Studies show how stress impacts disease activity

Researchers find stress impacts MS, Parkinson's

If you work with multiple sclerosis (MS) or Parkinson's patients, you may want to refer your patients to a good stress management program. Two studies presented at the recent Society of Behavioral Medicine meeting in New Orleans show that psychological stress increases disease activity in both patient populations.

A study by Kristi Erdal, PhD, assistant professor of psychology at Colorado College in Colorado Springs, CO, found that Parkinson's patients experiencing "on-off syndrome" had higher anxiety levels during both their "on" and "off" periods. "After about five years on anti-Parkinson's medications, about 50% of patients start experiencing an on-off syndrome where their meds fail to work without warning throughout the day," explains Erdal. "It's very distressing for patients, and it's unclear neurologically what's going on."

Erdal tested stress levels in a group of Parkin son's patients exhibiting on-off fluctuations against a group with predictably degenerative symptoms, using the Spielberger State-Trait Anxiety Inventory. Groups did not differ in age, education, gender, marital status, cognitive impairment, or physical disability. Her findings confirm her theory that patients with on-off syndrome are more anxious even during their good periods.

"My goal is to get neurologists and case managers to recognize that depression and anxiety are not expected outcomes of Parkinson's. Neurologists often see psychological consequences as secondary," Erdal says. "But significant levels of depression and anxiety accelerate cognitive impairment in Parkinson's patients. So the consequences of this research are not incidental to treatment. It has serious clinical implications. If you treat stress, you may be able to slow progression of the disease."

Stress also appears to increase disease activity in MS patients. Preliminary results from a University of California San Francisco (UCSF)/Mount Zion Medical Center study of 48 MS patients indicate that major stressful events as well as small daily hassles are related to the development of new brain lesions two months later, says David Mohr, PhD, assistant clinical professor of neurology at UCSF and a psychologist with the MS Center at UCSF/Mount Zion Medical Center.

In the study, patients were followed 12 to 68 weeks. They rated the amount of psychological stress and stressful events they experienced each month. In addition, they received gadolinium-enhanced magnetic resonance imaging scans once a month to measure MS activity in the brain.

To assess levels of stress, depression, and anxiety, researchers used the Hassles Scale, the Social Adjustment Rating Scale, and the Profile of Mood States. UCSF researchers found that patients experiencing higher levels of stress, anxiety, and depression had a greater incidence of new lesions in their brains. While brain lesions are not necessarily a sign of increased impairment, they do indicate increases in disease activity, he notes.