Advertisement

Coexistence of Multiple Sclerosis and Alzheimer's disease: A review

  • Pauline Luczynski
    Affiliations
    MD Program, University of British Columbia, Vancouver, BC, Canada
    Search for articles by this author
  • Cornelia Laule
    Affiliations
    Department of Radiology, University of British Columbia, Vancouver, BC, Canada

    Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada

    Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada

    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada

    Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
    Search for articles by this author
  • Ging-Yuek Robin Hsiung
    Affiliations
    Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada

    Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
    Search for articles by this author
  • G.R. Wayne Moore
    Affiliations
    Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada

    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada

    Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada

    Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
    Search for articles by this author
  • Helen Tremlett
    Correspondence
    Corresponding author. Helen Tremlett Faculty of Medicine (Neurology) rm S126, UBC Hospital, 2211 Wesbrook Mall, University of British Columbia, Vancouver BC, Canada V6T 2B5
    Affiliations
    Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada

    Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
    Search for articles by this author
Published:October 27, 2018DOI:https://doi.org/10.1016/j.msard.2018.10.109

      Highlights

      • Little is known about the coexistence of MS with other diseases of aging, such as AD
      • We discuss the epidemiology, diagnosis, and pathophysiology of MS and AD
      • A literature search found 24 cases with both MS and AD, but no epidemiological study
      • AD was observed in both relapsing-onset and progressive forms of MS
      • We highlight a major gap in our knowledge of these common neurological conditions

      ABSTRACT

      Background

      People with multiple sclerosis (MS) are living longer than ever and will likely face the same age-related diseases as other seniors; however, there is strikingly little information on the coexistence of MS with many common diseases of aging. In particular, little appears to be known about the coexistence of MS with Alzheimer's disease (AD), the most common form of dementia.

      Methods

      In this review, we explore what is known about the coexistence of MS and AD, including a focused literature search to identify any reports of individuals with both MS and AD (PubMed, to May 2017). We also discuss the wider epidemiology, diagnosis, and pathophysiology of MS and AD.

      Results

      In total, we found 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.’ Despite the clear diagnostic challenges involved, these individual case reports provide evidence that AD and MS can coexist in the same person.

