MULTİPL SKLEROZ HASTALARINDA KOGNİTİF YORGUNLUĞUN DENGE ÜZERİNE AKUT ETKİSİNİN İNCELENMESİ

Abstract

In this study, which was conducted to examine the acute effect of cognitive fatigue on balance in Multiple Sclerosis (MS) patients; Fifty MS patients aged 20-50 years, without cognitive impairment, with an Expanded Disability Status Scale (EDSS) score of 0-4 were included. The patients were randomly divided into control and study groups. While the study group had cognitive activities that would cause cognitive fatigue for 30-45 minutes, the control group was rested for 30 minutes. Clinical balance assessments, static posturography assessments, and cognitive fatigue assessment were applied to both groups twice, just before and just after the treatments. Cognitive fatigue was assessed with the Visual Analog Scale (VAS). Functional Reach Test (FUT) and Single Leg Standing Test (TBUDT) were used for clinical balance assessments. Modified Clinical Test of Sensory Integration and Balance m (CTSIB), Limits of Stability (LOS), Tandem Walk (TW), Walk Across (WA), Rhythmic Weight Shift (RWS), and Unilateral Stance (US) were used for static posturography assessments. Cognitive activities including Verbal Fluency Test, Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and Paced Auditory Serial Addition Test (PASAT) were applied to the study group. When the two groups were compared at the end of the study, the study group was found to be cognitive fatigue according to VAS (p<0,001). As a result of the measurements of the study group in m(CTSIB), one of the balance tests evaluated with static posturography, it was found that postural sway increased in firm-eyes open, foam-eyes open, and composite score (p<0,001, p<0,005, p<0,001). When the two groups were compared, a difference was found in the firm-eyes open, firm-eyes closed, foam-eyes open and composite score (p<0,001, p<0,007, p<0,005, p<0,001). In the evaluations of the study group in LOS, an increase in speed of movement (MVL) and end-point excursion (EPE) was found (p<0,001, p<0,009). While the reaction time (RT) of the control group decreased, an increase was observed in end-point excursion (EPE) and maximum excursion (MXE) (p<0,019, p<0,010, p<0,005). When the two groups were compared, a difference was observed only in MXE (p<0.009). While there was only an increase in speed in both the study group and the control group in TW evaluations, this increase was not statistically significant when the two groups were compared (p<0,002, p<0,001, p>0,60). It was found that the stride length of the study group increased in WA (p<0,005). When the groups were compared, only the stride length was found to be different (p<0,026). In RWS, only an increase in on-axis velocity in the anterior/posterior direction was found in the control group (p<0,012). When the groups were compared, no significant difference was found (p>0,05). On the US, there was a difference in the right leg eyes closed position of the control group, but no significant difference was found when the two groups were compared (p≤0,05, p>0,05). In the in-group evaluation of FUT, which is used for clinical balance assessment, it was found that the reach distance of the study group decreased, while the reach distance of the control group did not change (p<0,001, p>0,438). When the groups were compared, the difference was significant (p<0,001). In TBUDT, a significant decrease in stance time was found in the study group in the left leg with eyes open, right leg with eyes open, and left leg with eyes closed (p<0,002, p<0,004, p<0,007). In the control group, the increase in stance time in the left leg with eyes open, right leg with eyes open and right leg with eyes closed was statistically significant (p<0,001, p<0,001, p<0,02). When the groups were compared, the difference in stance times was found to be significant in the left leg with eyes open, right leg with eyes open, left leg with eyes closed, and right leg with eyes closed (p<0,001, p<0,001, p<0,004, p<0,001). In line with the findings of this study, in which the acute effect of cognitive fatigue on balance in patients with MS was examined for the first time, it was shown that cognitive fatigue can be seen even in patients without cognitive impairment and negatively affects balance.

Key words: Multiple sclerosis, cognitive fatigue, static balance, dynamic balance