Fatigue, commonly called MS lassitude, can affect a patient's perception of their own cognitive abilities. courtesy of MS FoundationBy Dave DeFusco
Fatigue plays a significant role in how people with Multiple Sclerosis and their clinicians perceive and identify cognitive difficulties, according to a recently published paper co-authored by Dr. Marissa Barrera, assistant dean of health sciences and director of the Katz School鈥檚 M.S. in Speech-Language Pathology.
Fatigue dictates a patient鈥檚 perception of cognitive difficulties, whereas a clinician鈥檚 perception is affected by multiple factors, including cognitive and behavioral difficulties, according to the authors of the paper, 鈥,鈥 published in the journal Multiple Sclerosis and Related Disorders.
鈥淔atigue is hard for healthcare providers to measure and understand its effect on someone with MS throughout the day,鈥 said Dr. Barrera. 鈥淲hat we鈥檙e trying to explore is their perception of how fatigue affects them and the reality of it on cognitive performance measures.鈥
With Multiple Sclerosis (MS), a person鈥檚 immune system goes awry and attacks the fatty sleeves surrounding the nerves in the brain and spine. Symptoms include numbness in the extremities, spasticity and visual changes. Moreover, MS is characterized by episodes of unusual neurological symptoms that come and go, usually lasting days or weeks. Still, there are different forms of the disorder, and they can vary widely in symptom intensity and rate of progression.
MS also causes cognitive impairment, including difficulty with memory, processing speed and executive functioning. Approximately 40% to 65% of people with MS show varying degrees and combinations of cognitive impairment on neuropsychological assessments. Fatigue and depression are commonly reported symptoms and have been shown to significantly impact an MS patient鈥檚 daily functioning and quality of life.
In the study, 202 patients with MS, ranging in age from 20 to 88 and 71% female, were asked if they had trouble with their memory as a result of MS. Clinicians were asked whether they believed their patient had a problem with memory due to MS. A computerized cognitive screening battery, called NeuroTrax, then assessed patients鈥 cognitive functioning by testing their memory (verbal and nonverbal), executive function, visual-spatial and verbal proficiency, ability to pay attention, information processing speed and motor skills.
Clinicians assessed memory impairment using the Expanded Disability Status Scale (EDSS), a widely used measure of detecting disability in MS patients, and clinicians and patients estimated cognitive deficits along a Likert scale, which measures attitudes, ranging from none, mild, moderate and severe.
The researchers found that patients鈥 accuracy in detecting attention deficits was 鈥渓ow,鈥 while clinicians鈥 accuracy in detecting global cognitive impairment and a number of specific domain deficits was 鈥渕oderate.鈥 For patients, fatigue was a significant factor in how they perceived their own cognitive performance, while clinicians evaluated their patients鈥 performance through multiple factors, including cognitive scores, physical disability, age and depression.
Overall, there was a lack of consistent agreement among MS patients and clinicians on the presence of cognitive impairment. Of the 202 people studied, 158, or 78%, reported noticing some level of cognitive difficulties which were influenced by their experience with fatigue, whereas clinicians predicted that 42, or 21%, had some degree of cognitive difficulties.
鈥淐ognitive deficits continue to be underreported and undiagnosed in people with MS because doctors and practitioners are often more focused on mobility and disease management,鈥 said Dr. Barrera. 鈥淐ognition, language and swallowing are in critical need of more attention.鈥
The researchers said that incorporating screening tests for cognitive impairment should be part of routine care. Early detection would provide multiple opportunities to compensate for, stabilize or improve cognitive impairment, while also addressing its emotional consequences, that would improve a patient鈥檚 quality of life.
Dr. Barrera said that the ultimate purpose of the research is to improve bedside interactions for people with MS. Faculty and students in the Katz School鈥檚 Occupational Therapy Doctorate program will be joining her and her colleagues in later rounds of the research and will continue to explore how clinicians can better identify and help patients manage cognitive change.
鈥淭he longer we can keep people with MS happy, healthy and working,鈥 said Dr. Barrera, 鈥渢he better for them and society.鈥
