Goal Attainment Interventions May Reduce Cognitive Fatigue in MS, Study Finds

Behavioral therapy focusing on goal attainment might reduce cognitive fatigue in multiple sclerosis (MS) patients, finds a study that used brain imaging to examine goal-oriented tasks involving rewards.

Since fatigue is one of the most common MS symptoms, affecting up to 90 percent of patients, researchers at the Kessler Foundation in East Hanover, New Jersey, say their findings could open the door to new non-medication approaches to treating MS-related fatigue.

Their study, “Fronto-striatal network activation leads to less fatigue in multiple sclerosis,” appeared in the Multiple Sclerosis Journal.

Scientists believe that a part of the brain, called the fronto-striatal network, causes fatigue. But studies also show that the network is active during goal attainment tasks, and that such tasks can reduce fatigue in healthy people.

Equipped with this knowledge, Kessler researchers recruited 19 MS patients and 14 healthy controls, and exposed them to one of two conditions. In the first, they had the chance to win money while gambling. Researchers called this the outcome condition. The second condition did not include the prospect of a reward, or outcome. The tasks were performed in a brain scanner.

Using functional magnetic resonance imaging (fMRI) of the brain — a method that tracks brain activity by monitoring blood flow — researchers could study how different tasks activated the fronto-striatal network.

It turned out that the prospect of a reward activated parts of the network in deep brain structures, while parts of the prefrontal cortex were more active during the task without a potential reward. Importantly, the activation seen during the reward condition was linked to significantly lower levels of fatigue, which researchers measured outside the scanner.

“We found significant differences in activation between the two conditions in both groups,” Ekaterina Dobryakova, the study’s lead author, said in a press release. “With the outcome condition, significant activation of the fronto-striatal network was associated with significant reduction in fatigue, suggesting that behavioral interventions that motivate individuals to reach a particular goal may be an effective approach to reducing fatigue.”

While researchers used a gambling task to study the process, similar exercises like achieving a good score on a test, might work equally well, researchers said. In fact, goal attainment is already incorporated in many neuropsychological rehabilitation efforts, including in MS.