People with multiple sclerosis (PwMS) often experience symptoms that can have a significant impact on psychological and cognitive functioning. Research has previously shown a significant...Show morePeople with multiple sclerosis (PwMS) often experience symptoms that can have a significant impact on psychological and cognitive functioning. Research has previously shown a significant association between these two functions. The aim of this paper was to study the association between psychological factors (depression and fatigue) and cognitive functions (memory, verbal fluency, and information processing speed). Studying fatigue, depressed mood, and the combination between them can provide important indications to how psychological status relates to cognitive functioning. Cognitive functions of memory, verbal fluency, and information processing speed were measured through Buschke Selective Reminding test, Controlled Oral Word Association test, and the Symbol Digit Modalities test, respectively. Depressed mood was measured with the Hospital Anxiety and Depression Scale, and fatigue was measured with the Fatigue Scale for Motor and Cognitive Functions. Patients (N=124; mean age = 50.77 [SD = 13.5]; 25% male, 93% female; 9.7% PPMS, 28.5% SPMS, 61.3% RRMS) were categorized into four groups based on their depression and fatigue scores using clinical cut-offs (i.e., psychologically intact [no depressive mood, not fatigued], depressive mood but not fatigued, fatigued but no depressive mood, and psychologically impaired [depressive mood and fatigued]). Group did significantly differ on MS type (p < .05), Group 1 (psychologically intact) and Group 4 (no depressive mood but fatigued) were more likely to have a relapse-remitting disease course. However, findings suggest no significant association between group and cognitive functioning. Scores on the cognitive tests were similar across all groups (p = .203). This indicates that cognitive functioning is independent of psychological status. However, in light of the limitations, it is important to build on future studies to investigate this relationship further, to indicate a next step in the treatment and intervention of MS in terms of psychological problems, cognitive deficits, or both.Show less
Multiple Sclerosis (MS) is a chronic disease of the central nervous system that affects an estimate of 2.8 million people worldwide. Fatigue, impairments in processing speed, and depression are...Show moreMultiple Sclerosis (MS) is a chronic disease of the central nervous system that affects an estimate of 2.8 million people worldwide. Fatigue, impairments in processing speed, and depression are common symptoms reported by People with MS (PwMS). However, the relationship between these symptoms is not well understood. This study aimed to investigate this relationship and examine the (in)stability of fatigue levels over time in PwMS. The study utilized a longitudinal, retrospective cohort design and included participants diagnosed with MS (n= 141) who attended a specialized clinic in Overpelt, Belgium. Seventy-three percent of the sample was female, with a mean age of 51.88 (SD ±13.46). The average disease duration was of 16.94 years (SD ± 8.86), and a majority of the sample had the relapsing-remitting type of MS (RRMS) (n= 43). The median of disease severity, as measured by the EDSS, was of 3.50 (IQR – 3.5). The study hypothesized that fatigue levels would increase over time and that depression would moderate the relationship between fatigue and processing speed. Fatigue levels did not significantly change over time (p = 0.055). A significant relationship was found between fatigue and processing speed impairment (p < 0.05). However, depression did not significantly moderate this relationship (p = 0.215). These findings show that cognitive symptoms may influence each other in MS. Future research should look into the relationship of mood disorders, such as anxiety and depression, and cognitive impairment in PwMS.Show less
Information processing speed (IPS) impairment is a disabling cognitive symptom often present in people with multiple sclerosis (PwMS). IPS is the foundation of higher order cognitive processes, and...Show moreInformation processing speed (IPS) impairment is a disabling cognitive symptom often present in people with multiple sclerosis (PwMS). IPS is the foundation of higher order cognitive processes, and therefore IPS dysfunction significantly lowers quality of live. Early identification of PwMS at risk for IPS decline is necessary in order to provide timely cognitive rehabilitation and psychoeducation. As such, identifying who will or will not develop IPS impairment over time is important. Here, we investigated retrospectively which characteristics were associated with IPS impairment in a real-life sample of 218 PwMS (158 female; age M=47±12.7; baseline disease duration M=9.8±9.9) that visited the Noorderhart