151
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Supplementary motor area functional connectivity in “drug-naïve” Parkinson’s disease patients with fatigue. J Neural Transm (Vienna) 2020; 127:1133-1142. [DOI: 10.1007/s00702-020-02219-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
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152
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Greenhouse-Tucknott A, Wrightson JG, Raynsford M, Harrison NA, Dekerle J. Interactions between perceptions of fatigue, effort, and affect decrease knee extensor endurance performance following upper body motor activity, independent of changes in neuromuscular function. Psychophysiology 2020; 57:e13602. [PMID: 32578885 DOI: 10.1111/psyp.13602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022]
Abstract
Prior exercise has previously been shown to impair subsequent endurance performance in non-activated muscles. Declines in the neuromuscular function and altered perceptual/affective responses offer possible mechanisms through which endurance performance may be limited in these remote muscle groups. We thus conducted two experiments to better understand these performance-limiting mechanisms. In the first experiment, we examined the effect of prior handgrip exercise on the behavioral, perceptual, and affective responses to a sustained, sub-maximal contraction of the knee extensors. In the second experiment, transcranial magnetic stimulation was used to assess the neuromuscular function of the knee extensors before and after the handgrip exercise. The results of the first experiment demonstrated prior handgrip exercise increased the perceptions of effort and reduced affective valence during the subsequent knee extensor endurance exercise. Both effort and affect were associated with endurance performance. Subjective ratings of fatigue were also increased by the preceding handgrip exercise but were not directly related to knee extensor endurance performance. However, perceptions of fatigue were correlated with heightened effort perception and reduced affect during the knee extensor contraction. In the second experiment, prior handgrip exercise did not significantly alter the neuromuscular function of the knee extensors. The findings of the present study indicate that motor performance in the lower limbs following demanding exercise in the upper body appears to be regulated by complex, cognitive-emotional interactions, which may emerge independent of altered neuromuscular function. Subjective fatigue states are implicated in the control of perceptual and affective processes responsible for the regulation of endurance performance.
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Affiliation(s)
| | - J G Wrightson
- Fatigue and Exercise Laboratory, University of Brighton, Brighton, UK.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Raynsford
- Fatigue and Exercise Laboratory, University of Brighton, Brighton, UK
| | - N A Harrison
- Immunopsychiatry Research Group, Cardiff University, Cardiff, UK.,Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - J Dekerle
- Fatigue and Exercise Laboratory, University of Brighton, Brighton, UK
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153
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Matesic I, Marcinko I. Identifying the relevant determinants of MS related fatigue: The role of the clinical indicators of disease and personality. Mult Scler Relat Disord 2020; 42:102054. [PMID: 32213466 DOI: 10.1016/j.msard.2020.102054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/17/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Research on the factors contributing to multiple sclerosis (MS) related fatigue are far from conclusive. Some studies put forward that clinical aspects of the disease give rise to this symptom whilst others emphasize the effects of psychological factors on its etiology. This study investigated the relationship between clinical aspects of MS and personality with MS fatigue. METHOD A total of 201 participants with MS of which 48 (23.9%) males and 153 (76.1%) females took part in this online study. Questionnaires were populated measuring clinical features of the disease (disease duration, type of MS, Expanded Disability Status Scale - EDSS), personality traits, and MS-related fatigue. Data was analyzed by hierarchical regression analyses. RESULTS Personality traits accounted for a greater variance in MS fatigue (R² = .482, p < .01) than clinical aspects of the disease, these results were conclusive after controlling for the sociodemographic variables and depression. Temperament explained in total 10.5% variance of fatigue and character an additional 4.0 %. High Harm avoidance (HA) (β = .229, p < .01) and low Self-directedness (SD) (β = -.217, p < .01) directly predicted fatigue. Also, temperament was shown to indirectly affect fatigue, through character. High HA and high Novelty-seeking (NS) through low SD predicted fatigue. The association between clinical features and fatigue was not observed unless paired with personality traits. EDSS in conjunction with HA and Secondary - progressive MS (SPMS) coupled with SD negatively affected fatigue levels. CONCLUSION Personality traits directly and indirectly predicted MS-related fatigue. Furthermore, the impact of clinical indicators of disease on fatigue would not be observed unless these features occurred together with particular personality traits.
