Assessing Walking Endurance as an Indicator for Cognitive Decline in People with Multiple Sclerosis: A Cross-Sectional Study

INTRODUCTION Neurocognitive impairment occurs in 43 − 70% of people with multiple sclerosis (pwMS), of which most often in processing speed and visual and verbal learning and memory. Cognition is shown to improve with exercise in healthy populations, but in pwMS the results are not conclusive due to contradictory evidence, especially in cross-sectional studies. The Shuttle Walk Test (SWT) was validated for pwMS recently, allowing for new insights into the relations between endurance and cognition in pwMS. AIM To investigate (1) the relations between the Minimal Assessment of Cognitive Functions in Multiple Sclerosis test battery and the SWT, (2) whether there are cognitive differences between SWT abort reasons –reflecting cardiorespiratory and cardiovascular endurance–, and (3) if disability status has a mediating role between SWT abort reasons and walking endurance. METHODS 61 Dutch pwMS (40F) of working age (28 − 67) were measured for cognitive functioning and walking endurance...Show moreINTRODUCTION Neurocognitive impairment occurs in 43 − 70% of people with multiple sclerosis (pwMS), of which most often in processing speed and visual and verbal learning and memory. Cognition is shown to improve with exercise in healthy populations, but in pwMS the results are not conclusive due to contradictory evidence, especially in cross-sectional studies. The Shuttle Walk Test (SWT) was validated for pwMS recently, allowing for new insights into the relations between endurance and cognition in pwMS. AIM To investigate (1) the relations between the Minimal Assessment of Cognitive Functions in Multiple Sclerosis test battery and the SWT, (2) whether there are cognitive differences between SWT abort reasons –reflecting cardiorespiratory and cardiovascular endurance–, and (3) if disability status has a mediating role between SWT abort reasons and walking endurance. METHODS 61 Dutch pwMS (40F) of working age (28 − 67) were measured for cognitive functioning and walking endurance closely spread over two visits. The Minimal Assessment for Cognitive Functioning in Multiple Sclerosis and the SWT (walking endurance) were used as measurements. Cognitive scores were converted to z-scores with normdata and averaged per cognitive test. SWT associations with cognition were analysed with Pearson r correlations, ANOVAs were performed to assess cognitive differences between SWT abort reasons, and a mediation analysis was used to evaluate the relation between SWT abort reasons and walking distance, controlling for disability status. RESULTS Results show a significant correlation (r = .279, p = .031) between the SWT and Delis–Kaplan Executive Function System – System Sorting Task. No cognitive differences were found between SWT abort reasons, and the group representing cardiorespiratory endurance was too small to be analysed. Disability status did not come out as a mediating factor. CONCLUSION Some pwMS in early stages of the disease with impaired walking endurance might also have decreased executive functioning. This result agrees with some experimental research, but not with similar cross-sectional studies. Research should focus on the cognition–walking endurance relation in more heterogeneous pwMS populations. Lastly, specific executive functions should be identified in its association to executive functioning.Show less

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Assessing Walking Endurance as an Indicator for Cognitive Decline in People with Multiple Sclerosis: A Cross-Sectional Study