Fatigue in multiple sclerosis: relationship with disease duration, physical disability, disease pattern, age and sex

Ghajarzadeh, Mahsa; Jalilian, Rozita; Eskandari, Ghazaleh; Sahraian, Mohammad Ali; Azimi, Amirreza; Mohammadifar, Mehdi

doi:10.1007/s13760-013-0198-2

Cited by 55 publications

(46 citation statements)

References 20 publications

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“…Fatigue is a universal experience in both normal and clinical populations and a common symptom of multiple diseases (Carter et al, 1993; Bonner et al, 2013; Fabbrini et al, 2013; Ghajarzadeh et al, 2013). Recent studies have identified DMN dysfunction in some clinical populations in which fatigue symptoms are pervasive.…”

Section: Discussionmentioning

confidence: 99%

Resting spontaneous activity in the default mode network predicts performance decline during prolonged attention workload

Gui

Zhu

et al. 2015

NeuroImage

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After continuous and prolonged cognitive workload, people typically show reduced behavioral performance and increased feelings of fatigue, which are known as “time-on-task (TOT) effects”. Although TOT effects are pervasive in modern life, their underlying neural mechanisms remain elusive. In this study, we induced TOT effects by administering a 20-minute continuous psychomotor vigilance test (PVT) to a group of 16 healthy adults and used resting-state blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to examine spontaneous brain activity changes associated with fatigue and performance. Behaviorally, subjects displayed robust TOT effects, as reflected by increasingly slower reaction times as the test progressed and higher self-reported mental fatigue ratings after the 20-minute PVT. Compared to pre-test measurements, subjects exhibited reduced amplitudes of low-frequency fluctuation (ALFF) in the default mode network (DMN) and increased ALFF in the thalamus after the test. Subjects also exhibited reduced anti-correlations between the posterior cingulate cortex (PCC) and right middle prefrontal cortex after the test. Moreover, pre-test resting ALFF in the PCC and medial prefrontal cortex (MePFC) predicted subjects’ subsequent performance decline; individuals with higher ALFF in these regions exhibited more stable reaction times throughout the 20-minute PVT. These results support the important role of both task-positive and task-negative networks in mediating TOT effects and suggest that spontaneous activity measured by resting-state BOLD fMRI may be a marker of mental fatigue.

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Section: Discussionmentioning

confidence: 99%

Resting spontaneous activity in the default mode network predicts performance decline during prolonged attention workload

Gui

Zhu

et al. 2015

NeuroImage

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“…Fatigue in MS has previously been linked to age, disability, MS type, and sex (28, 29), with some suggestion that disability is a driving factor (30). For this reason, data were extracted from articles to consider disability, measured using the extended disability status scale (EDSS)(31), and MS type as moderators (age and sex could not be included due to insufficient reporting in the articles).…”

Section: Methodsmentioning

confidence: 99%

Relationship between perceived fatigue and performance fatigability in people with multiple sclerosis: A systematic review and meta-analysis

Loy

Taylor

Fling

et al. 2017

Journal of Psychosomatic Research

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Objective Perceived fatigue (i.e., subjective perception of reduced capacity) is one of the most common and disabling symptoms for people with multiple sclerosis (MS). Perceived fatigue may also be related to performance fatigability (i.e., decline in physical performance over time), although study findings have been inconsistent. Objective To locate all studies reporting the relationship between perceived fatigue and fatigability in people with MS, determine the population correlation, and examine moderating variables of the correlation size. Methods In accordance with PRISMA guidelines, systematic searches were completed in Medline, PsychInfo, Google Scholar, and the Cochrane Library for peer-reviewed articles published between March 1983 and August 2016. Included articles measured perceived fatigue and performance fatigability in people with MS and provided a correlation between measures. Moderator variables expected to influence the relationship were also coded. Searches located 19 studies of 848 people with MS and a random-effects model was used to pool correlations. Results The mean correlation between fatigue and fatigability was positive, “medium” in magnitude, and statistically significant, r = 0.31 (95% CI = 0.21, 0.42), p < .001. Despite moderate between-study heterogeneity (I2 = 46%) no statistically significant moderators were found, perhaps due to the small number of studies per moderator category. Conclusion There is a significant relationship between perceived fatigue and fatigability in MS, such that people reporting elevated fatigue also are highly fatigable. The size of the relationship is not large enough to suggest fatigue and fatigability are the same construct, and both should continue to be assessed independently.

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“…Fatigue in MS is neither consistently linked to disease severity as measured by the Expanded Disability Status Scale (EDSS 5 ) nor disease duration, although it is generally found to be worse in individuals with the secondary progressive subtype. 2,6 Fatigue is distinct from sleepiness, and fails to improve with adequate sleep. 7 Multiple factors are thought to contribute to fatigue 8,9 with no specific biomarker or etiology yet confirmed.…”

Section: Introductionmentioning

confidence: 99%

Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial

et al. 2017

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Background Fatigue is a common and debilitating feature of multiple sclerosis (MS) that remains without reliably effective treatment. Transcranial direct current stimulation (tDCS) is a promising option for fatigue reduction. We developed a telerehabilitation protocol that delivers tDCS to participants at home using specially designed equipment and real-time supervision (remotely supervised transcranial direct current stimulation (RS-tDCS)). Objective To evaluate whether tDCS can reduce fatigue in individuals with MS. Methods Dorsolateral prefrontal cortex left anodal tDCS was administered using a RS-tDCS protocol, paired with 20 minutes of cognitive training. Here, two studies are considered. Study 1 delivered 10 open-label tDCS treatments (1.5 mA; n = 15) compared to a cognitive training only condition (n = 20). Study 2 was a randomized trial of active (2.0 mA, n = 15) or sham (n = 12) delivered for 20 sessions. Fatigue was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS)—Fatigue Short Form. Results and conclusion In Study 1, there was modest fatigue reduction in the active group (−2.5 ± 7.4 vs −0.2 ± 5.3, p = 0.30, Cohen’s d = −0.35). However, in Study 2 there was statistically significant reduction for the active group (−5.6 ± 8.9 vs 0.9 ± 1.9, p = 0.02, Cohen’s d = −0.71). tDCS is a potential treatment for MS-related fatigue.

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Fatigue in multiple sclerosis: relationship with disease duration, physical disability, disease pattern, age and sex

Cited by 55 publications

References 20 publications

Resting spontaneous activity in the default mode network predicts performance decline during prolonged attention workload

Resting spontaneous activity in the default mode network predicts performance decline during prolonged attention workload

Relationship between perceived fatigue and performance fatigability in people with multiple sclerosis: A systematic review and meta-analysis

Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial

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