Cross-Sectional and Longitudinal Associations of Systolic Blood Pressure With Quality of Life and Depressive Mood in Older Adults With Cardiovascular Risk Factors: Results From the Observational DIAST-CHF Study.

OBJECTIVE: Although diagnosed arterial hypertension and antihypertensive medication usually have an adverse impact on quality of life, recent studies suggest that actual blood pressure may be positively related to better well-being. However, data in older patients with cardiovascular risk factors are lacking, for whom such an association may be of particular relevance. METHODS: In 1300 adults aged 50 to 85 years with cardiovascular risk factors (51.5% men, mean age = 65.7 ± 8.2 years) participating in an observational study, we performed standardized measurements of blood pressure and assessed quality of life and depressive symptoms at baseline and 1-year follow-up using the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Bivariate analysis demonstrated that systolic blood pressure was associated with higher SF-36 mental component summary scores (r = 0.100, p < .001) and reduced HADS depression (r = -0.082, p = .003). Multivariate regression models adjusting for age, sex, and disease severity confirmed that higher systolic blood pressure significantly predicted both better mental quality of life (ß = 0.070, p = .012) and less depressive mood (ß = -0.083, p = .003) at baseline, independently of antihypertensive medication and diagnosed hypertension. Moreover, the beneficial effects of baseline systolic blood pressure remained stable for both summary components of the SF-36 as well as HADS depression at 1-year follow-up. All results remained unchanged, when limiting the analyses to the 1072 patients with diagnosed hypertension. CONCLUSIONS: In older adults with cardiovascular risk factors, higher systolic blood pressure readings are independently related to better quality of life and fewer depressive symptoms in both cross-sectional and longitudinal settings, although the magnitude of the effect sizes is typically small.

Rationale, design, and methods of a non-interventional study to establish safety, effectiveness, quality of life, cognition, health-related and work capacity data on Alemtuzumab in multiple sclerosis patients in Germany (TREAT-MS).

BACKGROUND: Alemtuzumab, a humanized monoclonal antibody directed against the cell surface glycoprotein CD52, is licensed in Europe since October 2013 as treatment for adult patients with active relapsing-remitting multiple sclerosis (RRMS). In three randomized, rater-blinded active comparator clinical trials studies, alemtuzumab administered in two annual courses, had superior efficacy as compared to subcutaneous interferon beta-1a, and durable efficacy over 5 years in an extension study with a manageable safety profile in RRMS patients. Data on the utilization and the outcomes of alemtuzumab under clinical practice conditions are limited. METHODS: Here we describe the rationale, design and methods of the TREAT-MS study (non-interventional long-Term study foR obsErvAtion of Treatment with alemtuzumab in active relapsing-remitting MS). DISCUSSION: TREAT-MS is a prospective, multicenter, non-interventional, long-term study to collect data on safety, effectiveness, quality of life, cognition and other aspects from 3200 RRMS patients treated with alemtuzumab under the conditions of real-world clinical practice in Germany. TRIAL REGISTRATION: As non-interventional trial in Germany.

Association between chronic stress and blood pressure: findings from the German Health Interview and Examination Survey for Adults 2008-2011.

OBJECTIVE: The magnitude of the contribution of psychosocial stressors to the development of hypertension remains controversial. Using data from the population-based, nationwide German Health Interview and Examination Survey for Adults, we investigated the relationship between objectively measured and subjectively perceived stressors and blood pressure (BP). METHODS: The study sample comprised 3352 participants not taking antihypertensive medication, for whom data on stress exposure and resting BP measurements were available. The Trier Inventory for the Assessment of Chronic Stress screening scale (TICS-SSCS) was used as a measurement of self-perceived chronic stress, and work-related stress was assessed using the recently developed occupational Overall Job Index. RESULTS: On the basis of bivariate tests, TICS-SSCS was negatively associated with both systolic (ß-coefficient [B] = -0.16, standard error = 0.03, p < .001) and diastolic BP (B = -0.10, standard error = 0.02, p < .001). After adjustment for age, sex, and body mass index, the TICS-SSCS but not the Overall Job Index was significantly related to systolic and diastolic BP. When alcohol consumption, smoking, physical activity, residential traffic intensity, caregiving, socioeconomic status, social support, and living without a partner were added to the model, the TICS-SSCS again remained independently associated with both BP measures (p ≤ .007). CONCLUSIONS: In a large and representative German study, we found that less perceived stress is associated with higher BP levels, whereas the exposure to objective stressors was unrelated to BP. These findings suggest that stress perception and objective stressors influence BP regulation via different biobehavioral pathways.

