{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:14:01Z","timestamp":1783606441798,"version":"3.55.0"},"reference-count":54,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000381","name":"Multiple Sclerosis Society","doi-asserted-by":"publisher","award":["174"],"award-info":[{"award-number":["174"]}],"id":[{"id":"10.13039\/501100000381","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jns-journal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Neurological Sciences"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.jns.2026.126007","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T15:20:46Z","timestamp":1778944846000},"page":"126007","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"special_numbering":"C","title":["Comparative impact of mental and cardiovascular comorbidities on adverse outcomes in people with MS"],"prefix":"10.1016","volume":"488","author":[{"given":"Madeleine","family":"France-Ratcliffe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leona A.","family":"Verma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azmil H.","family":"Abdul-Rahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linsay","family":"McCallum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garry","family":"McDowell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn A.","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.R.","family":"Buckley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.jns.2026.126007_bb0005","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.apnu.2018.08.006","article-title":"Health related quality of life among patients with multiple sclerosis: the role of psychosocial adjustment to illness","volume":"33","author":"Hyarat","year":"2019","journal-title":"Arch. Psychiatr. Nurs."},{"key":"10.1016\/j.jns.2026.126007_bb0010","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.msard.2019.01.049","article-title":"Determinants of quality of life in relapsing-remitting and progressive multiple sclerosis","volume":"30","author":"Yalachkov","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"issue":"11","key":"10.1016\/j.jns.2026.126007_bb0015","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-041249","article-title":"Quality of life in adults with multiple sclerosis: a systematic review","volume":"10","author":"Gil-Gonz\u00e1lez","year":"2020","journal-title":"BMJ Open"},{"issue":"2","key":"10.1016\/j.jns.2026.126007_bb0020","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/0920-1211(96)00024-1","article-title":"A comparison of health-related quality of life in patients with epilepsy, diabetes and multiple sclerosis","volume":"25","author":"Hermann","year":"1996","journal-title":"Epilepsy Res."},{"issue":"5","key":"10.1016\/j.jns.2026.126007_bb0025","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1212\/WNL.53.5.1098","article-title":"Quality of life in multiple sclerosis: measuring the disease effects more broadly","volume":"53","author":"Nortvedt","year":"1999","journal-title":"Neurology"},{"key":"10.1016\/j.jns.2026.126007_bb0030","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1023\/A:1020734901150","article-title":"Quality of life and multiple sclerosis: comparison between people with multiple sclerosis and people from the general population","volume":"9","author":"McCabe","year":"2002","journal-title":"J. Clin. Psychol. Med. Settings"},{"issue":"1","key":"10.1016\/j.jns.2026.126007_bb0035","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.dhjo.2017.04.008","article-title":"People with multiple sclerosis report significantly worse symptoms and health related quality of life than the US general population as measured by PROMIS and NeuroQoL outcome measures","volume":"11","author":"Amtmann","year":"2018","journal-title":"Disabil. Health J."},{"issue":"3","key":"10.1016\/j.jns.2026.126007_bb0040","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1212\/WNL.0000000000000560","article-title":"Defining the clinical course of multiple sclerosis: the 2013 revisions","volume":"83","author":"Lublin","year":"2014","journal-title":"Neurology"},{"issue":"3","key":"10.1016\/j.jns.2026.126007_bb0045","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1177\/1352458507084264","article-title":"Natural history of secondary-progressive multiple sclerosis","volume":"14","author":"Tremlett","year":"2008","journal-title":"Mult. Scler. J."