Bailey, Alastair; (2003) An investigation into fatigue and cognitive function in advanced multiple sclerosis. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Fatigue is a common symptom of multiple sclerosis (MS) and the impact of fatigue on the quality of life of a person with MS is significant. It has been associated with overall mental health, perceived control over the illness and unemployment. Cognitive impairment in MS is also common. People with MS are often impaired on measures of speed of information processing, attention, memory, executive function and working memory. As with fatigue, the psychosocial impact of cognitive dysfunction on the individual with MS is significant. However, there are relatively few investigations of the link between the two symptoms of MS. The present study aimed to examine the effects of fatigue on cognitive performance in MS. Of particular interest, were changes in cognitive performance within a task and across a session (which may be evidence of cognitive fatigue) and their relationship with self-reported fatigue and depression. Sixteen people with advanced MS and 19 healthy control participants completed two neuropsychological testing sessions. Each testing session involved repeated administration of a continuous cognitive task (the n-back task). At the beginning and the end of one session participants completed the 0-back task, a test of sustained attention. In the other session they completed repeated administration of the 1-back task, which requires sustained attention and has an additional working memory load. A neuropsychological battery was administered between each n-back presentation in each session. In addition, self-reported fatigue was measured at regular intervals during each session. All participants also completed depression and fatigue questionnaires. Overall, the performance of the MS group was worse than the control group on the n-back task and the neuropsychological tests. There was mixed evidence to support the notion that compared to a healthy control group, people with MS show more objective signs of cognitive fatigue (a decline in cognitive performance over time) during a continuous cognitive task. There was no significant evidence that people with MS showed a greater decline in performance across a neuropsychological testing session compared to a control group. However, participants with MS did report greater subjective changes in their level of fatigue across a testing session compared to the control group when the task had a working memory load. Also, ratings of the symptoms of fatigue were associated with symptoms of depression. However, a significant finding was the poor association between changes in subjective fatigue and changes in cognitive performance over the testing session. These findings suggest that although people with MS may report subjective changes in fatigue across a testing session, their cognitive performance may not necessarily reflect the same pattern. In addition, there appears to be a relationship between depression and fatigue that has important treatment implications and should be examined in future studies.

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