Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Hechenberger, SMC.
Hidden Symptoms in Multiple Sclerosis: Cognitive Impairment and Fatigue.
[ Dissertation ] Universität Graz; 2024. pp.139.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Pinter Daniela Theresia
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- Abstract:
- The majority of people with multiple sclerosis (pwMS) suffer from "hidden" symptoms, with fatigue (78%) and cognitive impairment (65%) being the most commonly reported. These symptoms significantly affect patients' quality of life, working ability, and social integration. They are among the most debilitating features of MS, and more profound understanding could improve the management of these symptoms. Therefore, this thesis investigated three key areas: (1) the relationship between cognition and physical disability, (2) the application of an iPad®-based cognitive assessment in a clinical setting, and (3) psychological and brain magnetic resonance imaging (MRI) factors potentially influencing fatigue. The first study examined if cognition serves as a potential prognostic marker for physical impairment and disease progression in pwMS. The findings suggest that cognitive function, particularly information processing speed, is a crucial marker for the evolution of MS and could serve as an independent prognostic marker for physical impairment and progression due to shared underlying brain pathology. This highlights the importance of integrating neuropsychological assessments into standard clinical care to better monitor MS progression. The second study evaluated a self-administered iPad®-based processing speed test (PST) for use in clinical routine settings. The results showed that the PST demonstrates high feasibility and strong validity, correlates well with the established Symbol Digit Modalities Test (SDMT) and other cognitive assessments, as well as with MRI parameters and psychological factors, such as level of depression, anxiety, and fatigue. However, the study found that the commonly used threshold of -1.5 standard deviations for the PST is not appropriate in Europe, as it identified fewer cases of impaired processing speed compared to the SDMT. The results underscore the importance of comprehensive neuropsychological assessment, but also suggest that the PST could be a valuable tool for resource-efficient cognitive screening in pwMS. In the third study, we examined how psychological factors and brain MRI metrics are associated with fatigue in pwMS and healthy controls (HC). We found that depression and self-efficacy significantly affect fatigue severity in both pwMS and HC. Additionally, white matter integrity (a microstructural MRI metric) along the cortico-striato-thalamo-cortical loop explained incremental variance of fatigue only in pwMS. Overall, findings of this thesis underlined that cognitive impairment and fatigue are common in MS. They are not isolated features but closely related to other MS-symptoms, adding information about progression of the disease. Furthermore, our research critically evaluated a more efficient cognitive assessment in clinical routine. Moreover, we found that not only neurobiological changes lead to fatigue, but malleable psychological factors influence perceived fatigue severity, providing crucial information for the development of targeted treatment.