},{"issue":"9","key":"10.1016\/j.jns.2026.126007_bb0050","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1136\/jnnp.2010.208173","article-title":"The natural history of secondary progressive multiple sclerosis","volume":"81","author":"Koch","year":"2010","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"issue":"23","key":"10.1016\/j.jns.2026.126007_bb0055","doi-asserted-by":"crossref","first-page":"1996","DOI":"10.1212\/WNL.0b013e3181c5b47f","article-title":"The natural history of primary progressive multiple sclerosis","volume":"73","author":"Koch","year":"2009","journal-title":"Neurology"},{"issue":"5","key":"10.1016\/j.jns.2026.126007_bb0060","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1177\/1352458520936214","article-title":"Patient reported outcomes and performance metrics at diagnosis of secondary progressive multiple sclerosis","volume":"27","author":"Conway","year":"2021","journal-title":"Mult. Scler. J."},{"key":"10.1016\/j.jns.2026.126007_bb0065","first-page":"1","article-title":"Patient-reported outcomes associated with transition to secondary progressive multiple sclerosis","author":"Healy","year":"2021","journal-title":"Qual. Life Res."},{"issue":"15","key":"10.1016\/j.jns.2026.126007_bb0070","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1212\/WNL.0000000000002564","article-title":"Health-related quality of life in multiple sclerosis: direct and indirect effects of comorbidity","volume":"86","author":"Berrigan","year":"2016","journal-title":"Neurology"},{"key":"10.1016\/j.jns.2026.126007_bb0075","doi-asserted-by":"crossref","DOI":"10.1016\/j.jns.2021.117437","article-title":"Quality of life in multiple sclerosis is dominated by fatigue, disability and self-efficacy","volume":"426","author":"Young","year":"2021","journal-title":"J. Neurol. Sci."},{"key":"10.1016\/j.jns.2026.126007_bb0080","doi-asserted-by":"crossref","DOI":"10.1016\/j.msard.2019.101861","article-title":"A mixed methods approach towards understanding key disease characteristics associated with the progression from RRMS to SPMS: physicians\u2019 and patients\u2019 views","volume":"38","author":"Ziemssen","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"issue":"10","key":"10.1016\/j.jns.2026.126007_bb0085","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1177\/1352458511407951","article-title":"Patient characteristics and determinants of quality of life in an international population with multiple sclerosis: assessment using the MusiQoL and SF-36 questionnaires","volume":"17","author":"Fern\u00e1ndez","year":"2011","journal-title":"Mult. Scler. J."},{"issue":"3","key":"10.1016\/j.jns.2026.126007_bb0090","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1111\/j.1600-0404.2011.01526.x","article-title":"Cumulative impact of comorbidity on quality of life in MS","volume":"125","author":"Marrie","year":"2012","journal-title":"Acta Neurol. Scand."},{"issue":"8","key":"10.1016\/j.jns.2026.126007_bb0095","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1177\/13524585241260550","article-title":"Impact of multiple sclerosis comorbidities on quality of life and job activity","volume":"30","author":"Mallucci","year":"2024","journal-title":"Mult. Scler. J."},{"key":"10.1016\/j.jns.2026.126007_bb0100","doi-asserted-by":"crossref","DOI":"10.1016\/j.jns.2024.123156","article-title":"Comorbid onset of cardiovascular diagnosis and long-term confirmed disability progression in multiple sclerosis: a 15-year follow-up study","volume":"464","author":"Wicks","year":"2024","journal-title":"J. Neurol. Sci."},{"issue":"11","key":"10.1016\/j.jns.2026.126007_bb0105","doi-asserted-by":"crossref","first-page":"6407","DOI":"10.1007\/s10072-022-06345-9","article-title":"Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy)","volume":"43","author":"Bezzini","year":"2022","journal-title":"Neurol. Sci."},{"key":"10.1016\/j.jns.2026.126007_bb0110","doi-asserted-by":"crossref","DOI":"10.1016\/j.jns.2025.123409","article-title":"Clinical and socio-demographic characteristics of people with multiple sclerosis at the time of diagnosis: influences on outcome trajectories","volume":"470","author":"Young","year":"2025","journal-title":"J. Neurol. Sci."},{"key":"10.1016\/j.jns.2026.126007_bb0115","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.msard.2018.05.015","article-title":"Validating the portal population of the United Kingdom multiple sclerosis register","volume":"24","author":"Middleton","year":"2018","journal-title":"Mult. Scler. Relat. Disord."},{"issue":"2","key":"10.1016\/j.jns.2026.126007_bb0120","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/ana.22366","article-title":"Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria","volume":"69","author":"Polman","year":"2011","journal-title":"Ann. Neurol."},{"key":"10.1016\/j.jns.2026.126007_bb0125","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-6947-12-73","article-title":"The feasibility of collecting information from people with multiple sclerosis for the UK MS register via a web portal: characterising a cohort of people with MS","volume":"12","author":"Ford","year":"2012","journal-title":"BMC Med. Inform. Decis. Mak."