On the other hand, psychophysics tasks enable a straightforward detailed assessment of attention with minimal influence from other cognitive domains. These tests only give a general evaluation of attention without distinguishing between different forms of impairment, which can partly explain the inconsistency of previous results. Most studies have used neuropsychological tests to assess attention of MS patients 2, 25, 26. Conflicting findings and unclear pathophysiology of these conditions in MS 24 highlight the need for further evaluation. However, the results regarding this relationship are inconsistent As reviewed by Golan et al., Some studies have found a negative correlation between fatigue and attention, while in others no association was observed after considering cofounding variables 23. Moreover, attention tests have been proposed as a valid measure of cognitive fatigue in MS 21, 22. Fatigue is the most common and debilitating symptom in MS patients 19 and has been shown to correlate with changes in brain networks e.g., salience network, which are responsible for attentional processes 20. MS-related fatigue has been also suggested as a possible effective factor on attention 17, 18. However, patterns of attention deficit in different MS phenotypes have not been studied in details. Both neuropsychological and psychophysics studies have highlighted the role of disease phenotype in impairment of attention Some studies have shown more frequent and severe difficulties in progressive forms of the disease, while others point to contrary findings 14, 15, 16. Various factors can affect attention of MS patients. Moreover, attention is also frequently impaired in pediatric MS patients 11, 12, 13. Their common complaints are about switching attention and keeping up with a specific stimulus when there are distractors nearby 10. Attention, the process through which the brain selects information for further processing 7, 8, is one of the main affected cognitive domains in adults with MS 9. Although there is increasing evidence for the importance of cognitive comorbidities in MS, consensus on appropriate objective assessment and treatment has not been reached so far 3 and the course of these comorbidities can only be poorly predicted 4, 5, 6. Two-third of MS patients suffer from cognitive impairment which reduces their quality of personal, social, and professional life 2. Multiple sclerosis (MS) is the primary cause of non-traumatic disability in young adults 1. Fatigue trait predicts impairment of endogenous and orienting attention in MS. Exogenous attention is impaired in RRMS patients while SPMS patients have deficit in endogenous attention. The pattern of attention deficit in MS differs between phenotypes. Executive attentional effect in RRMS patients with shorter disease duration and orienting attentional effect in longer diagnosed SPMS were correlated with MFIS scores. Total MFIS was the predictor of gain in 250 ms endogenous blocks and cognitive MFIS predicted orienting attentional effect. RRMS and SPMS patients had less gain in exogenous trials with 62.5 ms cue-target interval time (CTIT) and endogenous trials with 250 ms CTIT, respectively. In Posner task, RRMS or SPMS patients did not benefit from valid cues unlike HC. In ANT, attentional network effects were not different between MS phenotypes and HC. ![]() ![]() Results of psychophysics tasks (attention network test (ANT) and Posner spatial cueing test) and fatigue assessments (visual analogue scale and modified fatigue impact scale (MFIS)) were compared between groups. Thirty-four relapse-remitting MS (RRMS), 35 secondary-progressive MS (SPMS) and 45 healthy controls (HC) were included. ![]() This study aimed to clarify impairment of attention and its relationship with MS-related fatigue. Behavioral aspects and underlying pathology of attention deficit in multiple sclerosis (MS) remain unknown.
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