NP03
Coexistence of Multiple Sclerosis and Alzheimer's Disease
People with multiple sclerosis (MS) are living longer than ever and will likely face the same age-related diseases as other seniors; however, little is known about the coexistence of MS with many common diseases of aging. In particular, there exists a paucity of information about the coexistence of MS with Alzheimer’s disease (AD), the most common form of dementia worldwide.
Objectives:
To perform a literature review followed by creation of an original case-series (via post-mortem neuropathology reports) in order to: 1. determine if MS and AD can coexist in the same patient; and 2. identify the clinical and neuropathological features of an individual with both MS and AD.
Methods:
To explore what is currently known about the coexistence of MS and AD, firstly, we used a focused literature search to identify any reports of individuals with both MS and AD (PubMed, to May 2017). Secondly, we searched the Sunset Database of Vancouver Coastal Health of British Columbia, Canada for autopsy pathology reports with diagnoses of both multiple sclerosis and Alzheimer's disease dated between January, 1980 and May, 2017. This regional health authority provides primary through to quaternary care to one in four of British Columbia’s 4.6 million population and provides an estimated 2.8 million patient days of care every year.
Results:
Our literature search found a total of 24 individuals with pathological features of both MS and AD described as case series or reports (published between 1976-2014), but no epidemiological or population-based studies, aside from one conference proceeding (2011). Comorbid MS and AD was reported in a broad range of MS disease courses including relapsing-remitting, primary progressive, secondary progressive and so-called ‘benign.’ Of the 14,007 autopsy pathology reports included in the Sunset Database, we retrieved 4 autopsy reports with definite neuropathological diagnoses of both MS and AD. Despite the clear diagnostic challenges involved, these individual case reports provide evidence that AD can develop in patients with MS.
Conclusions:
In summary, we highlight a critical gap in our understanding of two relatively common neurological conditions. With the ageing population, and an estimated 2.3 million people living with MS and 46 million with AD or other dementias worldwide, it will become increasingly important to recognize and understand how to manage individuals living with both complex neurological conditions.