The Impact of Severe Cognitive Fatigue and Anxiety on MS Patients' Visual Learning

Background: Cognitive fatigue is a physiological fatigue phenomenon that is a common subjective complaint in Multiple Sclerosis. Anxiety is also common among individuals living with MS, with prevalence rates ranging from 19% to 57%. Anxiety in the MS population has been found to be associated with fatigue. Research has shown that anxiety in the general population is also associated with cognitive impairment, particularly in processing speed, attention, and visual memory. Further, cognitive fatigue has been shown to be associated with reduced concentration and attention. Studies have not yet examined the effect of anxiety and severe cognitive fatigue in visual learning in the MS population. The present study wishes to address this gap, and hypothesizes that anxiety and severe cognitive fatigue is associated with impairment in visual learning in patients with multiple sclerosis.

Objectives: This study tested the relationship of anxiety and severe cognitive fatigue on three trials of visual learning. 

Methods: Data was collected from 112 MS patients who underwent full neuropsychological evaluation at the MS Center at Holy Name Medical Center in Teaneck, NJ. Anxiety was measured using the self-report measure, Hospital Anxiety and Depression Scale. Cognitive fatigue was measured using the cognitive subscale of The Fatigue Scale for Motor and Cognitive Functions. All of the instruments have been well-validated in the MS population. Patients were also administered the Brief Visuospatial Memory Test-Revised, a neuropsychological measure of visual learning and memory. A multivariate general linear model was conducted using SPSS 24.0. Anxiety and severe cognitive fatigue were entered as the predictor variables, and BVMT Trials 1-3, were entered as the outcome variables. 

Results: When controlling for education, age, and years of education, there was a significant effect of severe cognitive fatigue on visual learning (Wilks' Lambda= .903 , F(3,104)=3.715, p=.014). Severe cognitive fatigue had a significant effect on BVMT Trial 2 (F= 5.529, p=.021). There was not a significant effect on BVMT Trial 1 (F=3.408, p=.068) or Trial 3 (F= 35.702, p=.662). When controlling for severe cognitive fatigue, anxiety had a significant effect on visual learning (Wilks' Lambda= .877, F(3,104)=4.870,p=.003). Anxiety had a significant effect all three trails, BVMT Trial 1 (F=13.060, p<.001), BVMT Trial 2 (F= 9.935, p=.002), and Trial 3 (F= 4.394, p=.038).

Conclusions: Severe cognitive fatigue and anxiety were found to have an effect on MS patients' visual learning. Specifically, cognitive fatigue had an effect on visual learning, such that cognitive fatigue had a signficant effect onTrial 2. When controlling for severe cognitive fatigue, anxiety had an effect on patient's learning for Trials 1,2, and 3. Anxious MS patients and those with severe cognitive fatigue on average scored lower on all three visual learning trials than those without the aforementioned symptoms.