Assessment of Global Fatigue in Multiple Sclerosis: A Spanish Language Version of the CGI and PGI Fatigue Scales


Background: Fatigue is often identified as weakness following muscular exertion in patients with multiple sclerosis (MS) but may be associated with other physical, cognitive and emotional symptoms. Objective: To develop a Spanish language global impression of fatigue scales to evaluate symptoms of fatigue distinct from a particular disease. Methods: 50 ambulatory patients with MS attending a clinical institute in Argentina consented to participate in this reliability study. The Spanish language version of the Clinical and Patient Global Impressions of Fatigue (CGI-S-F and PGI-S-F) instruments were administered with the Massachusetts General Hospital cognitive and physical functioning questionnaire (MGH-CPFQ). Results: The CGI-S-F and PGI-S-F scores were well correlated with each other (p < 0.00005). The mean CGI-S for fatigue was 2.28 ± 1.07 (SD) and PGI-S for fatigue was 2.30 ± 1.16 (p = ns) reflecting borderline to mild perception of fatigue. The total MGH-CPFQ was 16.68 ± 4.32. Both CGI-S-F and PGI-S-F measures were correlated with the MGH-CPFQ: CGI-Severity (r = 0.632; p < 0.00005); PGI-Severity (r = 0.717; p < 0.00005). Conclusions: In this study, the Spanish language versions of the CGI-S-F and PGI-S-F were reliable measures in an MS population and can be useful and easily applied metrics in a busy clinical practice.

