Fatigue in multiple sclerosis: relationship to depression, disability, and disease pattern

Abstract

In order to investigate the associations between fatigue and depression, disability, and disease subtype, 207 individuals with clinically definite Multiple Sclerosis (MS) were administered the Fatigue Severity Scale and the Zung Self-rating Depression Scale during a regular clinic appointment. Their current level of disability was established using the Expanded Disability Status Scale. Fatigue and depression were highly correlated (r=0.58), even when the depression measure was corrected for items overlapping with fatigue and other symptoms or consequences of MS (r=0.44). Fatigue and disability were also correlated (r=0.33). Multiple regression revealed that both depressed mood and disability were significant predictors of fatigue, together accounting for approximately 23% of the variance in patients' self-reported fatigue. The combined groups of primary progressive (n=45) and secondary progressive patients (n=25) appeared to have higher fatigue scores than relapsing-remitting patients (n=137). However, an analysis of covariance revealed that this apparent difference was in fact attributable almost exclusively to differences in disability among the three subtypes of MS. Other reports of differences in fatigue between subtypes of MS should be re-examined in light of this finding.

Multiple Sclerosis Fatigue is Associated with Reduced Psychomotor Vigilance

“…Mood has been characterized as a contributor to MS fatigue in many studies. [5][6][7] However, our findings suggest that mood may affect the perception of fatigue more than its cognitive correlates in MS. This hypothesis is supported by a recent study showing that MS patients' self-rankings on the Beck Depression Inventory Fast Screen were moderately correlated with rankings on the Fatigue Severity Scale, but not with cognitive results from formal neuropsychological testing.…”

“…Mood has been demonstrated in previous research to be correlated with MS fatigue, but did not significantly affect reaction times in this study. [4][5]7 The PVT can be influenced by demographic factors that have not been consistently linked to MS-related fatigue. For example, in other studies age has been shown to affect PVT performance, and in this study, gender was a significant contributor.…”

“…The subjective experience of fatigue is multifactorial and has been correlated with factors such as disability, depression, and pain. [5][6][7] Interestingly, no clear association has been established between MS fatigue and demographic factors, such as age and gender; lesion burden; or the clinical form of MS. 1,[7][8][9] ABSTRACT: Background: Fatigue is common and disabling in multiple sclerosis, yet its physiologic substrates remain poorly defined. The aim of this study was to determine the relationship between fatigue and an objective measure of alertness in MS patients.…”

Changes in Fatigue and Cognition in Patients with Relapsing Forms of Multiple Sclerosis Treated with Natalizumab

“…Fatigue in MS may be related to impaired interactions among functionally related cortical and subcortical areas, it could be a side effect of depression, or both. 15,31,32 MS-related cognitive dysfunction could be a function of fatigue, central inflammation, neurodegeneration, neuroendocrine dysregulation, and/or depression. 33 This study is the first to document moderate correlations between measurements of fatigue and cognitive function at baseline and during natalizumab treatment.…”

“…14 Fatigue and cognitive deficits are associated with disability. 15,16 Although fatigue and cognition are not explicitly captured by the Expanded Disability Status Scale (EDSS), a reduction in sustained disability progression as measured by the EDSS is seen with natalizumab as compared with placebo. 13 Here we report findings from the Evaluation of Natalizumab for thE Relief of MS Associated FatiGue (ENER-G) study, which was designed to evaluate changes in and correlations between fatigue and cognition in natalizumab-treated patients with relapsing MS.…”