      Conclusion

      In summary, we highlight a major knowledge gap in our understanding of two potentially 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 with these complex comorbid conditions.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abuabara K
        • Azfar RS
        • Shin DB
        • Neimann AL
        • Troxel AB
        • Gelfand JM
        Cause‐specific mortality in patients with severe psoriasis: a population‐based cohort study in the UK.
        Br. J. Dermatol. 2010; 163: 586-592
        • Adelman G
        • Rane SG
        • Villa KF
        The cost burden of multiple sclerosis in the United States: a systematic review of the literature.
        J. Med. Econ. [Internet]. 2013; 16 (May 1Available from:): 639-647
        • Akiyama H.
        • Barger S.
        • Barnum S.
        • Bradt B.
        • Bauer J.
        • et al.
        • Neuroinflammation Working Group
        Inflammation and Alzheimer's disease.
        Neurobiol. Aging [Internet]. 2000; 21 (Available from): 383-421
        • Alzheimer's Association
        2015 Alzheimer's disease facts and figures.
        Alzheimer's Dement. [Internet]. 2015; 11 (MarAvailable from:): 332-384
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        Fifth Edit. American Psychiatric Association, Arlington, VA2013
        • Andrieu S
        • Coley N
        • Lovestone S
        • Aisen PS
        • Vellas B
        Prevention of sporadic Alzheimer's disease: lessons learned from clinical trials and future directions.
        Lancet. Neurol. [Internet]. 2017; 14 (May 24Available from:): 926-944
        • Ascherio A
        • Munger KL
        Environmental risk factors for multiple sclerosis. Part II: Noninfectious factors.
        Ann. Neurol. [Internet]. 2007; 61 (Jun 1Available from:): 504-513
        • Bachman DL
        • Wolf PA
        • Linn RT
        • Knoefel JE
        • Cobb JL
        • Belanger AJ
        • et al.
        Incidence of dementia and probable Alzheimer's disease in a general population The Framingham Study.
        Neurology. 1993; 43: 515
        • Barkhof F
        • Filippi M
        • Miller DH
        • Scheltens P
        • Campi A
        • Polman CH
        • et al.
        Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis.
        Brain [Internet]. 1997; 120 (Nov 1Available from:): 2059-2069
        • Barkhof F
        • Scheltens P
        • Kamphorst W
        Pre- and post-mortem MR imaging of unsuspected multiple sclerosis in a patient with Alzheimer's disease.
        J. Neurol. Sci. [Internet]. 1993; 117 (May 24Available from:): 175-178
        • Barnes LL
        • Wilson RS
        • Schneider JA
        • Bienias JL
        • Evans DA
        • Bennett DA
        Gender, cognitive decline, and risk of AD in older persons.
        Neurol. [Internet]. 2003; 60 (Jun 10Available from:): 1777-1781
        • Beach TG
        • Monsell SE
        • Phillips LE
        • Kukull W
        Accuracy of the clinical diagnosis of Alzheimer disease at National Institute on Aging Alzheimer Disease Centers, 2005–2010.
        J Neuropathol. Exp. Neurol. 2012; 71: 266-273
        • Braak H
        • Braak E
        Neuropathological stageing of Alzheimer-related changes.
        Acta Neuropathol. [Internet]. 1991; 82 (Available from:): 239-259
        • Burns A
        • Iliffe S
        Alzheimer's disease.
        BMJ. 2009; : 338
        • Calabrese M
        • Agosta F
        • Rinaldi F
        • Mattisi I
        • Grossi P
        • Favaretto A
        • et al.
        Cortical lesions and atrophy associated with cognitive impairment in relapsing-remitting multiple sclerosis.
        Arch. Neurol. 2009; 66: 1144-1150
        • Carter CL
        • Resnick EM
        • Mallampalli M
        • Kalbarczyk A
        Sex and gender differences in Alzheimer's disease: recommendations for future research.
        J. Women's Heal. 2012; 21: 1018-1023
        • Chiaravalloti ND
        • DeLuca J
        Cognitive impairment in multiple sclerosis.
        Lancet Neurol. [Internet]. 2008; 7 (DecAvailable from:): 1139-1151
        • Comi G
        • Radaelli M
        • Soelberg Sørensen P
        Evolving concepts in the treatment of relapsing multiple sclerosis.
        Lancet [Internet]. 2017; 389 (Apr 7Available from:): 1347-1356
        • Cummings JL
        • Benson DF
        Subcortical dementia: Review of an emerging concept.
        Arch. Neurol. 1984; 41: 874-879
        • Dal Bianco A
