Barak Yoram, Achiron Anat
Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
J Neurol Sci. 2006 Jun 15;245(1-2):73-6. doi: 10.1016/j.jns.2005.09.015. Epub 2006 Apr 19.
Multiple sclerosis (MS) patients commonly suffer from fatigue and define it as one of their most disabling symptom profoundly disrupting their lives. However, the relationship of fatigue to cognitive functions and its impact on quality of life have not been widely studied.
To define (1) "cognitive fatigue", (2) survey its frequency and (3) characterize severity and impact on quality of life in MS patients in the first 10 years of the disease.
A two-wave design was utilized to enrich the studied population in subjects whose fatigue is significant. In the first wave, fatigue was measured by the self-reported fatigue severity scale (FSS) in randomly selected MS patients from our computerized database. Patients responding to the 9th item of the FSS i.e., "Fatigue interferes with my work, family, or social life" by a grade of 3 or higher (of 7) were further assessed (wave two) by the fatigue impact scale (FIS) and the RAYS quality of life questionnaire.
Of the 259 patients that completed the first-wave screening, 158 patients (61%, 118 females, mean age 41.1+/-9.2 years, mean disease duration 6.2+/-5.5 years) satisfied the additional criterion and were defined to suffer from significant fatigue. The great majority of these patients-91.7%-had a relapsing-remitting disease course, mean FIS score was 77+/-25.9 and their mean EDSS was 2.9+/-2.6. Fatigue was reported to occur most of the day in 30.9% of patients, persist in 69% for more than 1 year, and in 59.8%, it was reported not to be associated with effort. No correlations were found between age, gender, disease duration or neurological disability and FIS cognitive subscale score. Significant correlations were found between the FIS cognitive subscale score and the three domains (physical, psychological and social-familial) of the RAYS quality of life questionnaire (p<0.001).
Cognitive fatigue was found in more than half of MS patients in the first decade from onset that were particularly selected for significant fatigue in their lives. This aspect of fatigue correlated with all quality of life domains and especially with psychological everyday tasks.
多发性硬化症（MS）患者常受疲劳困扰，并将其视为最具致残性的症状之一，严重影响他们的生活。然而，疲劳与认知功能的关系及其对生活质量的影响尚未得到广泛研究。
确定（1）“认知疲劳”，（2）调查其发生频率，（3）描述疾病发病头10年MS患者中疲劳的严重程度及其对生活质量的影响。
采用两阶段设计，以纳入疲劳程度显著的研究对象。在第一阶段，通过自我报告的疲劳严重程度量表（FSS）对从我们的计算机数据库中随机选取的MS患者进行疲劳测量。对FSS第9项即“疲劳干扰我的工作、家庭或社交生活”回答评分为3分或更高（满分7分）的患者，在第二阶段进一步通过疲劳影响量表（FIS）和RAYS生活质量问卷进行评估。
在完成第一阶段筛查的259例患者中，158例患者（61%，118例女性，平均年龄41.1±9.2岁，平均病程6.2±5.5年）符合附加标准，被定义为患有严重疲劳。这些患者中的绝大多数——91.7%——病程为复发缓解型，平均FIS评分为77±25.9，平均扩展残疾状态量表（EDSS）评分为2.9±2.6。据报告，30.9%的患者疲劳在一天中的大部分时间出现，69%的患者疲劳持续超过1年，59.8%的患者报告疲劳与活动量无关。未发现年龄、性别、病程或神经功能障碍与FIS认知子量表评分之间存在相关性。发现FIS认知子量表评分与RAYS生活质量问卷的三个领域（身体、心理和社会家庭）之间存在显著相关性（p<0.001）。
在发病后的头十年里，超过一半特别被选入研究的MS患者存在认知疲劳，这些患者在生活中存在明显疲劳。疲劳的这一方面与生活质量的所有领域相关，尤其是与日常心理任务相关。
