1
|
DeJonge SR, DuBose NG, Motl RW, Baynard T, Fernhall B. Inverse association between arterial stiffness and perceived fatigue independent of disability status and BMI in multiple sclerosis. Neurol Sci 2024; 45:4957-4962. [PMID: 38713451 DOI: 10.1007/s10072-024-07556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated, neurodegenerative disease of the central nervous system. Fatigue represents one of the most prevalent and limiting symptoms of MS, and is associated with vascular dysfunction, notably increased arterial stiffness. OBJECTIVE This study examined the relationship between arterial stiffness and perceived fatigue in persons with MS. METHODS The sample of 52 persons with MS (71.2% Female; Age: 46.7 ± 12.3 yrs.) completed arterial stiffness and fatigue assessments as baseline for an exercise training intervention. Applanation tonometry measured arterial stiffness, pulsatility and waveform characteristics, and yielded the following outcomes: carotid-femoral pulse wave velocity (cfPWV), carotid pulse-pressure (cPP), and aortic augmentation pressure (AP). Perceived fatigue was measured using the Fatigue Severity Scale (FSS). RESULTS The mean (SD) scores for cfPWV, cPP, and AP were 7.0 ± 1.8 m/s, 35.7 ± 8.8 mmHg, 8.2 ± 6.2 mmHg, respectively. The mean (SD) FSS score was 4.6 ± 1.4 and indicated elevated fatigue. There were statistically significant (p < .05) inverse correlations between cfPWV (r = -.32), cPP (r = -.37) and AP (r = -.32) with FSS scores, and the correlations remained significant even after controlling for disability, body mass index, age, and sex. CONCLUSION Our results indicate a consistent pattern of inverse relationships between arterial stiffness, pulsatility, and waveforms with fatigue independent of disability, body mass index, age, and sex in MS. This could be explained by lower sympathetic activation linking higher arterial stiffness, pulsatility and augmentation pressure with lower fatigue in persons with MS.
Collapse
Affiliation(s)
- Sydney R DeJonge
- Integrative Physiology Lab, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Noah G DuBose
- Integrative Physiology Lab, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert W Motl
- Integrative Physiology Lab, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Tracy Baynard
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Bo Fernhall
- Integrative Physiology Lab, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| |
Collapse
|
2
|
Danciut I, Rae CL, Rashid W, Scott J, Bozzali M, Iancu M, Garfinkel SN, Bouyagoub S, Dowell NG, Langdon D, Cercignani M. Understanding the mechanisms of fatigue in multiple sclerosis: linking interoception, metacognition and white matter dysconnectivity. Brain Commun 2024; 6:fcae292. [PMID: 39291169 PMCID: PMC11406465 DOI: 10.1093/braincomms/fcae292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 06/25/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024] Open
Abstract
One of the most prominent symptoms in multiple sclerosis is pathological fatigue, often described by sufferers as one of the most debilitating symptoms, affecting quality of life and employment. However, the mechanisms of both, physical and cognitive fatigue in multiple sclerosis remain elusive. Here, we use behavioural tasks and quantitative MRI to investigate the neural correlates of interoception (the ability to sense internal bodily signals) and metacognition (the ability of the brain to assess its own performance), in modulating cognitive fatigue. Assuming that structural damage caused by multiple sclerosis pathology might impair the neural pathways subtending interoception and/or metacognition, we considered three alternative hypotheses to explain fatigue as a consequence of, respectively: (i) reduced interoceptive accuracy, (ii) reduced interoceptive insight or (iii) reduced global metacognition. We then explored associations between these behavioural measures and white matter microstructure, assessed by diffusion and magnetisation transfer MRI. Seventy-one relapsing-remitting multiple sclerosis patients participated in this cross-sectional study (mean age 43, 62% female). Patient outcomes relevant for fatigue were measured, including disability, disease duration, depression, anxiety, sleepiness, cognitive function, disease modifying treatment and quality of life. Interoceptive and metacognitive parameters were measured using heartbeat tracking and discrimination tasks, and metacognitive visual and memory tasks. MRI was performed in 69 participants, including diffusion tensor MRI, neurite orientation dispersion and density imaging and quantitative magnetisation transfer. Associations between interoception and metacognition and the odds of high cognitive fatigue were tested by unconditional binomial logistic regression. The odds of cognitive fatigue were higher in the people with low interoceptive insight (P = 0.03), while no significant relationships were found between fatigue and other interoceptive or metacognitive parameters, suggesting a specific impairment in interoceptive metacognition, rather than interoception generally, or metacognition generally. Diffusion MRI-derived fractional anisotropy and neurite density index showed significant (P < 0.05) negative associations with cognitive fatigue in a widespread bilateral white matter network. Moreover, there was a significant (P < 0.05) interaction between cognitive fatigue and interoceptive insight, suggesting that the poorer the white matter structure, the lower the interoceptive insight, and the worse the fatigue. The results point towards metacognitive impairment confined to the interoceptive domain, in relapsing-remitting patients with cognitive fatigue. The neural basis of this impairment is supported by a widespread white matter network in which loss of neurite density plays a role.