Improving Clinical Documentation of Rare Neuromuscular Diseases: Development of a Standardised Information Model.

Rare neuromuscular diseases (NMDs) encompass various disorders of the nervous system and skeletal muscles, and present intricate challenges in diagnosis, treatment, and research due to their low prevalence and often diverse multisystemic manifestations. Leveraging collected patient data for secondary use and analysis holds promise for advancing medical understanding in this field. However, a certain level of data quality is a prerequisite for the methods that can be used to analyze data. The heterogeneous nature of NMDs poses a significant obstacle to the creation of standardized documentation, as there are still many challenges to accurate diagnosis and many discrepancies in the diagnostic process between different countries. This paper proposes the development of an information model tailored to NMDs, aiming to augment visibility, address deficiencies in documentation, and facilitate comprehensive analysis and research endeavors. By providing a structured framework, this model seeks to propel advancements in understanding and managing NMD, ultimately benefiting patients and healthcare providers worldwide.

Mild Amnestic Cognitive Impairment and Depressive Symptoms in Autoimmune Encephalitis Associated with Serum Anti-Neurexin-3α Autoantibodies.

(1) Background: autoimmune encephalitis associated with neurexin-3α antibodies is a seldom reported disease entity often accompanied by a severe clinical neuropsychiatric syndrome. (2) Method: we report on the case of a 58-year-old man diagnosed with neurexin-3α-associated autoimmune encephalitis revealing cognitive decline and depression before the proof of neurexin-3α antibodies. He underwent neuropsychological testing, peripheral blood and cerebrospinal fluid analysis, neuroimaging and electroencephalography. (3) Results: our patient's main clinical feature was amnestic cognitive decline in combination with depressive symptoms. CSF analysis showed elevated phosphorylated tau protein 181 and positive proof of serum neurexin-3α antibodies in a cell-based assay. An 18F-FDG-PET/CT of the brain initially showed bilateral cerebral hypometabolism prefrontal and parietal, which was absent in follow up. The brain MRI was unremarkable. EEG recordings showed frontotemporal slowing in the theta and delta range. (4) Conclusions: taken together, we assumed autoimmune encephalitis associated with serum neurexin-3α antibodies. To the best of our knowledge, we are the first to report on a predominantly mild clinical manifestation entailing amnestic mild cognitive impairment in addition to depression, thus broadening the clinical spectrum associated with neurexin-3α antibodies.

Cardiovascular reactivity is independently associated with better mental health: results from the nationwide German DEGS1 study.

OBJECTIVE: Using data from the nationwide German DEGS1 study, we assessed whether resting blood pressure (BP) and transient changes in BP are associated with symptoms of depression and quality of life (QoL). METHODS: The study included n=4852 adult participants not taking antihypertensives, who completed the Patient Health Questionnaire-9 for assessment of depressive symptoms and the SF-36 for assessment of QoL. Resting BP was defined as the mean of the second and third reading taken at 3-min intervals. RESULTS: General linear models adjusting for age, sex, and BMI showed that both resting BP and short-term BP changes were associated with higher SF-36 mental component summary and lower Patient Health Questionnaire-9 scores. CONCLUSION: Our data showed that a greater decrease in systolic BP as an indicator for cardiovascular reactivity is related to better mental QoL and fewer depressive symptoms, suggesting a link between BP regulation and mental well-being as part of an adaptive process to mild stressors.