        • Bradl M
        • Frischer J
        • Kutzelnigg A
        • Jellinger K
        • Lassmann H
        Multiple sclerosis and Alzheimer's disease.
        Ann. Neurol. 2008; 63: 174-183
        • Dubois B
        • Feldman HH
        • Jacova C
        • DeKosky ST
        • Barberger-Gateau P
        • Cummings J
        • et al.
        Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS–ADRDA criteria.
        Lancet Neurol. [Internet]. 2007; 6 (AugAvailable from:): 734-746
        • Dutta R
        • McDonough J
        • Yin X
        • Peterson J
        • Chang A
        • Torres T
        • et al.
        Mitochondrial dysfunction as a cause of axonal degeneration in multiple sclerosis patients.
        Ann. Neurol. 2006; 59: 478-489
        • Eckert A
        • Schulz KL
        • Rhein V
        • Götz J
        Convergence of Amyloid-β and Tau Pathologies on Mitochondria In Vivo.
        Mol. Neurobiol. [Internet]. 2010; 41 (Available from:): 107-114
        • Evans C
        • Beland S-G
        • Kulaga S
        • Wolfson C
        • Kingwell E
        • Marriott J
        • et al.
        Incidence and prevalence of multiple sclerosis in the Americas: a systematic review.
        Neuroepidemiology. 2013; 40: 195-210
        • Fagan A
        • Roe C
        • Xiong C
        • Mintun M
        • Morris J
        • Holtzman D
        Cerebrospinal fluid tau/β-amyloid42 ratio as a prediction of cognitive decline in nondemented older adults.
        Arch. Neurol. [Internet]. 2007; 64 (Mar 1Available from:): 343-349
        • Falagas ME
        • Pitsouni EI
        • Malietzis GA
        • Pappas G
        Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses.
        FASEB J. [Internet]. 2007; 22 (Sep 20Available from:): 338-342
        • Flanagan EP
        • Knopman DS
        • Keegan BM
        Dementia in MS complicated by coexistent Alzheimer disease: Diagnosis premortem and postmortem.
        Neurol. Clin. Pract. [Internet]. 2014; 4 (Jun 1Available from): 226-230
        • Frischer JM
        • Bramow S
        • Dal-Bianco A
        • Lucchinetti CF
        • Rauschka H
        • Schmidbauer M
        • et al.
        The relation between inflammation and neurodegeneration in multiple sclerosis brains.
        Brain [Internet]. 2009; 132 (May 1Available from:): 1175-1189
        • Gandy S
        • DeKosky ST
        Toward the Treatment and Prevention of Alzheimer's Disease: Rational Strategies and Recent Progress.
        Annu. Rev. Med. [Internet]. 2013; 64 (Available from): 367-383
        • Giannakopoulos P
        • Hof PR
        • Mottier S
        • Michel JP
        • Bouras C
        Neuropathological changes in the cerebral cortex of 1258 cases from a geriatric hospital: retrospective clinicopathological evaluation of a 10-year autopsy population.
        Acta Neuropathol. [Internet]. 1994; 87 (Available from): 456-468
        • Giovannoni G
        Should we rebrand multiple sclerosis a dementia?.
        Mult. Scler. Relat Disord. [Internet]. 2017; 12 (FebAvailable from:): 79-81
        • Glanz BI
        • Healy BC
        • Rintell DJ
        • Jaffin SK
        • Bakshi R
        • Weiner HL
        The association between cognitive impairment and quality of life in patients with early multiple sclerosis.
        J. Neurol. Sci. [Internet]. 2010; 290 (Mar 15Available from:): 75-79
        • Hardy JA
        • Higgins GA
        Alzheimer's disease: the amyloid cascade hypothesis.
        Science (80-). 1992; 256: 184
        • Hebert LE
        • Weuve J
        • Scherr PA
        • Evans DA
        Alzheimer disease in the United States (2010–2050) estimated using the 2010 census.
        Neurology [Internet]. 2013; 80 (May 7Available from:): 1778-1783
        • Heneka MT
        • Kummer MP
        • Latz E
        Innate immune activation in neurodegenerative disease.
        Nat. Rev. Immunol. 2014; 14: 463
        • Henriksson F
        • Fredrikson S
        • Masterman T
        • Jönsson B
        Costs, quality of life and disease severity in multiple sclerosis: a cross-sectional study in Sweden.
        Eur. J. Neurol. [Internet]. 2001; 8 (Jan 1Available from): 27-35
        • Heppner FL
        • Ransohoff RM
        • Becher B
        Immune attack: the role of inflammation in Alzheimer disease.
        Nat. Rev. Neurosci. [Internet]. 2015; 16 (JunAvailable from:): 358-372
        • Hodges JR
        Is pathology-specific diagnosis of the dementia possible in life?.