Collapse
Affiliation(s)
- Iulia Danciut
- Clinical Imaging Sciences Centre, Department of Clinical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RR, UK
- Department of Neurology, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - Charlotte L Rae
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QH, UK
| | - Waqar Rashid
- Department of Neurology, St George's Teaching Hospitals, London SW17 0QT, UK
| | - James Scott
- Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AB, UK
| | - Marco Bozzali
- 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, 10126 Turin, Italy
| | - Mihaela Iancu
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, 'Iuliu Haţieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Sarah N Garfinkel
- Institute of Cognitive Neuroscience, UCL, Queen Square, London WC1N 3AZ, UK
| | - Samira Bouyagoub
- Clinical Imaging Sciences Centre, Department of Clinical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RR, UK
| | - Nicholas G Dowell
- Clinical Imaging Sciences Centre, Department of Clinical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RR, UK
| | - Dawn Langdon
- Psychology Department, Royal Holloway University of London, Egham, Surrey TW20 0EX, UK
| | - Mara Cercignani
- Clinical Imaging Sciences Centre, Department of Clinical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RR, UK
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff CF24 4HQ, UK
| |
Collapse
|
3
|
Pauletti C, Mannarelli D, Pauri F, Petritis A, Maffucci A, Currà A, Fattapposta F. The role of fatigue in attentional processing in multiple sclerosis: data from event-related potentials. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02827-6. [PMID: 39196370 DOI: 10.1007/s00702-024-02827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024]
Abstract
Fatigue is an extremely common symptom in in people with multiple sclerosis (PwMS) and has a severe impact on quality of life. The purpose of the present study was to verify whether fatigue in PwMS is associated with a selective covert attention impairment, as measured by event-related potentials and to assess whether it is more associated with an impairment of top-down or bottom-up attentional control. Twenty-two PwMS and fatigue-MSF, 17 without fatigue-MSnF and 35 healthy volunteers underwent a three-stimulus P300 novelty task that elicits both the P3a and the P3b components. P3b latency was comparable between groups, but PwMS, independently from the presence of fatigue displayed significantly greater P3b amplitudes. P3a latency was significantly prolonged in MSF alone, while P3a amplitude in MSnF group was greater than controls. MSF were able to categorize the task-relevant target stimulus but the orienting response to a novel salient stimulus was delayed, indicating an impairment in bottom-up attentional control mechanism related to ventral attention network. Fatigue is selectively associated with a covert attentional deficit related to the ability to reallocate attentional resources to salient stimuli, a crucial function of adaptive decision-making behaviour.
Collapse
Affiliation(s)
- Caterina Pauletti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy.
| | - Daniela Mannarelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Flavia Pauri
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Alessia Petritis
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Andrea Maffucci
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Antonio Currà
- Academic Neurology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Terracina, 04019, Italy
| | - Francesco Fattapposta
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| |
Collapse
|
4
|
Tomasino B, Bonivento C, Dal Bello S, Lamon E, Garbo R, Gigli GL, D'Agostini S, Valente M. Multisensory mental imagery of fatigue in patients with multiple Sclerosis. Preliminary evidence from a fMRI study. Neuroimage Clin 2024; 43:103651. [PMID: 39126997 PMCID: PMC11363993 DOI: 10.1016/j.nicl.2024.103651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/30/2024] [Accepted: 08/03/2024] [Indexed: 08/12/2024]
Abstract
Fatigue, defined as a subjective lack of physical and/or mental energy, is a clinical symptom highly characterizing multiple sclerosis (MS). The present study utilized a novel approach to the study of fatigue, examining first person-mental imagery of the symptom. Eighteen right-handed patients with MS (14F, 4 M, mean age 45.8 ± 8.15 years) were evaluated and were compared to nineteen healthy controls (10F, 9 M, mean age 43.15 ± 8.34 years) Patients were all in relapsing remitting form and no patient had presented relapses in the 6 months prior to inclusion in the study. We evaluated their behavioral performance and fMRI activations. We used an fMRI paradigm used to trigger first person-mental imagery of fatigue, through short sentences describing the principal manifestations of fatigue. Participants were asked to imagine the corresponding sensations (Sensory Imagery, SI). As a control, they had to imagine the visual scenes (Visual Imagery, VI) described in short phrases. They made a vividness rating by pressing the corresponding button. Behaviorally, we found that patients' mean scores at the Multidimensional Fatigue Symptom Inventory for the general scale, physical scale, and mental scale were significantly higher than healthy controls (p = 0.05, p = 0.002, p = 0.006 respectively), but not for the emotional scale and for vigor scale (p = 0.207, n.s., p = 0.06, n.s.). In the imagery fMRI task, patients were significantly slower (mean reaction times and standard deviation: 2.24 s ± 0.33) than controls (mean reaction times and standard deviation: 1.918 s ± 0.455) for the SI task (Z=-2.058, p = 0.040), while no significant difference was found for the VI task. Regarding brain mapping, our main result is a group by task interaction. The SI task (vs. VI task) in healthy controls (relative to patients) increased activation in the left inferior parietal lobule. These preliminary results indicate that fatigue is related to dysfunctions in higher-order aspects of motor control, given the role of the posterior parietal lobe in motor planning and multisensory integration.
