Markus Stöcklin

The fatigue scale for motor and cognitive functions (FSMC) : validation of a new instrument to assess multiple sclerosis-related fatigue

Fatigue symptoms are reported by a majority of patients with multiple sclerosis (MS). Reliable assessment, however, is a demanding issue as the symptoms are experienced subjectively and as objective assessment strategies are missing. The objective of this study was to develop and validate a new tool, the Fatigue Scale for Motor and Cognitive Functions (FSMC), for the assessment of MS-related cognitive and motor fatigue. A total of 309 MS patients and 147 healthy controls were included into the validation study. The FSMC was tested against several external criteria (e.g. cognition, motivation, personality and other fatigue scales). The item-analysis and validation procedure showed that the FSMC is highly sensitive and specific in detecting fatigued MS patients, that both subscales significantly differentiated between patients and controls (p < 0.01), and that internal consistency (Cronbach’s alpha α > 0.91) as well as test—retest reliability (r > 0.80) were high. Cut-off values were determined to classify patients as mildly, moderately or severely fatigued. In conclusion, the FSMC is a new scale that has undergone validation based on a large sample of patients and that provides differential quantification and graduation of cognitive and motor fatigue.

Satisfaction, image and loyalty: new versus experienced customers

Purpose – Customer satisfaction and image are important factors for service companies because of their impact on loyalty. Although much research has looked at the relationship of both of these factors individually, little is known about them when they are considered together. Furthermore, experience with the service or product has largely been neglected in this line of research. This paper aims to undertake a first step to fill this gap.Design/methodology/approach – This research, with data from one of Europes most modern night‐train companies, employs structural equation modelling to test the proposed hypotheses.Findings – Differentiating new customers from experienced ones, the results show that for new customers satisfaction is crucial whereas image plays a much smaller role in terms of loyalty. For experienced customers, however, the importance of satisfaction decreases whereas the impact of image increases.Research limitations/implications – Satisfaction and image were both measured by a single item...

Working memory training in patients with multiple sclerosis – comparison of two different training schedules

PURPOSE Evaluation of two different training schedules of a computer based working memory training (BrainStim) in patients with multiple sclerosis (MS). METHOD Forty-five MS outpatients were allocated to two different training groups and a control group without training. Patients with treatment received 16 training sessions scheduled either as a high intensity training (4 times per week for 4 weeks) or as a distributed training (2 times per week for 8 weeks). A neuropsychological test battery including self-report measures was applied at baseline and at retest. The baseline assessment was performed twice at an interval of two weeks to control for possible learning effects. RESULTS In the outcome measures training for both intervention groups led to significantly improved fatigue symptoms as well as working memory -, and mental speed performances. Log files recorded during training showed a similar increase in levels of difficulty for both intervention groups as training progressed. No effects were found on short term memory, quality of life or depression. CONCLUSIONS Since comparable improvements were observed in both training groups, BrainStim can be applied as a therapeutic intervention adjusted to the personal agenda of MS patients.

Fatigue in multiple sclerosis : relation to depression, physical impairment, personality and action control

Athough fatigue is one of the most common symptoms of multiple sclerosis, it is yet poorly understood and therefore difficult to manage. To clarify the nature of fatigue we investigated its relationship to depression, physical impairment, personality and action control and compared these variables between a sample of 41 MS patients and 41 healthy controls. Physical impairment was assessed by the EDSS and all other dimensions, using questionnaires. Stepwise linear regression analyses revealed that physical impairment was related to physical fatigue in MS patients. Depression was the main factor influencing fatigue among both, MS patients and controls. What clearly differentiated the two groups was the correlation between fatigue and action control. Decreased levels of action control imply attentional and motivational deficits and were only found in fatigued MS patients. Our study indicates that motivational disturbances might be specific for MS related fatigue. Multiple Sclerosis 2007; 13: 1161—1167. http://msj.sagepub.com

Computerised working memory training in healthy adults: A comparison of two different training schedules

This study compared a high intensity working memory training (45 minutes, 4 times per week for 4 weeks) with a distributed training (45 minutes, 2 times per week for 8 weeks) in middle-aged, healthy adults. The aim was to clarify whether a computerised working memory training is effective and whether intensity of training influences training outcome. To evaluate the efficacy and possible transfer effects, a neuropsychological test battery assessing short- and long-term memory, working memory, executive functions and mental speed was applied at baseline and at retest. Our results indicate that the distributed training led to increased performance in all cognitive domains when compared to the high intensity training and the control group without training. The most significant differences revealed by interaction contrasts were found for verbal and visual working memory, verbal short-term memory and mental speed. These results support the hypothesis that cognitive enhancement by cognitive intervention is effective in healthy individuals, and that a distributed training schedule is superior to a high intensity intervention.

Assessment of post-stroke fatigue: the fatigue scale for motor and cognitive functions.

Background/Aims: Post-stroke fatigue (PSF) is an important but still controversial issue since knowledge on its nature is still humble. The aim of the present study was to characterize PSF beyond the subacute phase. Methods: Thirty-one stroke patients (gender: 6 female, 25 male; age range: 35–76 years; 28 patients with ischemic stroke, 3 patients with hemorrhagic stroke; mean delay after stroke: 50.65 ± 31.57 days) were recruited and assessed by measures of fatigue (Fatigue Scale for Motor and Cognitive Functions [FSMC], Fatigue Severity Scale, and Modified Fatigue Impact Scale), depression (Beck Depression Inventory Fast Screen), cognition (Brief Repeatable Battery of Neuropsychological Tests) and upper and lower extremity functions (Nine-Hole Peg Test and 25-foot walk). Results: Depending on the different scales, PSF prevalence ranged from 16.1 to 58.1%. Depression measures correlated significantly (r(29) ≥ 0.46; p < 0.01) with the results of all fatigue scales. Seventy-one percent of patients showed cognitive deficits in at least one cognitive domain. Cognitive fatigue measured by one subscale of the FSMC correlated most significantly with mental speed, working memory, and verbal short-term memory, while the motor subscale was associated with upper and lower extremity functions, mental speed, visual short-term memory, and working memory. A differentiation between lesion localization and fatigue severity in the motor or cognitive domain was only possible when applying the FSMC. Patients with cortical lesions scored higher on the cognitive subscale, while patients with subcortical lesions showed higher physical subscale scores. Conclusion: The present pilot study revealed differences between lesion localization and subdomains of fatigue after stroke by applying a new fatigue scale (FSMC). The results underline the necessity for separate assessment of motor and cognitive fatigue in stroke patients.