        J. Neurol. Neurosurg. Psychiatry [Internet]. 2017; (Jun 19; Available from:)
        • Hyman BT
        • Phelps CH
        • Beach TG
        • Bigio EH
        • Cairns NJ
        • Carrillo MC
        • et al.
        National Institute on Aging–Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease.
        Alzheimer's Dement. [Internet]. 2012; 8 (JanAvailable from:): 1-13
        • Ittner LM
        • Götz J
        Amyloid-β and tau—a toxic pas de deux in Alzheimer's disease.
        Nat. Rev. Neurosci. 2011; 12: 67-72
        • Jaturapatporn D
        • Isaac MGEKN
        • McCleery J
        • Tabet N
        Aspirin, steroidal and non-steroidal anti-inflammatory drugs for the treatment of Alzheimer's disease.
        Cochrane Database Syst. Rev. [Internet]. 2012; (Available from:)
        • Khachaturian ZS
        Diagnosis of Alzheimer's disease.
        Arch. Neurol. 1985; 42: 1097-1105
        • Kingwell E
        • Marriott JJ
        • Jetté N
        • Pringsheim T
        • Makhani N
        • Morrow SA
        • et al.
        Incidence and prevalence of multiple sclerosis in Europe: a systematic review.
        BMC Neurol. [Internet]. 2013; 13 (Available from): 128
        • Kingwell E
        • van der Kop M
        • Zhao Y
        • Shirani A
        • Zhu F
        • Oger J
        • et al.
        Relative mortality and survival in multiple sclerosis: findings from British Columbia, Canada.
        J. Neurol. Neurosurg. Psychiatry [Internet]. 2011; 83 (Dec 13Available from): 61-66
        • Kingwell E
        • Zhu F
        • Marrie RA
        • Fisk JD
        • Wolfson C
        • Warren S
        • et al.
        High incidence and increasing prevalence of multiple sclerosis in British Columbia, Canada: findings from over two decades (1991–2010).
        J. Neurol. 2015; 262: 2352-2363
        • Kobelt G
        • Thompson A
        • Berg J
        • Gannedahl M
        • Eriksson J
        New insights into the burden and costs of multiple sclerosis in Europe.
        Mult. Scler. J. [Internet]. 2017; (Feb 1;1352458517694432. Available from:)
        • Kukull WA
        • Higdon R
        • Bowen JD
        • McCormick WC
        • Teri L
        • Schellenberg GD
        • et al.
        Dementia and Alzheimer disease incidence: a prospective cohort study.
        Arch. Neurol. 2002; 59: 1737-1746
        • Kutzelnigg A
        • Lucchinetti CF
        • Stadelmann C
        • Brück W
        • Rauschka H
        • Bergmann M
        • et al.
        Cortical demyelination and diffuse white matter injury in multiple sclerosis.
        Brain [Internet]. 2005; 128 (Nov 1Available from:): 2705-2712
        • Lassmann H
        Mechanisms of neurodegeneration shared between multiple sclerosis and Alzheimer's disease.
        J. Neural Transm. 2011; 118: 747-752
        • Lassmann H
        • Brück W
        • Lucchinetti CF
        The Immunopathology of Multiple Sclerosis: An Overview.
        Brain Pathol. [Internet]. 2007; 17 (Apr 1Available from:): 210-218
        • Lassmann H
        • van Horssen J
        • Mahad D
        Progressive multiple sclerosis: pathology and pathogenesis.
        Nat. Rev. Neurol. [Internet]. 2012; 8 (NovAvailable from:): 647-656
        • Mackenzie IS
        • Morant S V
        • Bloomfield GA
        • MacDonald TM
        • Riordan J
        Incidence and prevalence of multiple sclerosis in the UK 1990–2010: a descriptive study in the General Practice Research Database.
        J. Neurol. Neurosurg. Psychiatry [Internet]. 2013; 85 (Dec 10Available from:): 76-84
        • Mahad DJ
        • Ziabreva I
        • Campbell G
        • Lax N
        • White K
        • Hanson PS
        • et al.
        Mitochondrial changes within axons in multiple sclerosis.
        Brain. 2009; 132: 1161-1174
        • Manouchehrinia A
        • Tanasescu R
        • Tench CR
        • Constantinescu CS
        Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios.
        J. Neurol. Neurosurg. Psychiatry [Internet]. 2016; 87 (Feb 14Available from:): 324-331
        • Marrie RA
        • Horwitz RI
        Emerging effects of comorbidities on multiple sclerosis.
        Lancet Neurol. [Internet]. 2010; 9 (AugAvailable from): 820-828
        • Marrie RA
        • Yu N
        • Blanchard J
        • Leung S
        • Elliott L
        The rising prevalence and changing age distribution of multiple sclerosis in Manitoba.
        Neurol. [Internet]. 2010; 74 (Feb 9Available from): 465-471
