Multipl Sklerozda Kognitif Fonksiyon ile Fiziksel, Fonksiyonel ve Psikolojik Faktörler Arasındaki Etkileşim

Öz

Amaç: Multipl skleroz (MS), merkezi sinir sisteminde inflamasyon ve demiyelinizasyon ile karakterize, nörodejeneratif bir hastalıktır ve sıklıkla özellikle işlemleme hızı olmak üzere kognitif bozukluklarla birlikte seyreder. Bu çalışma, MS’li bireylerde kognitif fonksiyon ile fonksiyonel performans, yorgunluk, kinezyofobi ve fiziksel aktivite arasındaki ilişkiyi incelemeyi amaçlamıştır. Gereç ve Yöntemler: Çalışmaya 40 MS hastası ve 40 sağlıklı kontrol bireyi dâhil edilmiştir. Kognitif fonksiyon, Montreal Bilişsel Değerlendirme Ölçeği (MOBİD) ve İz Sürme Testi (İST-A ve İST-B) ile değerlendirilmiştir. Fonksiyonel performans, 6 Dakika Yürüme Testi (6DYT), 30 Saniye Otur-Kalk Testi (30sn-OKT) ve Zamanlı Ayağa Kalk ve Yürü Testi (ZKYT) ile ölçülmüştür. Yorgunluk, kinezyofobi ve fiziksel aktivite düzeyleri sırasıyla Yorgunluk Şiddeti Ölçeği (YŞÖ), Tampa Kinezyofobi Ölçeği (TKÖ) ve Uluslararası Fiziksel Aktivite Anketi - Kısa Form (UFAA-KF) ile değerlendirilmiştir. Bulgular: MS ve kontrol grupları arasında bilişsel skorlar (MOBİD, İST-A/B), fonksiyonel performans (6DYT, 30sn-OKT, ZKYT), yorgunluk (YŞÖ), kinezyofobi (TKÖ) ve fiziksel aktivite düzeyleri (UFAA-KF) açısından anlamlı farklar bulunmuştur (p<0.05). MOBİD skorları; yürüme mesafesi, 30sn-OKT ve fiziksel aktivite düzeyleri ile pozitif; yorgunluk düzeyi ile negatif yönde ilişkili bulunmuştur. İST-A ve İST-B performansları da fonksiyonel testlerle anlamlı şekilde koreledir. Sonuç: Bu çalışma, MS’li bireylerin sağlıklı bireylere kıyasla kognitif fonksiyon, fiziksel aktivite, yorgunluk ve fonksiyonel performans açısından belirgin bozulmalar gösterdiğini ortaya koymuştur. Kognitif disfonksiyonun azalmış dayanıklılık, alt ekstremite kas kuvvetinde azalma, artmış yorgunluk ve düşük fiziksel aktivite düzeyi ile orta düzeyde ilişkili olduğu belirlenmiştir. Bu bulgular, MS’te kognitif bozulmanın çok faktörlü doğasını vurgulamakta ve kognitif değerlendirmenin rutin klinik uygulamalara dâhil edilmesini desteklemektedir. Rehabilitasyona kognisyon odaklı stratejilerin entegre edilmesi, fonksiyonel sonuçları ve yaşam kalitesini artırabilir.

Anahtar Kelimeler

• yorgunluk
• fonksiyonel performans
• kinezyofobi
• multipl skleroz
• fiziksel aktivite
• kognitif fonksiyon

The Interplay Between Cognitive Function and Physical, Functional, and Psychological Factors in Multiple Sclerosis

Abstract

Aim: Multiple sclerosis (MS) is a neurodegenerative disorder involving central nervous system inflammation and myelin damage, often leading to cognitive deficits, especially in information processing speed. This study aimed to examine the relationship between cognitive function and functional performance, fatigue, kinesiophobia, and physical activity level in individuals with MS. Material and Methods: A total of 40 individuals with MS and 40 healthy participants were recruited for the study. Cognitive performance was evaluated through the Montreal Cognitive Assessment (MoCA) and the Trail Making Test parts A and B (TMT A-B). Functional performance was assessed using the 6-Minute Walk Test (6MWT), the 30-Second Sit-to-Stand Test (30-sSTST), and the Timed Up and Go (TUG) test. Fatigue, kinesiophobia, and physical activity level were evaluated using the Fatigue Severity Scale (FSS), Tampa Kinesiophobia Scale (TSK), and International Physical Activity Questionnaire Short Form (IPAQ-SF), respectively. Results: Significant differences were found between MS and control groups in cognitive scores (MoCA, TMT A-B), functional performance (6MWT, 30-s STST, TUG), fatigue, kinesiophobia, and physical activity levels (p<0.05). MoCA scores were positively correlated with walking distance, 30-s STST, and physical activity levels, and negatively correlated with fatigue. TMT A-B performance was also significantly correlated with functional tests. Conclusion: This study demonstrates that individuals with MS show significant impairments in cognitive function, physical activity level, fatigue, and functional performance compared to healthy controls. Cognitive dysfunction was moderately associated with reduced endurance, lower limb strength, higher fatigue, and lower physical activity levels. These findings underscore the multifactorial nature of cognitive impairment in MS and support the integration of cognitive evaluation into routine clinical assessments. Incorporating cognitive-focused strategies into rehabilitation may enhance functional outcomes and quality of life in this population.

Keywords

• Cognitive function
• fatigue
• functional performance
• kinesiophobia
• multiple sclerosis
• physical activity

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