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Background <p>Fatigue is one of the most disabling symptoms of multiple sclerosis (MS) and may interfere with behavioral regulation and health-related activities independent of physical disability. While cognitive reserve has been associated with better performance on measures of cognitive performance in MS, its contribution to self-management behaviors remains unclear.</p> Methods <p>In this cross-sectional study, 79 patients with relapsing–remitting MS (RRMS) and low physical disability (Expanded Disability Status Scale ≤ 4) were evaluated. Self-management was assessed using the Multiple Sclerosis Self-Management Scale (MSSM). Fatigue was measured with the Modified Fatigue Impact Scale (MFIS), cognitive impairment was screened with the Symbol Digit Modalities Test (SDMT), and cognitive reserve was assessed with the Cognitive Reserve Index questionnaire (CRIq). Associations were examined using Spearman’s rank correlation, stepwise multiple linear regression, and structural equation modeling (SEM).</p> Results <p>The median age was 36 years (IQR: 31–42), and 70.9% of participants were female. The median EDSS score was 1 (IQR: 0–2). A total of 69.6% of participants met criteria for cognitive impairment based on age-adjusted SDMT normative values ( ≤ − 1.5 SD). Cognitive reserve was positively correlated with SDMT performance (<i>r</i> = 0.48, <i>p</i> &lt; 0.01). However, SDMT performance was not independently associated with self-management when fatigue was included in the SEM model (β = 0.14, <i>p</i> = 0.15). In SEM analyses, fatigue showed a significant negative association with MSSM (β = -0.33, <i>p</i> &lt; 0.001), and disease duration was a significant negative predictor of MSSM (β = -0.3, <i>p</i> = 0.003). In the stepwise regression model, cognitive fatigue was the strongest contributing factor to self-management among the fatigue dimensions (β = −0.358, <i>p</i> = 0.001). Despite the high prevalence of cognitive impairment in the sample, cognitive performance was not independently associated with self-management when fatigue was included in the model.</p> Conclusions <p>In patients with RRMS and low physical disability, fatigue showed a stronger association with self-management than cognitive performance or cognitive reserve. Addressing fatigue-related behavioral barriers that may limit sustained engagement in goal-directed health behaviors may be important for optimizing self-management strategies in this population.</p>

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Fatigue rather than cognitive reserve is associated with self-management in low-disability multiple sclerosis

  • 期刊论文

  • 发表日期：

    2026年4月16日

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  • Simge Karadeniz,
  • Bengu Altunan,
  • Aysun Ünal,
  • Filiz Dilek,
  • Tuba Karakoyun Alpay

摘要

Background

Fatigue is one of the most disabling symptoms of multiple sclerosis (MS) and may interfere with behavioral regulation and health-related activities independent of physical disability. While cognitive reserve has been associated with better performance on measures of cognitive performance in MS, its contribution to self-management behaviors remains unclear.

Methods

In this cross-sectional study, 79 patients with relapsing–remitting MS (RRMS) and low physical disability (Expanded Disability Status Scale ≤ 4) were evaluated. Self-management was assessed using the Multiple Sclerosis Self-Management Scale (MSSM). Fatigue was measured with the Modified Fatigue Impact Scale (MFIS), cognitive impairment was screened with the Symbol Digit Modalities Test (SDMT), and cognitive reserve was assessed with the Cognitive Reserve Index questionnaire (CRIq). Associations were examined using Spearman’s rank correlation, stepwise multiple linear regression, and structural equation modeling (SEM).

Results

The median age was 36 years (IQR: 31–42), and 70.9% of participants were female. The median EDSS score was 1 (IQR: 0–2). A total of 69.6% of participants met criteria for cognitive impairment based on age-adjusted SDMT normative values ( ≤ − 1.5 SD). Cognitive reserve was positively correlated with SDMT performance (r = 0.48, p < 0.01). However, SDMT performance was not independently associated with self-management when fatigue was included in the SEM model (β = 0.14, p = 0.15). In SEM analyses, fatigue showed a significant negative association with MSSM (β = -0.33, p < 0.001), and disease duration was a significant negative predictor of MSSM (β = -0.3, p = 0.003). In the stepwise regression model, cognitive fatigue was the strongest contributing factor to self-management among the fatigue dimensions (β = −0.358, p = 0.001). Despite the high prevalence of cognitive impairment in the sample, cognitive performance was not independently associated with self-management when fatigue was included in the model.

Conclusions

In patients with RRMS and low physical disability, fatigue showed a stronger association with self-management than cognitive performance or cognitive reserve. Addressing fatigue-related behavioral barriers that may limit sustained engagement in goal-directed health behaviors may be important for optimizing self-management strategies in this population.