        • Matías-Guiu JA
        • Oreja-Guevara C
        • Cabrera-Martín MN
        • Moreno-Ramos T
        • Carreras JL
        • Matías-Guiu J
        Amyloid Proteins and Their Role in Multiple Sclerosis. Considerations in the Use of Amyloid-PET Imaging [Internet].
        Frontiers Neurol. 2016; 7 (Available from:): 53
        • Mayeux R
        • Ottman R
        • Tang M
        • Noboa‐Bauza L
        • Marder K
        • Gurland B
        • et al.
        Genetic susceptibility and head injury as risk factors for Alzheimer's disease among community‐dwelling elderly persons and their first‐degree relatives.
        Ann. Neurol. 1993; 33: 494-501
        • McDonald WI
        • Compston A
        • Edan G
        • Goodkin D
        • Hartung H-P
        • Lublin FD
        • et al.
        Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis.
        Ann. Neurol. [Internet]. 2001; 50 (Jul 1Available from:): 121-127
        • McKhann G
        • Drachman D
        • Folstein M
        • Katzman R
        • Price D
        • Stadlan EM
        Clinical diagnosis of Alzheimer's disease Report of the NINCDS‐ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease.
        Neurology. 1984; 34: 939
        • McKhann GM
        • Knopman DS
        • Chertkow H
        • Hyman BT
        • Jack CR
        • Kawas CH
        • et al.
        The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease.
        Alzheimers Dement [Internet]. 2011; 7 (May 21Available from:): 263-269
        • Mirra SS
        • Heyman A
        • McKeel D
        • Sumi SM
        • Crain BJ
        • Brownlee LM
        • et al.
        The Consortium to Establish a Registry for Alzheimer's Disease (CERAD): Part II. Standardization of the neuropathologic assessment of Alzheimer's disease.
        Neurol. [Internet]. 1991; 41 (Apr 1Available from:): 479
        • Moreira PI
        • Carvalho C
        • Zhu X
        • Smith MA
        • Perry G
        Mitochondrial dysfunction is a trigger of Alzheimer's disease pathophysiology.
        Biochim Biophys Acta - Mol. Basis Dis. [Internet]. 2010; 1802 (JanAvailable from:): 2-10
        • Mori F
        • Rossi S
        • Sancesario G
        • Codecà C
        • Mataluni G
        • Monteleone F
        • et al.
        Cognitive and cortical plasticity deficits correlate with altered amyloid-β CSF levels in multiple sclerosis.
        Neuropsychopharmacology. 2011; 36: 559-568
        • Motter N
        • Vigo‐Pelfrey C
        • Kholodenko D
        • Barbour R
        • Johnson‐Wood K
        • Galasko D
        • et al.
        Reduction of β‐amyloid peptide42 in the cerebrospinal fluid of patients with Alzheimer's disease.
        Ann. Neurol. 1995; 38: 643-648
        • Multiple Sclerosis International Federation
        (Atlas of MS [Internet])
        • Naci H
        • Fleurence R
        • Birt J
        • Duhig A
        Economic Burden of Multiple Sclerosis.
        Pharmacoeconomics [Internet]. 2010; 28 (Available from:): 363-379
        • Ontaneda D
        • Thompson AJ
        • Fox RJ
        • Cohen JA
        Progressive multiple sclerosis: prospects for disease therapy, repair, and restoration of function.
        Lancet [Internet]. 2017; 389 (Apr 7Available from:): 1357-1366
        • Pietroboni AM
        • Scarioni M
        • Carandini T
        • Basilico P
        • Cadioli M
        • Giulietti G
        • et al.
        CSF β-amyloid and white matter damage: a new perspective on Alzheimer's disease.
        J. Neurol. Neurosurg. Psychiatry [Internet]. 2018; 89 (Apr 1Available from): 352-357
        • Pietroboni AM
        • Schiano di Cola F
        • Scarioni M
        • Fenoglio C
        • Spanò B
        • Arighi A
        • et al.
        CSF β-amyloid as a putative biomarker of disease progression in multiple sclerosis.
        Mult. Scler. J. [Internet]. 2016; 23 (Oct 17Available from:): 1085-1091
        • Polman CH
        • Reingold SC
        • Banwell B
        • Clanet M
        • Cohen JA
        • Filippi M
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria.
        Ann. Neurol. [Internet]. 2011; 69 (Feb 1Available from:): 292-302
        • Popescu BFG
        • Lucchinetti CF
        Pathology of demyelinating diseases.
        Annu. Rev. Pathol. Mech. Dis. 2012; 7: 185-217
      1. Prince MJ. World Alzheimer Report 2015: the global impact of dementia: an analysis of prevalence, incidence, cost and trends. 2015.