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S. Targum, P. Richly, V. Sinay, D. Goldberg-Zimring and F. Manes, "Assessment of Global Fatigue in Multiple Sclerosis: A Spanish Language Version of the CGI and PGI Fatigue Scales," Neuroscience and Medicine, Vol. 4 No. 3, 2013, pp. 140-144. doi: 10.4236/nm.2013.43022.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] O. Hadjimichael, T. Vollmer and M. Oleen-Burkey, “Fatigue Characteristics in Multiple Sclerosis: The North American Research Committee on Multiple Sclerosis (NARCOMS) Survey,” Health and Quality of Life Outcomes, Vol. 6, 2008, pp. 100-110. doi:10.1186/1477-7525-6-100
[2] R. A. Marrie, E. Fisher, D. M. Miller, J. Lee and R. A. Richard, “Association of Fatigue and Brain Atrophy in Multiple Sclerosis,” Journal of the Neurological Sciences, Vol. 228, No. 2, 2005, pp. 161-166. doi:10.1016/j.jns.2004.11.046
[3] G. Tedeschi, D. Dinacci, L. Lavorgna, et al., “Correlation between Fatigue and Brain Atrophy and Lesion Load in Multiple Sclerosis Patients Independent of Disability,” Journal of the Neurological Sciences, Vol. 263, No. 1, 2007, pp. 15-19. doi:10.1016/j.jns.2007.07.004
[4] A. K. Andreasen, J. Jakobsen, L. Soerensen, et al., “Regional Brain Atrophy in Primary Fatigued Patients with Multiple Sclerosis,” Neuroimage, Vol. 50, No. 2, 2010, pp. 608-615. doi:10.1016/j.neuroimage.2009.12.118
[5] L. B. Krupp, N. G. LaRocca, J. Muir-Nash and A. D. Steinberg, “The Fatigue Severity Scale, Application to Patients with Multiple Sclerosis and Systemic Lupus Erythematosus,” Archives of Neurology, Vol. 46, No. 10, 1989, pp. 1121-1123. doi:10.1001/archneur.1989.00520460115022
[6] L. B. Krupp and L. E. Elkins, “Fatigue and Declines in Cognitive Functioning in Multiple Sclerosis,” Neurology, Vol. 55, No. 7, 2000, pp. 934-939. doi:10.1212/WNL.55.7.934
[7] S. Sevy, M. H. Rosenthal, J. Alvir, et al., “Double-Blind, Placebo-Controlled Study of Modafinil for Fatigue and Cognition in Schizophrenia Patients Treated with Psychotropic Medications,” Journal of Clinical Psychiatry, Vol. 66, 2005, pp. 839-843. doi:10.4088/JCP.v66n0705
[8] R. S. McIntyre, J. Z. Konarksi, J. K. Soczynska, et al., “Medical Comorbidity in Bipolar Disorder: Implications for Functional Outcomes and Health Service Utilization,” Psychiatric Services, Vol. 57, No. 8, 2006, pp. 1140-1144. doi:10.1176/
[9] E. A. Walker, W. J. Katon and R. P. Jemelka, “Psychiatric Disorders and Medical Care Utilization among People in the General Population Who Report Fatigue,” Journal of General Internal Medicine, Vol. 8, No. 8, 1993, pp. 436-440. doi:10.1007/BF02599621
[10] M. Fava, “Symptoms of Fatigue and Cognitive/Executive Dysfunction in Major Depressive Disorder before and after Antidepressant Treatment,” Journal of Clinical Psychiatry, Vol. 64, No. 14, 2003, pp. 30-34.
[11] K. Demyttenaere, J. Fruyt and S. M. Stahl, “The Many Faces of Fatigue in Major Depressive Disorder,” International Journal of Neuropharmacology, Vol. 8, No. 1, 2005, pp. 93-105.
[12] S. B. Harvey, S. Wessely, D. Kuh and M. Hotopf, “The Relationship between Fatigue and Psychiatric Disorders: Evidence for the Concept of Neurasthenia,” Journal of Psychosomatic Research, Vol. 66, No. 5, 2009, pp. 445-454. doi:10.1016/j.jpsychores.2008.12.007
[13] L. M. Arnold, “Understanding Fatigue in Major Depressive Disorder and Other Medical Disorders,” Psychosomatics, Vol. 49, No. 3, 2008, pp. 185-190. doi:10.1176/appi.psy.49.3.185
[14] S. R. Schwid, C. A. Thornton, S. Pandya, et al., “Quantitative Assessment of Motor Fatigue and Strength in MS,” Neurology, Vol. 53, No. 4, 1999, pp. 743-750. doi:10.1212/WNL.53.4.743
[15] C. Christopoulou, “The Assessment and Measurement of Fatigue,” In: J. DeLuca, Ed., Fatigue as a Window to the Brain, MIT Press, New York, 2005, pp. 19-35.
[16] L. Whitehead, “The Measurement of Fatigue in Chronic Illness: A Systematic Review of Unidimensional and Multidimensional Fatigue Measures,” Journal of Pain and Symptom Management, Vol. 37, No. 1, 2009, pp. 107-128. doi:10.1016/j.jpainsymman.2007.08.019
[17] P. Ferrentinos, V. Kontaxakis, B. Havaki-Kontaxaki, D. Dikeos and G. Papadimitriou, “The Fatigue Questionnaire: Standardization in Patients with Major Depression,” Psychiatry Research, Vol. 177, No. 1, 2010, pp. 114-119. doi:10.1016/j.psychres.2009.01.029
[18] R. Bakshi, Z. A. Shaikh, R. S. Miletich, et al., “Fatigue in Multiple Sclerosis and Its Relationship to Depression and Neurologic Disability,” Multiple Sclerosis, Vol. 6, No. 3, 2000, pp. 181-185.
[19] J. F. Kurtzke, “Rating Neurologic Impairment in Multiple Sclerosis: An Expanded Disability Status Scale (EDSS),” Neurology, Vol. 33, No. 11, 1983, pp. 1444-1452. doi:10.1212/WNL.33.11.1444
[20] W. Guy, “ECDEU Assessment Manual for Psychopharmacology,” DHEW Publication ADM-76-338, 1976.
[21] J. Busner and S. D. Targum, “The Clinical Global Impressions Scale: Applying a Research Tool in Clinical Practice,” Psychiatry, Vol. 4, No. 7, 2007, pp. 28-37.
[22] S. D. Targum, H. Hassman, M. Pinho and M. Fava, “Development of a Clinical Global Impression Scale for Fatigue,” Journal of Psychosomatic Research, Vol. 46, No. 3, 2012, pp. 370-374. doi:10.1016/j.jpsychires.2011.12.001
[23] S. D. Targum, J. Busner and A. H. Young, “Targeted Scoring Criteria Reduce Variance in Global Impressions,” Human Psychopharmacology: Clinical and Experimental, Vol. 23, No. 7, 2008, pp. 629-633. doi:10.1002/hup.966
[24] M. Fava, D. V. Iosifescu, P. Pedrelli and L. Baer, “Reliability and Validity of the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire,” Psychotherapy and Psychosomatics, Vol. 78, 2009, pp. 91-97. doi:10.1159/000201934

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