Multiple Sclerosis in Mongolia; the First Study Exploring Predictors of Disability and Depression in Mongolian MS Patients. Pathophysiology 2023, 30, 15-26. https://doi.org/10.3390/pathophysiology30010003
Jaalkhorol M, Dulamsuren O, Dashtseren A, Byambajav E-A, Khaidav N, Bat-Orgil B, Bold A, Amgalan E, Chuluunbaatar A, Tsunoda I. Multiple Sclerosis in Mongolia; the First Study Exploring Predictors of Disability and Depression in Mongolian MS Patients. Pathophysiology. 2023; 30(1):15-26. https://doi.org/10.3390/pathophysiology30010003
Chicago/Turabian StyleJaalkhorol, Myadagmaa, Oyunbileg Dulamsuren, Amarsaikhan Dashtseren, Enkh-Amgalan Byambajav, Nansalmaa Khaidav, Badrangui Bat-Orgil, Anar Bold, Enkhdulguun Amgalan, Anujin Chuluunbaatar, and Ikuo Tsunoda. 2023. "Multiple Sclerosis in Mongolia; the First Study Exploring Predictors of Disability and Depression in Mongolian MS Patients" Pathophysiology 30, no. 1: 15-26. https://doi.org/10.3390/pathophysiology30010003