Rehabilitation and MS Centre in Overpelt (Belgium). IPS decline was determined based on performance on the Symbol Digit Modalities Test (SDMT), with two threshold settings: (1) minus 1.5 standard deviation, and (2) minus eight points decline of raw score. Next to SDMT scores, demographic information was collected (sex, age, educational level) as well as MS-specific characteristics (disease severity [measured with the EDSS], disease duration, MS subtype), and psychological measures (fatigue [FSMC], depression and anxiety [HADS]). The analyses at baseline showed that EDSS score (impaired median=4 [2.5-6]; preserved median=2 [1.1-3.5]; d=0.9), disease duration (impaired M=11±10.8; preserved M=7±7.6; ƞ2=0.04), MS subtype (V=0.26), and perceived fatigue (impaired M=68.2±18.5; preserved M=53.5±20.8; d=0.75) were significantly higher/ progressive for IPS impaired PwMS (N=134) compared to preserved (N=84). Measured over time (average of three years), nine PwMS (N=50) were found to decline from preserved IPS functioning into impairment, independent of threshold setting for impairment. However, for both thresholds no longitudinal differences between IPS impaired and preserved PwMS were found. Our results demonstrate that IPS impairment is very prevalent in PwMS (61% at baseline) and is associated with higher levels of disability (more progressive subtype, longer disease duration, higher disease severity) and more fatigue. Worsening of these factors indicate the need to pay extra attention to IPS functioning. Secondly, IPS impairment does not develop quickly, with only a few PwMS (9/50) who decline into IPS impairment in a three-year period. It is recommended to start early with regular measurements of cognitive functioning to detect initial IPS changes.Show less
Background. Multiple sclerosis (MS) is a degenerative disease affecting the central nervous system. Symptoms include fatigue, worsening mobility, and cognitive impairment. Unemployment is common in...Show moreBackground. Multiple sclerosis (MS) is a degenerative disease affecting the central nervous system. Symptoms include fatigue, worsening mobility, and cognitive impairment. Unemployment is common in the MS-community. Within 10 years of disease onset 50-80% of MS-patients will be unemployed. Absenteeism often precedes unemployment. Work absenteeism has been associated with several physical and psychological factors in MS, such as fatigue, and use of maladaptive coping styles. Our aim is to investigate both fatigue and maladaptive coping as possible predictors for work absenteeism. To our knowledge coping and fatigue have not been investigated together with respect to work absenteeism in MS-patients. It is important to study absenteeism to prevent future unemployment as much as possible. Method. We investigated 269 employed MS-patients (age 21-63, Mage = 42.09, SDage = 9.39, 77.3% female) of which 47 had been absent within the last seven days. Participants completed questionnaires regarding fatigue (checklist for individual strength), coping style (coping inventory for stressful situations), and work absenteeism. We conducted three logistic regression analyses in which absenteeism was the dependent variable. Fatigue was investigated with subjective fatigue, motivation, concentration, and physical activity as predictors. Coping style was investigated with task-oriented, emotion-oriented, and avoidant coping as predictors. The last analysis investigated both fatigue and coping as predictors for absenteeism with all previous predictors mentioned. Results. A model in which multidimensional aspects of fatigue predict absenteeism was significant (X2(4) = 30.46, p < .001), fatigue, concentration, and physical activity were significant predictors of absenteeism (Bfatigue = 0.04, p = .036; Bconcentration = 0.07, p = .011, Bphysical_activity = -0.03, p = .032 respectively).Show less
Adherence to a healthy lifestyle is an important requirement for patients with chronic kidney disease, as it can prevent disease progression and mortality. However, many patients find this...Show moreAdherence to a healthy lifestyle is an important requirement for patients with chronic kidney disease, as it can prevent disease progression and mortality. However, many patients find this difficult. In addition, people living with chronic kidney disease also experience various symptoms, of which fatigue is the most common and also the most impeding when it comes to carrying out daily activities. To increase adherence to a healthy lifestyle it is necessary to investigate which factors hinder or facilitate this adherence to a healthy lifestyle. Therefore, this study examined (1) whether fatigue may be a barrier for adhering to a healthy lifestyle, defined as adhering to guidelines regarding a healthy diet and taking physical activity, and adherence to an intervention to support a healthy lifestyle. This study also examined (2) whether actively