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Affiliation(s)
- I Matesic
- Primary school Julije Kempf Pozega, Croatia
| | - I Marcinko
- Faculty of Humanities and Social Sciences Osijek, Croatia.
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154
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Alawami AS, Abdulla FA. Psychometric properties of an Arabic translation of the modified fatigue impact scale in patients with multiple sclerosis. Disabil Rehabil 2020; 43:3251-3259. [DOI: 10.1080/09638288.2020.1731853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Abeer S. Alawami
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fuad A. Abdulla
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Department of Neuroscience, Institute for Research and Medical Consultation, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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155
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Effectiveness of Vestibular Training for Balance and Dizziness Rehabilitation in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9020590. [PMID: 32098162 PMCID: PMC7074243 DOI: 10.3390/jcm9020590] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/08/2020] [Accepted: 02/08/2020] [Indexed: 12/30/2022] Open
Abstract
Postural instability and dizziness are commonly observed in people with multiple sclerosis (PwMS). The aim of this systematic review was to evaluate the evidence for the use of vestibular rehabilitation, in comparison with other exercise interventions or no intervention, to treat balance impairments and dizziness in PwMS. An electronic search was conducted by two independent reviewers in the following databases: MEDLINE (Pubmed), Scopus, the Physiotherapy Evidence Database (PEDro), Web of Science (WOS), Lilacs, CINHAL and the Cochrane Database of Systematic Reviews (CDSR). A quality assessment was performed using the PEDro scale and the Cochrane Risk of Bias Tool. When possible, the data were pooled in a meta-analysis (95%CI). This systematic review followed the PRISMA guideline statement and was registered in the PROSPERO database (CRD42019134230). Seven studies were included, with a total of 321 participants analysed. Compared with no intervention, vestibular rehabilitation was more effective for balance development (SMD = 2.12; 95% CI = 0.49, 3.75; p = 0.01; I2 = 89%) and dizziness symptoms improvement (SMD = −17.43; 95% CI = −29.99, −4.87; p= 0.007; I2= 66%). Compared with other exercise interventions, improvements in favour of the experimental group were observed, but statistical significance for the differences between groups was not reached.
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156
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Pallais JP, Kotz CM, Stanojlovic M. Orexin/hypocretinin in multiple sclerosis and experimental autoimmune encephalomyelitis. Neural Regen Res 2020; 15:1039-1040. [PMID: 31823881 PMCID: PMC7034266 DOI: 10.4103/1673-5374.270310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jean Pierre Pallais
- Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Catherine M Kotz
- Integrative Biology and Physiology, University of Minnesota; Minneapolis VA Health Care System, Geriatric Research, Education and Clinical Center, Minneapolis, MN, USA
| | - Milos Stanojlovic
- Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
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157
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Manjaly ZM, Iglesias S. A Computational Theory of Mindfulness Based Cognitive Therapy from the "Bayesian Brain" Perspective. Front Psychiatry 2020; 11:404. [PMID: 32499726 PMCID: PMC7243935 DOI: 10.3389/fpsyt.2020.00404] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022] Open
Abstract
Mindfulness Based Cognitive Therapy (MBCT) was developed to combine methods from cognitive behavioral therapy and meditative techniques, with the specific goal of preventing relapse in recurrent depression. While supported by empirical evidence from multiple clinical trials, the cognitive mechanisms behind the effectiveness of MBCT are not well understood in computational (information processing) or biological terms. This article introduces a testable theory about the computational mechanisms behind MBCT that is grounded in "Bayesian brain" concepts of perception from cognitive neuroscience, such as predictive coding. These concepts regard the brain as embodying a model of its environment (including the external world and the body) which predicts future sensory inputs and is updated by prediction errors, depending on how precise these error signals are. This article offers a concrete proposal how core concepts of MBCT-(i) the being mode (accepting whatever sensations arise, without judging or changing them), (ii) decentering (experiencing thoughts and percepts simply as events in the mind that arise and pass), and (iii) cognitive reactivity (changes in mood reactivate negative beliefs)-could be understood in terms of perceptual and metacognitive processes that draw on specific computational mechanisms of the "Bayesian brain." Importantly, the proposed theory can be tested experimentally, using a combination of behavioral paradigms, computational modelling, and neuroimaging. The novel theoretical perspective on MBCT described in this paper may offer opportunities for finessing the conceptual and practical aspects of MBCT.
