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Fatigue in multiple sclerosis patients with different clinical phenotypes: a clinical and magnetic resonance imaging study
Author(s) -
Marchesi O.,
Vizzino C.,
Meani A.,
Conti L.,
Riccitelli G. C.,
Preziosa P.,
Filippi M.,
Rocca M. A.
Publication year - 2020
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14471
Subject(s) - medicine , multiple sclerosis , magnetic resonance imaging , neuropsychology , cohort , expanded disability status scale , logistic regression , cognition , radiology , psychiatry
Background and purpose The prevalence of fatigue and its relation with clinical, neuropsychological and brain magnetic resonance imaging (MRI) variables in a large cohort of multiple sclerosis (MS) patients was investigated. Method The Modified Fatigue Impact Scale and its subdomains were collected from 725 healthy controls and 366 MS patients [238 relapsing–remitting (RRMS) and 128 progressive (PMS)]. For the Modified Fatigue Impact Scale global and subdomains, MS patients were classified as fatigued (F‐MS) or non‐fatigued (NF‐MS) according to cut‐off values provided by logistic regression models with a specificity of 90% (i.e. a 10% false‐positive rate in classifying healthy controls). MS patients underwent neurological, neuropsychological and MRI evaluations. Clinical and MRI measures were compared between F‐MS and NF‐MS patients using age‐, sex‐ and phenotype‐adjusted linear models. Heterogeneities between phenotypes were tested with specific interaction terms. Results Global fatigue affected 174 (47.5%) MS patients, being more prevalent in PMS (PMS 64.1% vs. RRMS 38.7%, P < 0.001). For all dichotomizations, F‐MS were older ( P from <0.001 to 0.012) and more depressed ( P < 0.001) than NF‐MS patients. Compared to NF‐MS, cognitive F‐MS patients had lower education ( P = 0.035). Compared to NF‐MS, patients with global and physical fatigue had higher Expanded Disability Status Scale only for RRMS ( P < 0.001). Only RRMS patients with physical fatigue had lower brain ( P = 0.05), white matter ( P = 0.039) and thalamic volumes ( P = 0.022) compared to NF‐MS patients. Conclusions In MS, fatigue is associated with older age, lower education and higher depression. Only in RRMS, fatigue is associated with Expanded Disability Status Scale and brain atrophy. A plateauing effect of disability and structural damage can explain the lack of associations in PMS.