ArticleBrain communications2024
Understanding the mechanisms of fatigue in multiple sclerosis: linking interoception, metacognition and white matter dysconnectivity.
Article in Brain communications, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Interoceptive and metacognitive contributors to fatigue in multiple sclerosis: network and mediation analyses.Acta neurologica Belgica · 2026Article
- Motor fatigue and fatigability in early multiple sclerosis patients: an analysis of clinical, radiological and psychological underpinnings.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Linking movement-related beta oscillations to cortical excitability, structural damage, and fatigue in multiple sclerosis.Brain communications · 2026Article
- The Association Between the Occurrence of Sensory Integration Disorders, Depression, and Chronic Fatigue in Patients with Relapsing-Remitting Multiple Sclerosis.Journal of clinical medicine · 2025Article
- Magnetization transfer imaging using non-balanced SSFP at ultra-low field.Magnetic resonance in medicine · 2025Article
- White matter volume and microstructural integrity are associated with fatigue in relapsing multiple sclerosis.Scientific reports · 2025Article
- Multiple disconnection syndrome, interoceptive metacognition deficits and fatigue in multiple sclerosis.Brain communications · 2024Article
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
One of the most prominent symptoms in multiple sclerosis is pathological fatigue, often described by sufferers as one of the most debilitating symptoms, affecting quality of life and employment. However, the mechanisms of both, physical and cognitive fatigue in multiple sclerosis remain elusive. Here, we use behavioural tasks and quantitative MRI to investigate the neural correlates of interoception (the ability to sense internal bodily signals) and metacognition (the ability of the brain to assess its own performance), in modulating cognitive fatigue. Assuming that structural damage caused by multiple sclerosis pathology might impair the neural pathways subtending interoception and/or metacognition, we considered three alternative hypotheses to explain fatigue as a consequence of, respectively: (i) reduced interoceptive accuracy, (ii) reduced interoceptive insight or (iii) reduced global metacognition. We then explored associations between these behavioural measures and white matter microstructure, assessed by diffusion and magnetisation transfer MRI. Seventy-one relapsing-remitting multiple sclerosis patients participated in this cross-sectional study (mean age 43, 62% female). Patient outcomes relevant for fatigue were measured, including disability, disease duration, depression, anxiety, sleepiness, cognitive function, disease modifying treatment and quality of life. Interoceptive and metacognitive parameters were measured using heartbeat tracking and discrimination tasks, and metacognitive visual and memory tasks. MRI was performed in 69 participants, including diffusion tensor MRI, neurite orientation dispersion and density imaging and quantitative magnetisation transfer. Associations between interoception and metacognition and the odds of high cognitive fatigue were tested by unconditional binomial logistic regression. The odds of cognitive fatigue were higher in the people with low interoceptive insight (
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