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Affiliation(s)
- Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Sandra Iglesias
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
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158
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Proschinger S, Joisten N, Rademacher A, Schlagheck ML, Walzik D, Metcalfe AJ, Oberste M, Warnke C, Bloch W, Schenk A, Bansi J, Zimmer P. Influence of combined functional resistance and endurance exercise over 12 weeks on matrix metalloproteinase-2 serum concentration in persons with relapsing-remitting multiple sclerosis - a community-based randomized controlled trial. BMC Neurol 2019; 19:314. [PMID: 31810462 PMCID: PMC6898928 DOI: 10.1186/s12883-019-1544-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The relevance of regular moderate to intense exercise for ameliorating psychomotor symptoms in persons with multiple sclerosis (pwMS) is becoming increasingly evident. Over the last two decades, emerging evidence from clinical studies and animal models indicate immune regulatory mechanisms in both periphery and the central nervous system that may underlie these beneficial effects. The integrity of the blood-brain barrier as the main structural interface between periphery and brain seems to play an important role in MS. Reducing the secretion of proteolytic matrix metalloproteinases (MMP), i.e. MMP-2, as disruptors of blood-brain barrier integrity could have profound implications for MS. METHODS In this two-armed randomized controlled trial 64 participants with relapsing-remitting MS (RRMS) (EDSS 0-4.0) will be allocated to either an intervention group or a passive wait list control group. The intervention group will perform 60 min of combined functional resistance and endurance exercises 3x per week over a period of 12 weeks in a community-based and publicly available setting. Changes in serum concentration of MMP-2 will be the primary outcome. Secondary outcomes are numbers of immune cell subsets, soluble (anti-) inflammatory factors, physical capacity, cognitive performance, physical activity behavior, gait performance, and patient-reported outcomes. All outcome measures will be assessed at baseline and after week 12 with an additional blood sampling before, during and immediately after a single training session in week 6. DISCUSSION To our knowledge, this will be the first RCT to investigate both the acute and chronic effects of a community-based intense functional resistance and endurance exercise regimen in persons with RRMS. Combining analysis of biological and cognitive or psychological outcomes may provide a better understanding of the MS-specific symptomology. TRIAL REGISTRATION DRKS00017091; 05th of April, 2019; International Clinical Trials Registry Platform.
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Affiliation(s)
- Sebastian Proschinger
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Niklas Joisten
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Annette Rademacher
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Marit L Schlagheck
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - David Walzik
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Alan J Metcalfe
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Max Oberste
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Wilhelm Bloch
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Alexander Schenk
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Jens Bansi
- Deparment of Neurology, Kliniken-Valens, Rehabilitationsklinik-Valens, Taminaplatz 1, 7317, Valens, Switzerland
| | - Philipp Zimmer
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany.
- Department of Exercise and Health, Institute of Sports Science, Leibniz University Hannover, Hannover, Germany.
