Contributions
Abstract: EP1542
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Background: Fatigue is a frequent and debilitating symptom in patients with multiple sclerosis (MS). It could affect up to 90 % of cases during their disease course. Yet, the pathophysiology of MS fatigue remains unclear.
Objectives: This work aims to assess the neuropsychological correlates of MS fatigue.
Methods: Thirty-eight adult MS patients were enrolled. Patients were excluded if they had relapse in the last three months, excessive daytime sleepiness as per Epworth Sleepiness Scale score > 10, clinical depression as per Beck Depression Inventory score > 19 or other neuropsychiatric diagnoses. Patients were classified as fatigued and nonfatigued based on the Modified Fatigue Impact Scale. They underwent a neuropsychological evaluation that included the Symbol Digit Modalities test, the Hospital Anxiety and Depression Scale, and the Toronto Alexithymia Scale.
Results: There was no significant group difference (non-fatigued versus fatigued) with regard to age, gender, education, MS type, expanded disability status score, duration of disease or the progressive phase of illness. Compared to non-fatigued patients, those with fatigue had higher anxiety (3.88±1.93 vs. 6.14±3.47, p = 0.016), depression (4.00±2.72 vs. 6.05±2.60, p = 0.023) and alexithymia scores (45.35±11.53 vs. 53.43±9.52; p = 0.023). Direct correlations were found between fatigue and each of anxiety (p = 0.001), depression (p = 0.000) and alexithymia (p = 0.019).
Conclusions: These results support the existence of common underlying mechanisms for fatigue and anxiety/depression and a bidirectional interaction between these symptoms. In other words, the more the individuals are tired, the more they feel demotivated and melancholic, and the more they become worried and preoccupied with the future. The generation of this ill-being state would contribute to the accentuation of fatigue which would in turn generate new fears and negative thoughts. Thus, individuals would enter a difficult to manage vicious cycle. Our findings also suggest that autonomic hyperarousal and amplification of somatic complaints, generally described in the context of alexithymia, could influence the patients' experience and perception. Saying differently, in alexithymic patients who have difficulty analyzing and describing their own emotions, the underlying sympathetic hyperactivity may increase the tendency of patients to intensify their bodily sensations and thus exaggerate their perception of fatigue.
Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. AC gave expert testimony for CSL Behring, Novartis, received grants from Biogen, Novartis, CSL Behring, GE Neuro, Octapharma, and gave lectures for Genzyme. SSA declares having received travel grants or compensation from Genzyme, Biogen, Novartis and Roche. The remaining authors declare no conflict of interest.
Abstract: EP1542
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Background: Fatigue is a frequent and debilitating symptom in patients with multiple sclerosis (MS). It could affect up to 90 % of cases during their disease course. Yet, the pathophysiology of MS fatigue remains unclear.
Objectives: This work aims to assess the neuropsychological correlates of MS fatigue.
Methods: Thirty-eight adult MS patients were enrolled. Patients were excluded if they had relapse in the last three months, excessive daytime sleepiness as per Epworth Sleepiness Scale score > 10, clinical depression as per Beck Depression Inventory score > 19 or other neuropsychiatric diagnoses. Patients were classified as fatigued and nonfatigued based on the Modified Fatigue Impact Scale. They underwent a neuropsychological evaluation that included the Symbol Digit Modalities test, the Hospital Anxiety and Depression Scale, and the Toronto Alexithymia Scale.
Results: There was no significant group difference (non-fatigued versus fatigued) with regard to age, gender, education, MS type, expanded disability status score, duration of disease or the progressive phase of illness. Compared to non-fatigued patients, those with fatigue had higher anxiety (3.88±1.93 vs. 6.14±3.47, p = 0.016), depression (4.00±2.72 vs. 6.05±2.60, p = 0.023) and alexithymia scores (45.35±11.53 vs. 53.43±9.52; p = 0.023). Direct correlations were found between fatigue and each of anxiety (p = 0.001), depression (p = 0.000) and alexithymia (p = 0.019).
Conclusions: These results support the existence of common underlying mechanisms for fatigue and anxiety/depression and a bidirectional interaction between these symptoms. In other words, the more the individuals are tired, the more they feel demotivated and melancholic, and the more they become worried and preoccupied with the future. The generation of this ill-being state would contribute to the accentuation of fatigue which would in turn generate new fears and negative thoughts. Thus, individuals would enter a difficult to manage vicious cycle. Our findings also suggest that autonomic hyperarousal and amplification of somatic complaints, generally described in the context of alexithymia, could influence the patients' experience and perception. Saying differently, in alexithymic patients who have difficulty analyzing and describing their own emotions, the underlying sympathetic hyperactivity may increase the tendency of patients to intensify their bodily sensations and thus exaggerate their perception of fatigue.
Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. AC gave expert testimony for CSL Behring, Novartis, received grants from Biogen, Novartis, CSL Behring, GE Neuro, Octapharma, and gave lectures for Genzyme. SSA declares having received travel grants or compensation from Genzyme, Biogen, Novartis and Roche. The remaining authors declare no conflict of interest.