Fatigue is the worst debilitating symptom of patients with MS (multiple sclerosis) as it severely limits their participation in the public sphere and the workforce, besides alienating their interpersonal relationships. It has a subjective component, i.e. how patients feel, and an objective one, i.e. the diminished performance in physical and intellectual tasks. Kluger et al. created a unified taxonomy to guide its treatment in the medical settings.

Perceived fatigue is what the patient actually feels at any given time; it can be defined as a lack of purpose in daily activities that hampers performance.

Fatigability (also called performance fatigability) is what can be objectively measured by an examiner; it is defined by the measure of change in the performance of a physical or a cognitive task over a certain period of time.

Perceived fatigue is measured by the “Neurological Fatigue Index” (NFI-MS), which was approved by the FDA. It is made of 23 standard questions that cover three domains of fatigue; physical, cognitive and sleep quality. It also has a summary scale that covers the physical and cognitive domains. Fatigability can be measured with a 6-Minute Walk Test (6MWT), a grip strength test and the response speed to different cognitive tests. The third measurement of fatigability is carried out with the “Continuous Performance Test” (CPT) that checks the timely attention in front of a computer screen.

Mayis Aldughmi et al. studied the perceived fatigability and fatigability in 52 patients with mild forms of MS with a mean age of 46 years. The percent change score of the 6MWT was not statistically associated with the physical domain, the cognitive domain or the summary scale. The grip strength test change scores were not statistically associated with physical domain, the cognitive domain or the summary scale. But the performance fatigability was statistically associated with the three parameters of the NFI-MS. The data illustrates that performance fatigability during an attention-based test is associated with increased physical and cognitive perceived fatigue and the overall perceived fatigue. However those assessments of performance fatigability during a physical task did not yield some significant results. This study showed that the presence of depression was associated with fatigue.

In this study MS patients had fatigue after 3 performance fatigability tests: walking, handgrip and attention. Only attention had a statistically significant association with perceived fatigue, unlike the other 2 performance measures.

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14 thoughts on “Fatigue in Multiple Sclerosis

  1. Definitely fatigue is my worse part of my MS. I can handle my numb hands better than I can the fatigue. Recently, I got my handicap parking plaque cause of the fatigue, but have been struggling on using it because I feel I am giving in the fatigue. I have taken a big look at myself and had to remind myself it is me not giving in but keeping myself movin!

    1. Dear Kate: good morning and thanks for the commentary. It is extremely counter-productive to push yourself when you feel severe fatigue. Just try to relax, close the computer lid and engage in some light housekeeping like preparing a tasty snack for your family. Ciao!

  2. Some doctors here in the states “blame” the fatigue we complain about on being depressed…the cognitive issues on the meds we take, etc. I am happy to see research being done, perhaps they will also find a good treatment?

    1. Good evening dear Grace. Yes, there is ongoing research about this issue and I will blog about it when I return in March. Thanks for visiting my page. Un baccione. Arrivederci!

    1. Good morning Del and thanks for the commentary. Yes it does take a heavy emotional toll on the close family members. Very traumatic and sad. Ciao!

  3. Thank you for sharing this! I can say that fatigue is definitely one of the worst things I deal with. After I get showered, hair and make up done in the morning I feel like I need a nap. When I have to focus for LONG periods of time I get so exhausted. I knew that fatigue was a huge issue for those with MS but I really think a few months ago I had more energy but maybe not. Driving 10 miles to work, which actually takes 30 minutes sometimes is a difficult task! This really was a fantastic post with wonderful information! Take Care!!!

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