背景:疲劳在多发性硬化症(MS)和老年人群中都是一种普遍且使人衰弱的症状。测量感知疲劳的传统方法可能不能充分说明个体活动差异,导致不同的患病率。具有预定强度和持续时间的特定活动的感知疲劳性锚杆,从而减轻自我起搏偏差。尽管有潜力,老年人对感知的易疲劳性知之甚少,特别是那些有神经系统疾病的人,包括女士因此,这项研究的目的是(1)调查是否,在老年人中,MS与感知到的身体和精神疲劳性差有关;(2)评估是否,在患有MS(OAMS)的老年人中,患者报告的疾病相关残疾增加与感知到的身体和精神疲劳性差相关.
方法:参与者是96名经医生确诊为MS的老年人(平均年龄:64.6±4.2)和110名健康对照(平均年龄:68.2±7.2)。通过既定的病例会议程序,所有病例均被确认为无痴呆症。使用匹兹堡疲劳性量表测量身体和精神疲劳性,10个项目的问卷(得分范围:0至50),旨在评估个人在进行一系列典型的老年人活动后期望感到的疲劳水平。使用患者确定的疾病步骤量表评估MS疾病相关残疾,范围从0(正常)到8(卧床不起),分数≥2表示中位拆分后MS相关残疾更差。进行了单独的线性回归模型来调查组状态(MS与对照)作为预测因子,感知的身体和精神疲劳性得分作为结果变量。在MS组中,我们采用其他线性回归模型来探讨疾病相关残疾与易疲劳水平之间的关系.所有型号都根据年龄进行了调整,性别,种族,教育,全球健康,一般认知功能,和抑郁症状水平。
结果:完全调整的模型产生了以下关键发现:OAMS报告了明显高于对照组(M=17.95±8.35)的感知身体疲劳水平(M=25.11±9.67)(p=0.003)。同样,OAMS(M=16.82±11.79)的感知精神疲劳性显着大于对照组(M=9.15±7.12)(p=0.003)。在MS组中,与疾病相关的残疾程度更高的个体报告说,两种身体的水平都明显更高(M=30.13±7.71vs.18.67±8.00,p<0.001)和精神疲劳性(M=20.31±12.18vs.12.33±9.69,p=0.009)与MS相关残疾较低的人相比。值得注意的是,这些发现的重要性在校正抑郁症状的模型中仍然存在.
结论:我们的研究提供了令人信服的证据,表明与健康对照组相比,OAMS表现出明显更高的身体和精神疲劳性。此外,更差的MS相关残疾与更差的身体和精神疲劳相关。在调整包括抑郁症状在内的混杂因素后,这些结果仍然存在。我们的发现强调了全面管理策略的必要性,以满足MS的生理和心理方面,为未来的研究奠定基础,以揭示有和没有MS的老年人的易疲劳性的病理生理机制。
BACKGROUND: Fatigue stands out as a prevalent and debilitating symptom in both Multiple Sclerosis (MS) and the aging population. Traditional methods for measuring perceived fatigue may not adequately account for individual activity differences, leading to varied prevalence rates. Perceived
fatigability anchors fatigue to specific activities with predetermined intensity and duration, thereby mitigating self-pacing bias. Despite its potential, perceived
fatigability is poorly understood in older adults, particularly those with neurological conditions, including MS. This study thus aimed to (1) investigate whether, among older adults, MS was associated with worse perceived physical and mental fatigability; (2) evaluate whether, among older adults with MS (OAMS), greater patient-reported disease-related disability was associated with worse perceived physical and mental fatigability.
METHODS: Participants were 96 older adults with a physician-confirmed diagnosis of MS (mean age: 64.6 ± 4.2) and 110 healthy controls (mean age: 68.2 ± 7.2), all confirmed to be dementia-free through established case conference procedures. Physical and mental
fatigability were measured using the Pittsburgh
Fatigability Scale, a 10-item questionnaire (score range: 0 to 50) designed to assess fatigue levels that individuals expect to feel after engaging in a range of typical activities for older adults. MS disease-related disability was assessed with the Patient Determined Disease Steps scale, which ranges from 0 (normal) to 8 (bedridden), with scores ≥ 2 indicating worse MS-related disability after a median split. Separate linear regression models were performed to investigate associations between group status (MS vs. Control) as the predictor and perceived physical and mental
fatigability scores as the outcome variables. Within the MS group, additional linear regression models were performed to explore the relationship between disease-related disability and fatigability levels. All models adjusted for age, sex, race, education, global health, general cognitive function, and depressive symptoms levels.
RESULTS: The fully adjusted models yielded the following key findings: OAMS reported significantly higher levels of perceived physical fatigability (M = 25.11 ± 9.67) compared to controls (M = 17.95 ± 8.35) (p = 0.003). Similarly, the perceived mental fatigability in OAMS (M = 16.82 ± 11.79) was significantly greater than that in controls (M = 9.15 ± 7.12) (p = 0.003). Within the MS group, individuals with greater disease-related disability reported significantly greater levels of both physical (M = 30.13 ± 7.71 vs. 18.67 ± 8.00, p < 0.001) and mental fatigability (M = 20.31 ± 12.18 vs. 12.33 ± 9.69, p = 0.009) compared to those with lower MS-related disability. Of note, the significance of these findings persisted in models that adjusted for depressive symptoms.
CONCLUSIONS: Our study provides compelling evidence that OAMS exhibit significantly higher perceived physical and mental fatigability compared to healthy controls. Additionally, worse MS-related disability correlates with worse physical and mental
fatigability. These results persist after adjusting for confounders including depressive symptoms. Our findings underscore the necessity of holistic management strategies that cater to both physical and psychological aspects of MS, laying a foundation for future studies to uncover the pathophysiological mechanisms of fatigability in older adults with and without MS.