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02.08.2021 | Original Article

Unveiling the relationship between autonomic involvement, fatigue, and cognitive dysfunction in early relapsing–remitting multiple sclerosis

verfasst von: Alessandro Dinoto, Sara Baldini, Maria Elisa Morelli, Fulvio Pasquin, Alessio Bratina, Antonio Bosco, Arianna Sartori, Paolo Manganotti

Erschienen in: Neurological Sciences | Ausgabe 10/2021

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Abstract

Background

Fatigue is a common, yet disabling, symptom in patients with multiple sclerosis (PwMS). Fatigue has shown to be associated with self-reported autonomic nervous system (ANS) symptoms, particularly for cognitive fatigue; however, the question whether ANS involvement is related to cognitive impairment has never been addressed. We performed a study to unveil the complex relationship between fatigue, ANS symptoms, and cognitive impairment.

Methods

We prospectively recruited early PwMS that were tested with Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS) and Composite Autonomic Symptoms Scale-31 (COMPASS-31) scale. We performed a comparison between fatigued and non-fatigued patients and between cognitive unimpaired and impaired patients. We evaluated the association of COMPASS-31, MFIS, BDI, STAI, and BICAMS scores, and the analysis was repeated for each scale’s sub-scores. A multivariable analysis was performed to elucidate predictors of fatigue.

Results

Forty-four patients were recruited. Fatigued patients had higher COMPASS-31 total, orthostatic intolerance, secretomotor, and pupillomotor scores. No differences in fatigue and ANS symptoms were found between cognitive impaired and unimpaired patients. MFIS total score correlated with STAI state (p = 0.002) and trait (p < 0.001), BDI (p < 0.001), COMPASS-31 total (p < 0.001), orthostatic intolerance (p < 0.001), pupillomotor scores (p = 0.006). Multivariable analysis showed that BDI (p < 0.001) and COMPASS-31 (p = 0.021) predicted MFIS score. Sub-scores analysis showed that orthostatic intolerance has a relevant role in fatigue.

Conclusion

ANS symptoms are closely related with fatigue. Orthostatic intolerance may have a predominant role. Cognitive impairment seems not to be associated with ANS symptoms.

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Titel: Unveiling the relationship between autonomic involvement, fatigue, and cognitive dysfunction in early relapsing–remitting multiple sclerosis
verfasst von: Alessandro Dinoto
Sara Baldini
Maria Elisa Morelli
Fulvio Pasquin
Alessio Bratina
Antonio Bosco
Arianna Sartori
Paolo Manganotti
Publikationsdatum: 02.08.2021
Verlag: Springer International Publishing
Erschienen in: Neurological Sciences / Ausgabe 10/2021
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-021-05487-6

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Abstract

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