LEARNING OBJECTIVES Enhance understanding of how common disease - PDF document

HOW ANXIETY AND FATIGUE INTERACT TO INTERFERE W ITH MS PATIENT’S PROCESSING SPEED MA 1 ,JENNIFER MILLER, MA 1 ,NICHOLAS VISSICHIO, MA 1 AND FRED FOLEY , PHD 1,2 CAROLIN E ALTARAS, CMSC 2019 PLATFORM PRESENTATION (1) RKAUF GRADUATE SCHOOL OF PSYCHOLOGY, YESHIVA UNIVERSITY, BRONX, NY; (2) HOLY NAME MEDICAL CENTER, TEANECK, NJ LEARNING OBJECTIVES  Enhance understanding of how common disease factors in MS interact to impact cognition  Evaluate considerations for interventions that may indirectly target and improve cognition

INFORMATION PROCESSING SPEED The rate an individual can process information  Definition:  Most commonly impaired cognitive domain in MS 1 Underlies functioning of other cognitive abilities (e.g., memory, executive functioning, working memory) 3–6  Mediates the adverse effect of depression on cognition 7   Reduced processing speed associated with: 8 Increased risk on unemployment  Worse quality of life (QOL)   Symbol Digit Modality Test (SDMT) is commonly used in MS to capture PS One of the most sensitive measures of cognitive impairment in MS and best predictors of unemployment 9,10  ANXIETY  Anxiety can be defined as “anticipation of future threat” associated with increased vigilance in preparation of potential threat (see DSM-5)  Highly prevalent in MS, affecting 15- 57% of patients More prevalent than depression in early stages  Linked to psychosocial implications of MS (e.g., uncertainty of the disease, adjustment to disability)   Anxiety has been shown to negatively impact cognition, specifically processing speed, executive functioning, episodic memory, as well as patient’s perception of cognitive impairment 2,26–30 Findings have been inconsistent  Less attention has been paid to the impact of anxiety on cognition 

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FATIGUE One of the most common and debilitating symptoms of MS- 90% prevalence 13  MS fatigue is defined as a subjective lack of phys  ical and/or mental energy, out of proportion to amount of exerted effort, which interfere[s ] with the ability to engage in desired activities Negatively impacts multiple domains of functioning 14–18  Quality of life  Employment  Social engagement  Sense of well-being  FATIGUE  Classified by… 12,20–23  Origin  Central– originating in the central nervous system; can be motor or cognitive  Peripheral– originating in the peripheral nervous system (muscles and related tissues)  Affected domain  Motor– “physical fatigue” reduction in ability to perform sustained physical activities  Cognitive– “mental fatigue” inability to sustain attention/concentration or endure mental activity  Method of meas urement  Fatigue-“experienced” fatigue, measured subjectively  Excessive tiredness, exhaustion, lack of energy  Fatigability-“performance” fatigability, measured objectively  Decrement of performance on cognitive (e.g., processing speed) and motor tasks (e.g., gait velocity)

MECHANISMS OF MS FATIGUE  Multifactorial:  Biological  Primary disease factors: demyelination, axonal injury/loss, inflammation  Secondary disease factors: sleep disturbance, spasticity, weakness, mood disorders  Psychological: depression, anxiety, stress, sleep disturbance  Cognitive: Thoughts and beliefs (e.g., helplessness, catastrophizing, low sense of control)  Physical/behavioral patterns: “All or nothing” behavior and constant rest  Associated with reduced motor activity, as well as cognitive performance (i.e., slower processing speed) 24 FATIGUE AND INFORMATION PROCESSING SPEED  Reliance on Cognitive Process 25 Fatigue is a feeling that distracts from cognitive processing and is seen behaviorally only when relying on  specific process Any additional factor that interferes with attention will exacerbate performance decrement   Interaction of anxiety and fatigue on processing speed has not yet been investigated in MS, despite high prevalence of both symptoms Hypothesis: Fatigue will serve as a moderator, further exacerbating the negative impact of anxiety on  processing speed

METHODS AND DEMOGRAPHICS Participants recruited from ongoing study at the MS Center at Holy  Name Hospital in Teaneck, NJ Gender Underwent neuropsychological testing 69.%  Female 22.7% Data analysis: N= 533  Male Statistical Analysis- SPSS 25.0  Race/Ethnicity Three multivariate general linear models were run: 1) Total Fatigue; 2)  69.4% Caucasian Motor Fatigue; 3) Cognitive Fatigue 7.8% Black Controlled for age, gender, and education  12.8% Hispanic Characteristics M SD Employment Status Age 47.12 12.37 40.0% Unemployed Years of Education 14.74 2.90 22.8% Employed ISS Total Score 13.18 6.92 INSTRUMENTS Symbol Digit Modalities Test (SDMT): Oral Administration 36,37  Most commonly used test for processing speed in MS  Patient is given a key that pairs 9 symbols with numbers 1-9; each symbol has it’s own number.  The subject must then match an array of symbols with their corresponding digits either orally or written.  90s timed tasked  Fatigue Scale for Motor and Cognitive Functions (FSMC) 38  Subscales: 1) Motor Fatigue; 2) Cognitive Fatigue  20 item, 5 point scale  Cut-off= M ild: 43-52, M oderate : 53-62, and Severe : ≥ 63  Hospital Anxiety and Depression Scale (HADS) 39  14 item, 4 point scale  Subscales: 1) Anxiety; 2) Depression  Cut-off (per subscale)= M ild= 8-10, M oderate= 11-14, Severe= 15-21 

MODEL1: TOTAL FATIGUE SDMT Total B SE B 95% CI Intercept 56.088 5.623 (45.043, 67.134) HADSA (Anxiety) .673 .496 (-.300, 1.650) FSMCT (Total Fatigue) -.004 .059 (-.120, .112) HADSA x FSMCT -.013 .006 (-.026, -.001) Gender 2.504 1.216 (.115, 4.893) Y ears of Education .408 .172 (.070, -2.363) Age -.321 .043 (-.407, -.236) R 2 = .138, F (6, 533)=14.177, p <.001 MODEL 2: MOTOR FATIGUE SDMT Total B SE B 95% CI Intercept 55.900 5.665 (44.771, 67.029) HADSA (Anxiety) .392 .492 (-.575, 1.360) FSMCM (Motor Fatigue) -.019 .119 (-.253, .214) HADSA x FSMCM -.021 .012 (-.045, .004) Gender 2.563 1.241 (.126, 5.001) Y ears of Education .439 .174 (.098, .781) Age -.313 .043 (-.398, -.228) R 2 = .129, F (6, 533)=13.187, p <.001

MODEL 3: COGNITIVE FATIGUE SDMT Total B SE B 95% CI Intercept 55.571 5.558 (44.652, 66.490) HADSA (Anxiety) .930 .490 (-.033, 1.892) FSMCC (Cognitive Fatigue) .032 .117 (-.199, .263) HADSA x FSMCC -.033 .013 (-.058, -.009) Gender 2.357 1.203 (-.006, 4.720) Y ears of Education .370 .171 (.033, .707) Age -.330 .043 (-.415, -.245) R 2 = .144, F (6, 533)=14.952, p <.001 Interaction of Anxiety and Cognitive Fatigue on Proces s ing Efficiency 55 54 53 52 Total 51 50 SDMT 49 48 47 46 45 44 0 1 No Cognitive Fatigue Cognitive Fatigue No Anxiety Anxiety