The relationship of cognitive functions with functional performance, fatigue, kinesiophobia and physical activity level in individuals with multiple sclerosis

Introduction-Purpose: Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system (CNS) characterized by inflammation, demyelination and plaques. The prevalence and localization of plaques diversify the symptom picture in MS. Cognitive impairments in MS are often associated with cognitive processing speed. Although studies show that decreased motor function is a marker of impaired cognitive function, the etiopathogenesis of cognitive impairment in MS has not been fully elucidated. Therefore, our study aimed to examine the relationship between cognitive functions and functional performance, fatigue, kinesiophobia and physical activity level in individuals with MS. Materials and Methods: Our study was conducted with 40 individuals diagnosed with MS and 40 healthy individuals referred to Bingol Special Education and Rehabilitation Center and met the inclusion criteria. Participants were divided into two groups MS and control group. Sociodemographic data of all participants were obtained using the demographic information form, cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) and Trail Making Test (TMT A-B form), functional performance; 6-minute walk test (6MWT), 30-second Sit to Stand Test (30-sSTST), Timed up and Go test (TUG), fatigue; Fatigue Severity Scale (FSS), kinesiophobia; Tampa Kinesiophobia Scale (TSK) and physical activity; International Physical Activity Questionnaire Short Form (IPAQ-SF). SPSS 16.0 package program was used for data analysis. The analysis of qualitative variables was interpreted with X2-test. The difference values of the data between the groups were evaluated with the Independent Sample T test if the data were suitable for normal distribution and the Mann-Whitney U test if the data were not suitable for normal distribution. One Sample T test was used for comparison with the data of healthy participants. The relationship between the data was evaluated by Pearson or Spearman correlation test. Statistical significance was accepted as p<0.05. Results: In our study, employment status, MoCA (p<0.002), IST A-B (p<0.001) values, 6MWT VAS (p<0.001), dyspnea (p<0.001), fatigue (p<0.001) scores both at baseline and end, walking distance (p<0.001); 30-s STST (p<0.001), TUG (p<0.001), fatigue (p<0.001), kinesiophobia (p<0.001), IPAQ-SF total score (MET-min/week) (p=0.035) and physical activity levels (p=0.041). MoCA was correlated with 6MWT walking distance (r=0.405, p=0.035), 30-s STST (r=0.401, p=0.048), FSS (r=-0.550, p=0.032) and IPAQ-SF (MET-min/week) (r=0.495, p=0. 047), and statistically significant correlations were found between TMT A-B and 6MWT walking distance (A: r=0.465, p=0.045; B: r=0.420, p=0.039) and 30-s STST (A: r=0.410, p=0.038; B: r=0.405, p=0.045). Conclusion: Our results showed that impairments in cognitive function in MS patients were significantly associated with decreased functional performance, increased fatigue levels, increased kinesiophobia, and decreased physical activity levels. This suggests that a comprehensive assessment of cognitive functioning in MS patients has an important role in developing personalized rehabilitation programs and improving physical and psychological well-being. Keywords: Physical activity, functional performance, kinesiophobia, cognitive function, Multiple sclerosis, fatigue