        • Prokop S
        • Miller KR
        • Heppner FL
        Microglia actions in Alzheimer's disease.
        Acta Neuropathol. 2013; 126: 461-477
        • Ransohoff RM
        • Hafler DA
        • Lucchinetti CF
        Multiple sclerosis - a quiet revolution.
        Nat. Rev. Neurol. [Internet]. 2015; 11 (MarAvailable from): 134-142
        • Rao SM.
        Neuropsychology of multiple sclerosis: a critical review.
        J. Clin. Exp. Neuropsychol. 1986; 8: 503-542
        • Rhein V
        • Song X
        • Wiesner A
        • Ittner LM
        • Baysang G
        • Meier F
        • et al.
        Amyloid-β and tau synergistically impair the oxidative phosphorylation system in triple transgenic Alzheimer's disease mice.
        Proc. Natl. Acad. Sci. [Internet]. 2009; 106 (Nov 24Available from:): 20057-20062
        • Rovaris M
        • Confavreux C
        • Furlan R
        • Kappos L
        • Comi G
        • Filippi M
        Secondary progressive multiple sclerosis: current knowledge and future challenges.
        Lancet Neurol. 2006; 5: 343-354
        • Shah H
        • Albanese E
        • Duggan C
        • Rudan I
        • Langa KM
        • Carrillo MC
        • et al.
        Research priorities to reduce the global burden of dementia by 2025.
        Lancet Neurol. [Internet]. 2016; 15 (NovAvailable from:): 1285-1294
        • Sobel R
        • Moore G
        Demyelinating diseases.
        in: Love S Louis D Ellison D Greenfield's Neuropathology. 8th ed. Oxford University Press, London, England2008: 1513-1608
        • Stewart M
        • Phillips A
        • Gupta S
        • Edwards N
        • Goren A
        Comorbid illness among individuals with multiple sclerosis.
        in: Poster presented at the 83rd Annual Meeting of the American Academy of Neurology, Honolulu, Hawaii, USA2011 (April 9-16;)
        • Takizawa C
        • Thompson PL
        • van Walsem A
        • Faure C
        • Maier WC
        Epidemiological and economic burden of Alzheimer's disease: a systematic literature review of data across Europe and the United States of America.
        J. Alzheimer's Dis. 2015; 43: 1271-1284
        • The International Multiple Sclerosis Genetics Consortium
        Evidence for Polygenic susceptibility to multiple sclerosis—the shape of things to come.
        Am. J. Hum. Genet. [Internet]. 2010; 86 (Apr 9Available from:): 621-625
        • The National Institute on Aging and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease
        Consensus Recommendations for the Postmortem Diagnosis of Alzheimer's Disease.
        Neurobiol. Aging [Internet]. 1997; 18 (JulAvailable from:): S1-S2
        • Thompson AJ
        • Banwell BL
        • Barkhof F
        • Carroll WM
        • Coetzee T
        • Comi G
        • et al.
        Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.
        Lancet Neurol. 2017; 17: 162-173
        • Tintoré M
        • Rovira A
        • Río J
        • Nos C
        • Grivé E
        • Sastre-Garriga J
        • et al.
        New diagnostic criteria for multiple sclerosis: Application in first demyelinating episode.
        Neurol. [Internet]. 2003; 60 (Jan 14Available from:): 27-30
        • Weber W
        • Ulrich J
        Multiple Sclerosis, Diffuse Lymphoplasmocytic Encephalitis and Alzheimer's Disease in a Patient with Progressive Dementia.
        Eur. Neurol. [Internet]. 1976; 14 (Available from:): 266-274
        • Zhang C
        • Wang Y
        • Wang D
        • Zhang J
        • Zhang F
        NSAID Exposure and Risk of Alzheimer's Disease: An updated meta-analysis from cohort studies [Internet].
        Front. Aging Neurosci. 2018; 10 (Available from:): 83