Neural correlates of effort-dependent and effort-independent cognitive fatigue components in patients with multiple sclerosis

Spiteri, Stefan; Hassa, Thomas; Claros-Salinas, Dolores; Dettmers, Christian; Schoenfeld, Mircea Ariel

doi:10.1177/1352458517743090

Cited by 35 publications

(21 citation statements)

References 43 publications

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“…The term "fatigue" is used in different ways, ranging from unspecific (6) to more specific definitions, e.g., by the MS research council as "a subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities" (7). It is generally held that a sensation of fatigue does occur physiologically following an effort-demanding activity, while in the context of disease, fatigue may present as "pathological exhaustion" that occurs earlier, with lighter activity and more persistence or even independent of effort demands (8). Kluger et al (9) proposed "perception of fatigue" and "performance fatigability" as discernible but related components of fatigue which both can present in the motor or the cognitive domain.…”

Section: Introductionmentioning

confidence: 99%

Association Between Fatigue and Motor Exertion in Patients With Multiple Sclerosis—a Prospective Study

et al. 2020

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Background: Fatigue in multiple sclerosis (MS) is conceived as a multidimensional construct. Objectives: This study aims to describe the changes of balance and gait parameters after 6 min of walking (6 MW) as potential quantitative markers for perceptions of state fatigue and trait fatigue in MS. Methods: A total of 19 patients with MS (17 with fatigue) and 24 healthy subjects underwent static posturography, gait analysis, and ratings of perceived exertion before and after 6 MW. Results: 6 MW was perceived as exhaustive, but both groups featured more dynamic comfortable speed walking after 6 MW. Shorter stride length at maximum speed and increased postural sway after 6 MW indicated fatigability of balance and gait in MS group only. While most changes were related to higher levels of perceived exertion after 6 MW (state fatigue), higher fatigue ratings (trait fatigue) were only associated with less increase in arm swing at comfortable speed. Further analysis revealed different associations of trait fatigue and performance fatigability with disability and motor functions. Performance fatigability was most closely related to the Expanded Disability Status Scale, while for trait fatigue, the strongest correlations were seen with balance function and handgrip strength. Conclusions: Fatigability of performance was closely related to perceptions of exertion after 6 MW (state fatigue) and disability in MS but distinct from fatigue ratings, conceived as trait fatigue. Our study identified postural sway, arm swing during gait, and hand grip strength as unexpected potential motor indicators of fatigue ratings in MS.

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Section: Introductionmentioning

confidence: 99%

Association Between Fatigue and Motor Exertion in Patients With Multiple Sclerosis—a Prospective Study

et al. 2020

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“…Fatigue is one of the most common and disabling symptoms in multiple sclerosis (MS) [ 1 – 3 ]. Fatigue is a complex phenomenon to study because the patients experience an effort-independent general subjective feeling of fatigue as well excessive fatigability when engaging in physical or mental activity [ 4 ]. Effort-independent fatigue is often referred to as the “trait” fatigue, whereas fatigability is referred to as a “state” feature of fatigue.…”

Section: Introductionmentioning

confidence: 99%

“…Effort-independent fatigue is often referred to as the “trait” fatigue, whereas fatigability is referred to as a “state” feature of fatigue. In a clinical setting, the two aspects are usually measured jointly using standardized scales [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Cerebellar and premotor activity during a non-fatiguing grip task reflects motor fatigue in relapsing-remitting multiple sclerosis

et al. 2018

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Fatigue is a common and highly disabling symptom of multiple sclerosis. Patients experience an effort-independent general subjective feeling of fatigue as well as excessive fatigability when engaging in physical or mental activity. Previous research using functional magnetic resonance imaging (fMRI) has revealed heterogeneous findings, but some evidence implicates the motor system. To identify brain correlates of fatigue, 44 mildly impaired patients with relapsing-remitting multiple sclerosis and 25 age- and gender-matched healthy controls underwent functional magnetic resonance imaging at 3 Tesla, while they performed alternating blocks of rest and a non-fatiguing precision grip task. We investigated neural correlates of fatigue using the motor subscore of Fatigue Scale for Motor and Cognitive Functions (FSMCMOTOR) using the bilateral motor cerebellum, putamen, and dorsal premotor cortex as regions of interest. Patients and healthy controls performed the grip force task equally well without being fatigued. In patients, task-related activity in lobule VI of right motor cerebellum changed in proportion with individual FSMCMOTOR scores. In right dorsal premotor cortex, linear increases in activity across consecutive task blocks scaled with individual FSMCMOTOR scores in healthy controls, but not in patients. In premotor and dorsomedial prefrontal areas, patients were impaired at upscaling task-related activity the more they were affected by motor fatigue. The results support the notion that increased sensorimotor processing in the cerebellum contributes to the experience of motor fatigue and fatigability in multiple sclerosis. Additionally, downscaling of motivational input or sensorimotor processing in prefrontal and premotor areas may constitute an additional pathophysiological factor.

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“…To better account for the complexity of fatigue, fatigue and fatigability have been defined differently; the following definition of these two terms is now widely accepted [ 15 ]: fatigue refers to a patient’s subjective sensation of fatigue, while fatigability refers to an overt change in performance that can be observed and measured. Fatigability can be physical or cognitive, and different methods currently exist to measure physical fatigability [ 16 ], while other methods have been suggested to measure cognitive fatigability [ 10 ].…”

Section: Intentions As the Key To Change Physical Activity In Ms Patimentioning

confidence: 99%

“…A distinction has been made between effort-dependent fatigability (state component) and a more permanent trait component of fatigue, which is assessed through questionnaires [ 15 ]. Both components rely on different neural networks [ 16 ].…”

Section: Intentions As the Key To Change Physical Activity In Ms Patimentioning

confidence: 99%

Exercise in Multiple Sclerosis: Knowing is Not Enough—The Crucial Role of Intention Formation and Intention Realization

2019

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A large body of evidence supports the notion that patients with multiple sclerosis (MS) benefit from physical exercise. However, this research-based recommendation has been insufficiently translated into practice. In this commentary article, we highlight the psychological evidence for the intention–behaviour gap and discuss evidence-based recommendations for bridging this gap, with the aim to change behaviour in MS patients. It is accepted that psychological research distinguishes intention formation from intention realization and that these processes have to be considered when the aim is to enhance physical activity in MS patients. We suggest that the transtheoretical model of behaviour change is a useful and general framework for examining the process of intention formation and that a MS-specific perspective is more useful for realizing exercise intention. MS patients are faced with severe self-control demands that hinder the realization of sport and exercise goals. Specifically, MS patients experience fatigue, which imposes substantial self-control demands. Here, we suggest implementation intention as an effective tool that aids in counteracting deficits in intention realization (getting started and staying on track). We also note that research knowledge is not sufficiently translated into clinical practice. Based on an interdisciplinary approach we recommend that therapists of MS patients should be more aware of psychological theories of health behaviour change and that they should use these to improve and optimize treatment approaches.

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Neural correlates of effort-dependent and effort-independent cognitive fatigue components in patients with multiple sclerosis

Cited by 35 publications

References 43 publications

Association Between Fatigue and Motor Exertion in Patients With Multiple Sclerosis—a Prospective Study

Association Between Fatigue and Motor Exertion in Patients With Multiple Sclerosis—a Prospective Study

Cerebellar and premotor activity during a non-fatiguing grip task reflects motor fatigue in relapsing-remitting multiple sclerosis

Exercise in Multiple Sclerosis: Knowing is Not Enough—The Crucial Role of Intention Formation and Intention Realization

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