},{"issue":"10","key":"10.1016\/j.jns.2026.126007_bb0130","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1001\/archneur.1989.00520460115022","article-title":"The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus","volume":"46","author":"Krupp","year":"1989","journal-title":"Arch. Neurol."},{"issue":"6","key":"10.1016\/j.jns.2026.126007_bb0135","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"10.1016\/j.jns.2026.126007_bb0140","doi-asserted-by":"crossref","first-page":"2505","DOI":"10.1007\/s00415-013-7004-1","article-title":"Validating a novel web-based method to capture disease progression outcomes in multiple sclerosis","volume":"260","author":"Leddy","year":"2013","journal-title":"J. Neurol."},{"issue":"5","key":"10.1016\/j.jns.2026.126007_bb0145","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1093\/brain\/124.5.962","article-title":"The multiple sclerosis impact scale (MSIS-29) a new patient-based outcome measure","volume":"124","author":"Hobart","year":"2001","journal-title":"Brain"},{"issue":"1","key":"10.1016\/j.jns.2026.126007_bb0150","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1212\/WNL.60.1.31","article-title":"Measuring the impact of MS on walking ability: the 12-item MS walking scale (MSWS-12)","volume":"60","author":"Hobart","year":"2003","journal-title":"Neurology"},{"issue":"1","key":"10.1016\/j.jns.2026.126007_bb0155","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. B. Methodol."},{"key":"10.1016\/j.jns.2026.126007_bb0160","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v061.i06","article-title":"NbClust: an R package for determining the relevant number of clusters in a data set","volume":"61","author":"Charrad","year":"2014","journal-title":"J. Stat. Softw."},{"issue":"15","key":"10.1016\/j.jns.2026.126007_bb0165","doi-asserted-by":"crossref","first-page":"e1316","DOI":"10.1212\/WNL.0000000000005302","article-title":"Psychiatric comorbidity is associated with disability progression in multiple sclerosis","volume":"90","author":"McKay","year":"2018","journal-title":"Neurology"},{"issue":"7","key":"10.1016\/j.jns.2026.126007_bb0170","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1007\/s11136-021-03041-7","article-title":"Understanding quality of life across different clinical subtypes of multiple sclerosis: a thematic analysis","volume":"31","author":"Ando","year":"2022","journal-title":"Qual. Life Res."},{"issue":"15","key":"10.1016\/j.jns.2026.126007_bb0175","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1080\/09638288.2019.1695000","article-title":"Living with a neglected neurological disease: a qualitative study of patients with multiple sclerosis in Malaysia","volume":"43","author":"Cheong","year":"2021","journal-title":"Disabil. Rehabil."},{"issue":"11","key":"10.1016\/j.jns.2026.126007_bb0180","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1080\/09638288.2016.1180547","article-title":"Meeting the mental health needs of people with multiple sclerosis: a qualitative study of patients and professionals","volume":"39","author":"Methley","year":"2017","journal-title":"Disabil. Rehabil."},{"issue":"13","key":"10.1016\/j.jns.2026.126007_bb0185","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1212\/WNL.0b013e3181d6b125","article-title":"Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis","volume":"74","author":"Marrie","year":"2010","journal-title":"Neurology"},{"issue":"1","key":"10.1016\/j.jns.2026.126007_bb0190","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/ane.13516","article-title":"Impact of comorbidities on the disability progression in multiple sclerosis","volume":"145","author":"Maric","year":"2022","journal-title":"Acta Neurol. Scand."},{"issue":"2","key":"10.1016\/j.jns.2026.126007_bb0195","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s00415-020-10194-x","article-title":"Change and onset-type differences in the prevalence of comorbidities in people with multiple sclerosis","volume":"268","author":"Lo","year":"2021","journal-title":"J. Neurol."},{"issue":"S1","key":"10.1016\/j.jns.2026.126007_bb0200","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1002\/ana.410360704","article-title":"Natural history of multiple sclerosis","volume":"36","author":"Weinshenker","year":"1994","journal-title":"Ann. Neurol."},{"issue":"3","key":"10.1016\/j.jns.2026.126007_bb0205","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1177\/13524585070130030101","article-title":"Health-related quality of life in secondary progressive multiple sclerosis","volume":"13","author":"Beiske","year":"2007","journal-title":"Mult. Scler. J."},{"issue":"6","key":"10.1016\/j.jns.2026.126007_bb0210","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1097\/00005053-200206000-00007","article-title":"Is there a differential impact of fatigue and physical disability on quality of life in multiple sclerosis?","volume":"190","author":"Merkelbach","year":"2002","journal-title":"J. Nerv. Ment. Dis."