Unveiling the relationship between autonomic involvement, fatigue, and cognitive dysfunction in early relapsing-remitting multiple sclerosis

Alessandro Dinoto; Sara Baldini; Maria Elisa Morelli; Fulvio Pasquin; Alessio Bratina; Antonio Bosco; Arianna Sartori; Paolo Manganotti

doi:10.1007/s10072-021-05487-6

Unveiling the relationship between autonomic involvement, fatigue, and cognitive dysfunction in early relapsing-remitting multiple sclerosis

Neurol Sci. 2021 Oct;42(10):4281-4287. doi: 10.1007/s10072-021-05487-6. Epub 2021 Aug 2.

Authors

Alessandro Dinoto¹, Sara Baldini², Maria Elisa Morelli², Fulvio Pasquin², Alessio Bratina², Antonio Bosco², Arianna Sartori², Paolo Manganotti²

Affiliations

¹ Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy. alessandro.dinoto@hotmail.it.
² Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.

PMID: 34338931
DOI: 10.1007/s10072-021-05487-6

Abstract

Background: Fatigue is a common, yet disabling, symptom in patients with multiple sclerosis (PwMS). Fatigue has shown to be associated with self-reported autonomic nervous system (ANS) symptoms, particularly for cognitive fatigue; however, the question whether ANS involvement is related to cognitive impairment has never been addressed. We performed a study to unveil the complex relationship between fatigue, ANS symptoms, and cognitive impairment.

Methods: We prospectively recruited early PwMS that were tested with Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS) and Composite Autonomic Symptoms Scale-31 (COMPASS-31) scale. We performed a comparison between fatigued and non-fatigued patients and between cognitive unimpaired and impaired patients. We evaluated the association of COMPASS-31, MFIS, BDI, STAI, and BICAMS scores, and the analysis was repeated for each scale's sub-scores. A multivariable analysis was performed to elucidate predictors of fatigue.

Results: Forty-four patients were recruited. Fatigued patients had higher COMPASS-31 total, orthostatic intolerance, secretomotor, and pupillomotor scores. No differences in fatigue and ANS symptoms were found between cognitive impaired and unimpaired patients. MFIS total score correlated with STAI state (p = 0.002) and trait (p < 0.001), BDI (p < 0.001), COMPASS-31 total (p < 0.001), orthostatic intolerance (p < 0.001), pupillomotor scores (p = 0.006). Multivariable analysis showed that BDI (p < 0.001) and COMPASS-31 (p = 0.021) predicted MFIS score. Sub-scores analysis showed that orthostatic intolerance has a relevant role in fatigue.

Conclusion: ANS symptoms are closely related with fatigue. Orthostatic intolerance may have a predominant role. Cognitive impairment seems not to be associated with ANS symptoms.

Keywords: Autonomic nervous system; Cognitive impairment; Fatigue; Multiple sclerosis.

MeSH terms

Cognitive Dysfunction* / diagnosis
Cognitive Dysfunction* / etiology
Humans
Multiple Sclerosis*
Multiple Sclerosis, Relapsing-Remitting* / complications