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159
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Silva MDCND, Cavalcanti DBA. Avaliação da qualidade de vida em portadores de esclerose múltipla: impacto da fadiga, ansiedade e depressão. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17005426042019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do estudo foi avaliar a percepção da qualidade de vida em pacientes com esclerose múltipla (EM) e verificar se há associação com fadiga, ansiedade e depressão. Trata-se de um estudo transversal com amostra composta por 100 indivíduos com diagnóstico de EM cadastrados no Centro de Referência para Atenção ao Paciente Portador de Doença Desmielinizante do Hospital da Restauração. Foram aplicadas: a escala de determinação funcional da qualidade de vida na EM (Defu), a escala modificada do impacto da fadiga (MFIS-BR) e a escala hospitalar de ansiedade (HAD-a) e depressão (HAD-d). Os pacientes com a forma clínica primariamente progressiva apresentaram pior percepção da qualidade de vida (66,90±3,47) quando comparados às formas secundariamente progressivas (71,65±5,92) e remitente-recorrente (79,00±6,62), com diferença estatística significativa (p<0,001). Houve forte correlação positiva entre os escores da Defu e da MFIS-BR (r=0,84), e forte correlação negativa entre Defu e HAD-a (r=−0,85) e Defu e HAD-d (r=−0,82). A diminuição da percepção da qualidade de vida em pacientes com EM é mais crítica nas formas progressivas da doença e tem associação com a presença de fadiga, depressão e ansiedade.
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160
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Gonzalez Campo C, Salamone PC, Rodríguez-Arriagada N, Richter F, Herrera E, Bruno D, Pagani Cassara F, Sinay V, García AM, Ibáñez A, Sedeño L. Fatigue in multiple sclerosis is associated with multimodal interoceptive abnormalities. Mult Scler 2019; 26:1845-1853. [PMID: 31778101 DOI: 10.1177/1352458519888881] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Fatigue ranks among the most common and disabling symptoms in multiple sclerosis (MS). Recent theoretical works have surmised that this trait might be related to alterations across interoceptive mechanisms. However, this hypothesis has not been empirically evaluated. OBJECTIVES To determine whether fatigue in MS patients is associated with specific behavioral, structural, and functional disruptions of the interoceptive domain. METHODS Fatigue levels were established via the Modified Fatigue Impact Scale. Interoception was evaluated through a robust measure indexed by the heartbeat detection task. Structural and functional connectivity properties of key interoceptive hubs were tested by magnetic resonance imaging (MRI) and resting-state functional MRI. Machine learning analyses were employed to perform pairwise classifications. RESULTS Only patients with fatigue presented with decreased interoceptive accuracy alongside decreased gray matter volume and increased functional connectivity in core interoceptive regions, the insula, and the anterior cingulate cortex. Each of these alterations was positively associated with fatigue. Finally, machine-learning analysis with a combination of the above interoceptive indices (behavioral, structural, and functional) successfully discriminated (area under the curve > 90%) fatigued patients from both non-fatigued and healthy controls. CONCLUSION This study offers unprecedented evidence suggesting that disruptions of neurocognitive markers subserving interoception may constitute a signature of fatigue in MS.