Collapse
Affiliation(s)
- Barbara Tomasino
- Scientific Institute IRCCS "Eugenio Medea", Polo FVG, Pasian di Prato (UD), Italy.
| | - Carolina Bonivento
- Scientific Institute IRCCS "Eugenio Medea", Polo FVG, Pasian di Prato (UD), Italy
| | - Simone Dal Bello
- Clinical Neurology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Eleonora Lamon
- Clinical Neurology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Riccardo Garbo
- Clinical Neurology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy; Neurology Unit, Department of Medicine (DMED), University of Udine, Italy
| | - Serena D'Agostini
- Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy; Neurology Unit, Department of Medicine (DMED), University of Udine, Italy
| |
Collapse
|
5
|
Leussink VI, Jankovic M, Groth M, Schuh K, Sauerbeck IS, Hoffmann O. Addition of quantitative MRI to the routine clinical care of patients with multiple sclerosis-Results from the MAGNON project. Brain Behav 2024; 14:e3548. [PMID: 38841819 PMCID: PMC11154816 DOI: 10.1002/brb3.3548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The revised Lublin classification offers a framework for categorizing multiple sclerosis (MS) according to the clinical course and imaging results. Diagnosis of secondary progressive MS (SPMS) is often delayed by a period of uncertainty. Several quantitative magnetic resonance imaging (qMRI) markers are associated with progressive disease states, but they are not usually available in clinical practice. METHODS The MAGNON project enrolled 629 patients (early relapsing-remitting MS (RRMS), n = 51; RRMS with suspected SPMS, n = 386; SPMS, n = 192) at 55 centers in Germany. Routine magnetic resonance imaging (MRI) scans at baseline and after 12 months were analyzed using a centralized automatic processing pipeline to quantify lesions and normalized brain and thalamic volume. Clinical measures included relapse activity, disability, and MS phenotyping. Neurologists completed questionnaires before and after receiving the qMRI reports. RESULTS According to the physicians' reports, qMRI results changed their assessment of the patient in 31.8% (baseline scan) and 27.6% (follow-up scan). For ∼50% of patients with RRMS with suspected SPMS, reports provided additional information that the patient was transitioning to SPMS. In >25% of all patients, this information influenced the physicians' assessment of the patient's current phenotype. However, actual changes of treatment were reported only in a minority of these patients. CONCLUSIONS The MAGNON results suggest that standardized qMRI reports may be integrated into the routine clinical care of MS patients and support the application of the Lublin classification as well as treatment decisions. The highest impact was reported in patients with suspected SPMS, indicating a potential to reduce diagnostic uncertainty.
Collapse
Affiliation(s)
| | | | - Marie Groth
- Clinical Research NeuroscienceNovartis Pharma GmbHNurembergGermany
| | - Katrin Schuh
- Clinical Research NeuroscienceNovartis Pharma GmbHNurembergGermany
| | | | - Olaf Hoffmann
- St. Josefs‐Krankenhaus Potsdam‐SanssouciPotsdamGermany
- Medizinische Hochschule Brandenburg Theodor FontaneNeuruppinGermany
| |
Collapse
|
6
|
Mercadante S. Palliative Care Aspects in Multiple Sclerosis. J Pain Symptom Manage 2024; 67:e425-e437. [PMID: 38219965 DOI: 10.1016/j.jpainsymman.2024.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
CONTEXT Multiple sclerosis (MS) is an inflammatory, chronic, demyelinating, and neurodegenerative disorder of central nervous system, determined by an auto-immune dysfunction. Severe disability generally occurs in patients with progressive forms of MS that typically develop either after an earlier relapsing phase or less commonly from disease onset. Despite advances in research to slow the progression of MS, this condition remains a life-limiting disease with symptoms impacting negatively the lives of patients and caregivers. OBJECTIVES To analyze the difefrent aspects of palliative cae in patients with MS. METHODS To analyse selected literature assessing several palliative care aspects in patients with MS. RESULTS People with MS have complex symptoms and different needs. These demands include how to deal with the burden of physical disability, how to organise daily life, restructuring social roles in the family and at work, keeping self-sufficiency in personal care, and preserving personal identity and community roles. CONCLUSION An early palliative care approach aims to improve the palliative care skills and competencies of health professionals caring for the patients since the early stage of disease, including those who are actively undergoing disease-targeted therapies, rather than merely providing end-of-life care.
Collapse
Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care (S.M.), La Maddalena Cancer Center, Regional Home care program, SAMOT, Palermo, Italy.
| |
Collapse
|