Uncovering the association between fatigue and fatigability in multiple sclerosis using cognitive control

Eli K. Cehelyk, Denise Y. Harvey, Meghan L. Grubb, Rasha Jalel, Mohammad S. El-Sibai, Clyde E. Markowitz, Joseph R. Berger, Roy H. Hamilton, Salim Chahin

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Fatigue and cognitive dysfunction are two common symptoms experienced by patients with multiple sclerosis (MS). The relationship between subjective and objective fatigue (fatigability) in MS is poorly understood. Cognitive control tasks might be more conducive to fatigability and more likely to show associations between subjective and objective cognitive fatigue in MS. Objective: To study the association between objective fatigability, as induced by a cognitive control task called the Blocked Cyclic Naming Task (BCNT), subjective fatigue and baseline cognitive functioning in patients with MS. Methods: Twenty-one patients with MS completed baseline questions about their disease, the Montreal Cognitive Assessment (MoCA) battery and self-reported questionnaires on trait fatigue, sleep and depression. Disability was captured using the expanded disability status scale (EDSS). Participants then performed the BCNT and were asked about their level of state momentary fatigue before and after the BCNT. The BCNT consists of several blocks of either related or unrelated pictures that participants name as quickly as possible. The pictures cycled 4 times in each block and the difference in the response times (RTs) between related and unrelated blocks was captured. Data were analyzed using repeated measures analysis of variance and Pearson correlations. Results: MS participants’ performance declined for the related, but not unrelated blocks. The difference in RTs between related and unrelated conditions increased with repetition across cycles (p < 0.001). Participants also showed objective fatigability with less repetition priming (p = 0.02) in the 4th quarter and with greater differences between related and unrelated conditions in the later part of the task. Objective fatigability was strongly associated with participants’ assessment of their level of momentary state fatigue (r = 0.612, p = 0.007). Conclusion: Using the appropriate tools, this study showed an association between subjective and objective cognitive fatigue in people with MS. The BCNT and cognitive control are useful tools in assessing patients with MS and should be explored in future, larger studies in this population.

Original languageEnglish
Pages (from-to)269-275
Number of pages7
JournalMultiple Sclerosis and Related Disorders
StatePublished - Jan 2019


  • Cognitive dysfunction
  • Fatigue
  • Mental fatigue
  • Multiple sclerosis
  • Multiple sclerosis relapsing remitting
  • Repetition priming
  • analyses of variance (ANOVA)
  • blocked cyclic naming task (BCNT)
  • expanded disability status scale (EDSS)
  • fatigue severity scale (FSS)
  • modified fatigue impact scale (MFIS)
  • montreal cognitive assessment (MoCA)
  • patient-reported outcomes measurement information system (PROMIS)
  • response time (RT)
  • visual analog scale (VAS)


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