The Stroop Task: Comparison Between the Original Paradigm and Computerized Versions in Children and Adults

The Stroop task has a long-standing history in psychological research and diagnostics, and many variants have emerged. Computerized versions have recently gained popularity because of their applicability in brain-imaging studies. It remains unclear, however, whether computerized versions are content valid with reference to the original task. We compare the performance in the original task with two computerized versions. All three versions show high test–retest reliability and are able to elicit interference effects, but to varying degrees. However, performances in the computerized versions and in the original task do not correlate. The transition from oral to manual response and from listed to single stimulus presentation seems not only to diminish the interference effect, but also to alter its nature in such a way that it no longer looks genuinely “Stroop-like”. These findings have important clinical implications on the use and interpretation of computerized Stroop tasks in children and adults.

Working Memory Training in Patients with Chronic Schizophrenia: A Pilot Study

Background. There is evidence that patients with schizophrenia suffer from decline in working memory performance with consequences for psychosocial outcome. Objective. To evaluate the efficacy of a computerized working memory training program (BrainStim) in patients with chronic schizophrenia. Methods. Twenty-nine inpatients with chronic schizophrenia were assigned to either the intervention group receiving working memory training (N = 15) or the control group without intervention (N = 14). Training was performed four times a week for 45 minutes during four weeks under neuropsychological supervision. At baseline and followup all participants underwent neuropsychological testing. Results. Pre-post comparisons of neuropsychological measures showed improvements in visual and verbal working memories and visual short-term memory with small and large effect sizes in the intervention group. In contrast, the control group showed decreased performance in verbal working memory and only slight changes in visual working memory and visual and verbal short-term memories after 4 weeks. Analyses of training profiles during application of BrainStim revealed increased performance over the 4-week training period. Conclusions. The applied training tool BrainStim improved working memory and short-term memory in patients with chronic schizophrenia. The present study implies that chronic schizophrenic patients can benefit from computerized cognitive remediation training of working memory in a clinical setting.

Case-Based fMRI Analysis after Cognitive Rehabilitation in MS: A Novel Approach

Background Cognitive decline in multiple sclerosis (MS) negatively impacts patients’ everyday functioning and quality of life. Since symptomatic pharmacological treatment is not yet available alternative treatment strategies such as cognitive rehabilitation are of particular interest. Objectives To analyse the ways in which MS patients respond to cognitive training, by combining behavioral and fMRI data in a case-based triangulation approach. Methods Ten relapsing-remitting (RR) MS patients aged between 39 and 58 years and between 1 and 8 years post MS diagnosis were included. EDSS ranged from 1 to 3.5. Participants had normal to high intelligence levels. Six patients were assigned to the training group (TG) and four to the control group (CG) without intervention. The TG received a 4-week computerized working memory (WM) training, consisting of 16 training sessions of 45 min duration each. Before and after the training a neuropsychological examination and fMRI investigation by using an N-back task of different complexity was applied. Results Patients in the TG responded differently to cognitive training. Four participants did not meet the triangulation criteria for being treatment responders. The two responders showed two distinct changes regarding activation patterns after training: (I) decreased brain activation associated with increased processing speed and (II) increased brain activation associated with higher processing speed and WM performance. Conclusion The occurrence of different and opposed response patterns after the same training indicates a risk in applying classical group statistics. Different and especially opposed patterns within the same sample may distort results of classical statistical comparisons. Thus, underlying processes may not be discovered and lead to misinterpretation of results.

The FSMC (Fatigue Scale for Motor and Cognitive Functions) : a new patient-reported outcome measure for cognitive and motor fatigue in multiple sclerosis

writing, there were still 9 remaining PoMS. An IS IgG was present in 9/9 (100%) CDMS and 8/25 (32%) OND. The recruitment of strongly differentiated (the sum of effector memory [CCR7-/CD45RA-] and terminally differentiated [CCR7-/CD45RA /]) CD8 / (sdCD8 /) T cells in the CSF was higher for CDMS (47%) than for OND (19%, pB/0.03). By contrast, there was no significant difference in the CSF recruitment of sdCD4 / T cells in CDMS (31%) vs OND (22%). Interestingly, 8/9 (89%) CDMS had both a higher recruitment of sdCD8 / T cells in the CSF and evidence of an IS IgG. In the OND category, 9/25 had a higher recruitment of sdCD8 / T cells and 8/25 had an IS IgG, but only 1/25 OND had both. Conclusion: Our data show that there was a higher recruitment of sdCD8 / T cells in the CSF of MS than OND. A PoMS having both i) a higher recruitment of sdCD8 / than sdCD4 / T cells in the CSF and ii) an IS IgG, had 89% of becoming CDMS. By contrast, when such a combination was absent, a PoMS had 96% of chance of becoming OND. This work was supported by grants from the Swiss National Foundation 3200B0 /104262 and PP00B– 106716 and from the Swiss Society for MS to RADP.