},{"key":"10.1016\/j.jns.2026.126007_bb0215","doi-asserted-by":"crossref","DOI":"10.1016\/j.msard.2024.105787","article-title":"Clinical characteristics and impact on patient-reported outcomes and quality of life of people with ambulatory secondary progressive multiple sclerosis: DISCOVER study","volume":"90","author":"Oreja-Guevara","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"issue":"8","key":"10.1016\/j.jns.2026.126007_bb0220","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1111\/j.1468-1331.2007.01810.x","article-title":"Predictive value of clinical characteristics for \u2018benign\u2019multiple sclerosis","volume":"14","author":"Ramsaransing","year":"2007","journal-title":"Eur. J. Neurol."},{"issue":"1\u20132","key":"10.1016\/j.jns.2026.126007_bb0225","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jns.2004.12.009","article-title":"Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change","volume":"231","author":"Benedict","year":"2005","journal-title":"J. Neurol. Sci."},{"key":"10.1016\/j.jns.2026.126007_bb0230","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s004150050408","article-title":"Exploring differences between subgroups of multiple sclerosis patients in health-related quality of life","volume":"246","author":"Pfennings","year":"1999","journal-title":"J. Neurol."},{"issue":"4","key":"10.1016\/j.jns.2026.126007_bb0235","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1191\/1352458502ms808oa","article-title":"Determinants of health-related quality of life in multiple sclerosis: the role of illness intrusiveness","volume":"8","author":"Shawaryn","year":"2002","journal-title":"Mult. Scler. J."},{"issue":"1","key":"10.1016\/j.jns.2026.126007_bb0240","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/S0022-510X(03)00225-9","article-title":"A longitudinal study of quality of life and side effects in patients with multiple sclerosis treated with interferon beta-1a","volume":"216","author":"Zivadinov","year":"2003","journal-title":"J. Neurol. Sci."},{"issue":"4","key":"10.1016\/j.jns.2026.126007_bb0245","doi-asserted-by":"crossref","DOI":"10.1093\/braincomms\/fcad199","article-title":"Patient-reported outcomes in multiple sclerosis: a prospective registry cohort study","volume":"5","author":"Lerede","year":"2023","journal-title":"Brain Commun."},{"key":"10.1016\/j.jns.2026.126007_bb0250","article-title":"The prevalence and risk factors of anxiety in multiple sclerosis: a systematic review and meta-analysis","volume":"17","author":"Zhang","year":"2023","journal-title":"Front. Neurosci."},{"issue":"2","key":"10.1016\/j.jns.2026.126007_bb0255","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s11136-023-03546-3","article-title":"Perceived health- related quality of life in persons with multiple sclerosis with and without a vascular comorbidity","volume":"33","author":"Neto","year":"2024","journal-title":"Qual. Life Res."},{"key":"10.1016\/j.jns.2026.126007_bb0260","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s00415-020-10195-w","article-title":"Estimating the relative contribution of comorbidities in predicting health-related quality of life of people with multiple sclerosis","volume":"268","author":"Lo","year":"2021","journal-title":"J. Neurol."},{"issue":"15","key":"10.1016\/j.jns.2026.126007_bb0265","first-page":"1517","article-title":"Depression is the leading cause of disability around the world","volume":"317","author":"Friedrich","year":"2017","journal-title":"Jama"},{"issue":"7","key":"10.1016\/j.jns.2026.126007_bb0270","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1111\/j.1468-1331.2004.00815.x","article-title":"Pain and sensory complaints in multiple sclerosis","volume":"11","author":"Beiske","year":"2004","journal-title":"Eur. J. Neurol."}],"container-title":["Journal of the Neurological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022510X26002893?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022510X26002893?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:20:10Z","timestamp":1783603210000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0022510X26002893"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":54,"alternative-id":["S0022510X26002893"],"URL":"https:\/\/doi.org\/10.1016\/j.jns.2026.126007","relation":{},"ISSN":["0022-510X"],"issn-type":[{"value":"0022-510X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Comparative impact of mental and cardiovascular comorbidities on adverse outcomes in people with MS","name":"articletitle","label":"Article Title"},{"value":"Journal of the Neurological Sciences","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jns.2026.126007","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"126007"}}