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Affiliation(s)
- Cecilia Gonzalez Campo
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Paula C Salamone
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Nicolás Rodríguez-Arriagada
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Fabian Richter
- Department of Psychology, University of Cologne, Cologne, Germany
| | - Eduar Herrera
- Departamento de Estudios Psicológicos, Universidad Icesi, Cali, Colombia
| | - Diana Bruno
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/Instituto de Investigación en Psicología Básica y Aplicada (IIPBA), Facultad de Filosofía y Humanidades, Universidad Católica de Cuyo, San Juan, Argentina
| | - Fátima Pagani Cassara
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/Instituto de Neurociencias de Fundación Favaloro, Buenos Aires, Argentina
| | - Vladimiro Sinay
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/Instituto de Neurociencias de Fundación Favaloro, Buenos Aires, Argentina
| | - Adolfo M García
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina/Faculty of Education, National University of Cuyo (UNCuyo), Mendoza, Argentina
| | - Agustín Ibáñez
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina/ Universidad Autónoma del Caribe, Barranquilla, Colombia/Department of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile/Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), Macquarie University, Sydney, NSW, Australia
| | - Lucas Sedeño
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina/National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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161
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Tommasin S, De Luca F, Ferrante I, Gurreri F, Castelli L, Ruggieri S, Prosperini L, Pantano P, Pozzilli C, De Giglio L. Cognitive fatigability is a quantifiable distinct phenomenon in multiple sclerosis. J Neuropsychol 2019; 14:370-383. [PMID: 31729168 DOI: 10.1111/jnp.12197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/29/2019] [Indexed: 11/28/2022]
Abstract
Cognitive fatigability in multiple sclerosis represents the decrease in cognitive performance over time. It is a frequent symptom that negatively affects quality of life and ability to work. There are no objective measures of cognitive fatigability. This study aimed at quantifying cognitive fatigability despite the learning effect and to clarify whether cognitive fatigability represents a free-standing phenomenon rather than an aspect of cognitive impairment. We measured information processing speed with the Symbol Digit Modalities Test, and the number of right answers was recorded every 30 s for 180 s. We approximated the number of right answers as function of time with two logarithmic models, one including a first-order term alone and the other adding also a second-order term. The coefficient of the latter (B) may quantify performance deflection and may represent cognitive fatigability. We tested 173 patients with multiple sclerosis, including 119 cognitively impaired and 54 cognitively preserved patients, and 35 healthy subjects. The performance of cognitively preserved patients showed a deflection at the end of task that was detected neither in controls nor in cognitively impaired patients and needed a second-order term to be approximated (p < .03, F = 14.02). B was explained neither by depression nor fatigue. We proposed for the first time a method to quantify cognitive fatigue via a second-order least square fit model, easily usable in the clinical practice. By using this novel approach, cognitive fatigability results to be a free-standing phenomenon that is more evident in cognitively preserved than in cognitive impaired patients.
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Affiliation(s)
- Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Francesca De Luca
- MS Centre, Sapienza University Sant'Andrea Hospital, Roma, Italy.,Department of Psychology, Sapienza University of Rome, Italy
| | - Ilaria Ferrante
- MS Centre, Sapienza University Sant'Andrea Hospital, Roma, Italy
| | - Flavia Gurreri
- MS Centre, Sapienza University Sant'Andrea Hospital, Roma, Italy
| | | | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed, (Pozzilli [IS], IT), Pozzilli, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,MS Centre, Sapienza University Sant'Andrea Hospital, Roma, Italy
| | - Laura De Giglio
- Medicine Department, Neurology Unit, San Filippo Neri Hospital, Rome, Italy
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162
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Bächinger M, Lehner R, Thomas F, Hanimann S, Balsters J, Wenderoth N. Human motor fatigability as evoked by repetitive movements results from a gradual breakdown of surround inhibition. eLife 2019; 8:46750. [PMID: 31524600 PMCID: PMC6746551 DOI: 10.7554/elife.46750] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023] Open
Abstract
Motor fatigability emerges when demanding tasks are executed over an extended period of time. Here, we used repetitive low-force movements that cause a gradual reduction in movement speed (or 'motor slowing') to study the central component of fatigability in healthy adults. We show that motor slowing is associated with a gradual increase of net excitability in the motor network and, specifically, in primary motor cortex (M1), which results from overall disinhibition. Importantly, we link performance decrements to a breakdown of surround inhibition in M1, which is associated with high coactivation of antagonistic muscle groups. This is consistent with the model that a loss of inhibitory control might broaden the tuning of population vectors such that movement patterns become more variable, ill-timed and effortful. We propose that the release of inhibition in M1 is an important mechanism underpinning motor fatigability and, potentially, also pathological fatigue as frequently observed in patients with brain disorders.
