Dolphin
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Original Article
Physical and cognitive performance in older adults with fatigue:Comparing subjective and objective measurements.
Mona Hegazy Mohamed1, Doha Rasheedy Aly1, Kholoud Mahmoud Mostafa1,Sherine M. Elbanouby1
1 Geriatrics and Gerontology department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
ABSTRACT
Background:
Fatigue is one of the most common complaints among older adults and is associated with reduced functional capacity, impaired cognitive performance, and diminished quality of life. However, the assessment of fatigue remains challenging due to reliance on subjective self-report tools that may not fully reflect objective functional impairment.
Objectives: To compare subjective fatigue assessment tools with objective measures of physical and cognitive performance in community-dwelling older adults.
Methods:
A case–control study was conducted among 130 community-dwelling adults aged ≥60years. Participants were divided into two groups: individuals with fatigue (n = 65) and those withoutfatigue (n = 65). Fatigue was assessed using the Fatigue Severity Scale (FSS) and Modified FatigueImpact Scale (MFIS). Objective assessments included the 6-Minute Walk Test, 30-second Chair StandTest (CST), Cognitive Timed Up and Go (Cog TUG), Digit Span test, and Montreal CognitiveAssessment–Basic (MoCA-B). Depression was evaluated using the Geriatric Depression Scale-15.Statistical analysis included ROC curve analysis, correlations, and group comparisons.
Results:
The fatigue group was significantly older (68.98±6.25 vs. 66.08±4.48 years, p<0.001) and had higher prevalence of diabetes (52.3% vs. 24.6%), hypertension (67.1% vs. 32.9%), and ischemic heart disease (56.9% vs. 16.9%) (all p<0.001). The fatigue group demonstrated significantly worse physical performance (6MWT: 110.16±76.76 vs. 368.36±120.35 meters, p<0.001; CST: 5.04±2.94vs. 11.18±2.73 stands, p<0.001) and cognitive performance (Cog TUG: 33.39±20.87 vs. 10.93±4.33seconds, p<0.001). Notably, the fatigue group scored higher on MoCA-B (26.42±3.08 vs. 19.34±4.37,p<0.001) but demonstrated significant deficits in working memory with lower digit span forward(2.46±0.99 vs. 3.82±0.85, p<0.001) and backward (1.80±0.99 vs. 3.29±0.88, p<0.001) scores. Both FSS and MFIS correlated strongly with physical and cognitive performance measures, with particularly strong correlations with digit span tests (rho=-0.61 to -0.82).
Conclusion:
Subjective fatigue tools, particularly FSS, demonstrate strong correlations with objective physical and cognitive performance measures. While global cognitive screening (MoCAB) may not capture fatigue-related deficits, specific working memory tasks (digit span) reveal significant impairment. The 6MWT and Cog TUG are valuable objective screening tools for fatigue related impairment. Combined physical and mental fatigue is associated with greater cognitive deficits than physical fatigue alone. Combining subjective fatigue scales with objective performance measures provides a more comprehensive evaluation of fatigue in geriatric populations.
Keywords: fatigue, older adults, cognitive performance, physical performance, geriatric assessment.