participating in a lifestyle intervention is indeed related to improving lifestyle over time, and (3) whether the relation between fatigue and a change in healthy lifestyle adherence over time is mediated by the level of intervention adherence. To answer these research questions, an observational study was conducted. This study was a sub-project of the E-GOAL study, which comprised a multicenter randomized controlled trial (RCT) among patients with chronic kidney disease (N = 121) to assess the effectiveness of lifestyle intervention. The participants who were randomly assigned to the intervention group (N = 60) received an online intervention program including tailored e-coach modules with home assignments and e-coaching of a psychologist. This study distinguished two measures of intervention adherence: objective and subjective intervention adherence. Questionnaires were used to measure fatigue (SFQ), diet adherence, physical activity adherence (SQUASH), and subjective intervention adherence, which participants had to complete at baseline (t = 0) and after the 3-month during intervention (t = 3). To measure objective intervention adherence, the psychologist's records were used to calculate the average number of modules completed per week. To test the hypotheses, hierarchical multiple regression analyses and mediation analyses with Hayes' PROCESS macro model were performed. During the analyses, adjustments were made for baseline values, age, gender, and employment situation. The analyses revealed that, contrary to expectations (1) fatigue was not related to a change in physical activity adherence over time, and (2) fatigue was positive instead of negative related to a change in diet adherence over time, (3) and this effect between fatigue and a change in diet adherence overtime was fully mediated by patients' selfreported level of intervention adherence. In conclusion, more fatigued patients reported better adherence to the intervention and were, therefore, more adherent to a healthy diet over time. A suggestion for clinical practice is therefore to incorporate interventions such as the E-GOAL intervention into the standard treatment of chronic kidney disease. Further research is needed on fatigue as a barrier and what interventions need to improve physical activity adherence as well.Show less
Background. Multiple sclerosis (MS) is a degenerative disease affecting the central nervous system. Symptoms include fatigue, worsening mobility, and cognitive impairment. Unemployment is common in...Show moreBackground. Multiple sclerosis (MS) is a degenerative disease affecting the central nervous system. Symptoms include fatigue, worsening mobility, and cognitive impairment. Unemployment is common in the MS-community. Within 10 years of disease onset 50-80% of MS-patients will be unemployed. Absenteeism often precedes unemployment. Work absenteeism has been associated with several physical and psychological factors in MS, such as fatigue, and use of maladaptive coping styles. Our aim is to investigate both fatigue and maladaptive coping as possible predictors for work absenteeism. To our knowledge coping and fatigue have not been investigated together with respect to work absenteeism in MS-patients. It is important to study absenteeism to prevent future unemployment as much as possible. Method. We investigated 269 employed MS-patients (age 21-63, Mage = 42.09, SDage = 9.39, 77.3% female) of which 47 had been absent within the last seven days. Participants completed questionnaires regarding fatigue (checklist for individual strength), coping style (coping inventory for stressful situations), and work absenteeism. We conducted three logistic regression analyses in which absenteeism was the dependent variable. Fatigue was investigated with subjective fatigue, motivation, concentration, and physical activity as predictors. Coping style was investigated with task-oriented, emotion-oriented, and avoidant coping as predictors. The last analysis investigated both fatigue and coping as predictors for absenteeism with all previous predictors mentioned. Results. A model in which multidimensional aspects of fatigue predict absenteeism was significant (X 2 (4) = 30.46, p < .001), fatigue, concentration, and physical activity were significant predictors of absenteeism (Bfatigue = 0.04, p = .036; Bconcentration = 0.07, p = .011, Bphysical_activity = -0.03, p = .032 respectively). A model in which coping style predicts work absenteeism was non-significant (X 2 (3) = 5.88, p = .118). The model in which both fatigue and coping were investigated was significant (X 2 (7) = 30.80, p < .001), however this model did not yield any additional information. Conclusion. Fatigue, concentration, and physical activity predict work absenteeism for MS-patients. Possible interventions might be CBT or motivational interviewing, both these interventions can be used to minimize work absenteeism.Show less