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Affiliation(s)
- Marc Bächinger
- Department of Health Sciences and Technology, Neural Control of Movement Lab, Zurich, Switzerland.,Neuroscience Center Zurich (ZNZ), University of Zurich, Federal Institute of Technology Zurich, University and Balgrist Hospital Zurich, Zurich, Switzerland
| | - Rea Lehner
- Department of Health Sciences and Technology, Neural Control of Movement Lab, Zurich, Switzerland.,Neuroscience Center Zurich (ZNZ), University of Zurich, Federal Institute of Technology Zurich, University and Balgrist Hospital Zurich, Zurich, Switzerland
| | - Felix Thomas
- Department of Health Sciences and Technology, Neural Control of Movement Lab, Zurich, Switzerland.,Neuroscience Center Zurich (ZNZ), University of Zurich, Federal Institute of Technology Zurich, University and Balgrist Hospital Zurich, Zurich, Switzerland
| | - Samira Hanimann
- Department of Health Sciences and Technology, Neural Control of Movement Lab, Zurich, Switzerland
| | - Joshua Balsters
- Department of Health Sciences and Technology, Neural Control of Movement Lab, Zurich, Switzerland.,Department of Psychology, Royal Holloway University of London, Egham, United Kingdom
| | - Nicole Wenderoth
- Department of Health Sciences and Technology, Neural Control of Movement Lab, Zurich, Switzerland.,Neuroscience Center Zurich (ZNZ), University of Zurich, Federal Institute of Technology Zurich, University and Balgrist Hospital Zurich, Zurich, Switzerland
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163
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Ysrraelit MC, Fiol MP, Peña FV, Vanotti S, Terrasa SA, Tran VT, Montori VM, Correale J. Adaptation and validation of a Spanish version of the treatment burden questionnaire in patients with multiple sclerosis. BMC Neurol 2019; 19:209. [PMID: 31455235 PMCID: PMC6710872 DOI: 10.1186/s12883-019-1441-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/21/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The Treatment Burden Questionnaire (TBQ) is a self-reported measure of the effect of treatment workload on patient wellbeing. We sought to validate the TBQ in Spanish and use it to estimate the burden of treatment in Argentinian patients with multiple sclerosis (MS). METHODS The TBQ was forward-backward translated into Spanish. Two focus groups and 25 semi-structured interviews focused on wording and possible item exclusion. Validation was performed in 2 steps. First, 162 patients across a range of MS severity completed the questionnaire. Confirmatory factor analysis assessed the dimensional structure of the TBQ. Construct validity was assessed by studying correlations with fatigue and quality of life (QoL). Then, in a second cohort of 171 patients, we evaluated the association between TBQ scores and patients' sex, age, education level, employment status, type of MS, disease duration, comorbidities, EDSS, pharmacological treatment and medication adherence. RESULTS The questionnaire presented a 3-factor structure in which burden was related to pharmacological treatment; comprehensive health assistance; and psycho-social-economic context. Composite reliability was > 0.8 for all factors. TBQ showed positive correlation with fatigue (rs = 0.467, p = 0.006), negative correlation with QoL (rs - 0.446, p = 0.009). For the second cohort, total TBQ score was 43 (SD 29). Lowest scores were observed on self-monitoring (0.53, SD 1.3) and highest for administrative load (4.2, SD 3.4). Inverse association was found between the TBQ score and medication adherence (r 0.243 p = 0.001). TBQ scores also correlated with daily patient pill/injection requirements (r 0.175 p = 0.020). Individuals receiving injectable treatment scored higher than patients on oral drugs (total TBQ 51 (SD 32) vs 39 (SD 27) p = 0.002). CONCLUSIONS The TBQ in Spanish is a reliable instrument and showed adequate correlation with QoL and adherence scales in MS patients. TBQ may benefit health resources allocation and provide tailor therapeutic interventions to construct a minimally disruptive care.
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Affiliation(s)
| | | | | | - Sandra Vanotti
- Multiple Sclerosis Clinic, INEBA - Neurosciences Institute of Buenos Aires, Buenos Aires, Argentina
| | | | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistics (CRESS – UMR 1153), Paris, France
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905 USA
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