The art of brain preservation in multiple sclerosis

Considering Comorbidities in Multiple Sclerosis

The Role of Comorbidities and Lifestyle in Brain Preservation

Patient Choices and Long-term Brain Health

Part of MS Brain Preservation involves looking at the comorbidities and lifestyle behaviors of your patients with MS and considering the impact they can have on the long-term health of the brain. Research has shown that multiple sclerosis comorbidities can exacerbate the disease, increasing the likelihood of relapses.1-4 Lifestyle choices can also have a major impact on the overall health of the brain.1

View references on Comorbidities/Lifestyle.

The Prevalence of Comorbidities in Multiple Sclerosis

A Common and Exacerbating Problem

A Closer Look at the Multiple Sclerosis Comorbidities

Several adverse health conditions are more prevalent in patients with MS compared with the general population.5,6

In a 2016 Canadian population-based study of 23,382 patients with MS, the most common comorbidities were5,6:

  • Depression
  • Hypertension
  • Chronic lung disease
  • Anxiety

Prevalence of Comorbidity at Diagnosis and 5 Years Earlier5,6*

Chart showing prevalence of comorbidities at ms diagnosis and 5 years earlier
Reprinted by permission from Springer Nature. Nature Reviews Neurology. Comorbidity in multiple sclerosis: implications for patient care. Ruth Ann Marrie. © 2017.
*Comorbidities reported in a 2016 Canadian population-based study of patients with MS (n=23,382).5,6

Other comorbidities commonly associated with MS include rheumatoid arthritis, psoriasis, irritable bowel syndrome, thyroid diseases, and epilepsy.2,7

View references on prevalence of Comorbidities.

The Impact of Multiple Sclerosis Comorbidities

An Exacerbating Factor

A Closer Look at the Clinical Consequences

In patients with MS, comorbidities can have significant clinical consequences, including2,4,7:

  • Increased relapse rates
  • More severe MRI outcomes (demyelination and neurodegeneration)
  • Accelerated disability progression

Relapse Rates:

In a prospective observational study of MS patients (N=885), patients with ≥3 comorbidities at baseline had a 45% increased relapse rate (RR) over 2 years compared with patients with no comorbidities (adjusted RR 1.45; 95% CI: 1.00-2.08).4


increase relapse rate

MRI Outcomes:

Imaging studies have shown that patients with MS who have ≥1 cardiovascular risk factor have increased lesion burden and more advanced brain atrophy.2,8

More information about Grey Matter atrophy

Disability Progression:

In a retrospective study of 3166 patients with MS, physical disability increased with each additional comorbidity.7

Comorbidities and Brain Volume:

Numerous studies have shown that multiple sclerosis comorbidities can negatively impact brain volume.

Cardiovascular System

  • Hyperlipidemia: increased disability progression and lower brain volume (as measured by brain parenchymal fraction) was associated with higher total cholesterol levels9
  • Hypertension: decreased Grey Matter volume10,11
  • Heart disease: decreased Grey Matter and cortical volumes10


  • Obesity: increased T1 lesion volume; brain volume loss10,11
  • Thyroid disease: decreased whole-brain, cortical, and Grey Matter volumes2
  • Type 2 diabetes: decreased whole-brain, cortical, and Grey Matter volumes2

More information about Grey Matter atrophy

View references on impact of Comorbidities.

The Benefits of Lifestyle Changes

Empowering Patients to Manage Their Health

How Lifestyle Changes Can Impact Disease Activity

A comprehensive approach to health in MS includes lifestyle changes to manage comorbidities that can impact disease activity.12


Diet quality is associated with disability status11

Patients with MS may benefit from healthy low-cholesterol and low-fat diets, which can minimize excess proinflammatory factors13

Sleep Hygiene

Sleep disturbance is associated with decreased memory, executive function, attention, and processing speed14

Sleep hygiene can help support CNS health11


Patients with greater aerobic fitness can have larger deep Grey Matter tissue volume15

Vitamin D

Vitamin D supplementation may improve cognitive performance16

Limiting Tobacco Use

Smoking is associated with decreased brain volume and cognitive impairment10,17

Cognitive Rehabilitation

Structured rehabilitation has shown cognitive improvement in clinical trials18

Mental/Social Stimulation

Reading and lifelong intellectual pursuits can slow Grey Matter loss and cognitive decline1


Meditation may improve quality of life and be a beneficial intervention for stress and symptom relief19,20

View references on Lifestyle Changes.

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