Epidemiology of MS and other Neurological Disorders

Question 1

Describe the trend in prevalence of multiple sclerosis in Scotland.

Answer 1

• MS becomes more prevalent the further north you go.
• Hypothesis: lack of sunlight and therefore vitamin D could have an effect on the epidemiology of MS.

Question 2

What is the effect on prevalence of MS of geography and sex?

Answer 2

• Prevalence is higher at extreme latitudes.
• Prevalence is much higher in women than in men.

Question 3

What are the possible explanations for the fact that MS is 3.5x more prevalent in women than men?

Answer 3

• Sex chromosome differences?
• More men have occupations outdoors so have more light exposure?

Question 4

Describe the public health issues with this model when applied to MS.

Answer 4

• What is the cause?
  
  • Tricky to solve because we don’t know what the problem is. There is an apparent relationship with latitude, and it is much more common in women than in men.
• What works?
  
  • No ‘cure’ - symptomatic treatment only.
  • No risk factors to modify.
  • No prevention strategy.

Question 5

What are neurological disorders included in the GBD2016 disease classification?

Answer 5

• This classification includes 8 disorders:
  
  • Alzheimer’s disease and other dementias
  • Parkinson’s disease
  • Epilepsy
  • Multiple sclerosis
  • Motor neuron disease
  • Migraine tension-type headache
  • Other neurological disorders

Question 6

Between 1990 and 2015, the number of deaths from neurological disorders increased by 36.7%, and the number of DALYs by 7.4%.

These increases occurred despite decreases in age-standardised rates of death and DALYs of 26.1% and 29.7% respectively.

Why might this be?

Answer 6

• People live longer (long enough to acquire these disorders as a direct result of ageing).

Question 7

What are the risk factors for dementia?

Answer 7

• Ageing
• Genetics
• Medical history, particularly CV problems
• Lifestyle and environment
• Diet
• Physical activity
• Smoking
• Alcohol consumption
• Mental activity
• Social activity
• Head injury
• Stress and depression
• Hormones
• Aluminium

Question 8

What factors might influence the level and type of care provided for dementia?

Answer 8

• Social care funding.
• Which health board you are in - local allocation of resources and funding.
• On a national scale - political.