Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Eur J Neurol. 2020 Dec;27(12):2549-2560. doi: 10.1111/ene.14471. Epub 2020 Sep 6.
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.
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.
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.
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.
本研究旨在调查疲劳的流行程度及其与大型多发性硬化症（MS）患者队列中的临床、神经心理学和脑磁共振成像（MRI）变量的关系。
从 725 名健康对照者和 366 名 MS 患者（238 例复发缓解型 MS [RRMS]和 128 例进展型 MS [PMS]）中收集改良疲劳影响量表及其子域。对于改良疲劳影响量表的整体和子域，根据具有 90%特异性（即分类健康对照者的假阳性率为 10%）的逻辑回归模型的截断值，将 MS 患者分为疲劳（F-MS）或非疲劳（NF-MS）。MS 患者接受神经学、神经心理学和 MRI 评估。使用年龄、性别和表型调整的线性模型比较 F-MS 和 NF-MS 患者之间的临床和 MRI 测量值。使用特定的交互项测试表型之间的异质性。
全球疲劳影响了 174 名（47.5%）MS 患者，在 PMS 中更为普遍（PMS 为 64.1%，RRMS 为 38.7%，P<0.001）。对于所有二分法，F-MS 患者年龄较大（P<0.001 至 0.012）且抑郁程度较高（P<0.001）。与 NF-MS 患者相比，认知 F-MS 患者的教育程度较低（P=0.035）。与 NF-MS 患者相比，全球和躯体疲劳的患者仅在 RRMS 中扩展残疾状态量表更高（P<0.001）。只有躯体疲劳的 RRMS 患者与 NF-MS 患者相比，脑（P=0.05）、白质（P=0.039）和丘脑体积（P=0.022）较低。
在 MS 中，疲劳与年龄较大、教育程度较低和抑郁程度较高有关。仅在 RRMS 中，疲劳与扩展残疾状态量表和脑萎缩有关。残疾和结构损伤的平台效应可以解释 PMS 中缺乏关联的原因。
