再発寛解型および進行型多発性硬化症におけるメタ認知プロファイルの差異：疲労、認知、および自己申告による障害との関連性
Ozlem Totuk1, Merve Turkkol2, Hasan Can Gudek1
1Department of Neurology, University of Health Sciences, Hamidiye Faculty of Medicine, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey.
Objective:
This study examined metacognitive belief profiles in individuals with multiple sclerosis (MS) and their associations with cognitive, emotional, and functional outcomes. Specifically, we compared relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS) to determine whether distinct metacognitive patterns characterize different disease phenotypes.
Method:
A total of 504 participants (75.6% RRMS, 9.9% SPMS, 14.5% PPMS) were recruited from a neurology clinic. Participants completed the Metacognitions Questionnaire-30 (MCQ-30), Montreal Cognitive Assessment (MoCA), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS), Expanded Disability Status Scale (EDSS), Short Form-12 (SF-12), and Occupational Self-Assessment (OSA). Group differences were examined using ANOVA, correlations via Pearson coefficients, and hierarchical and ordinal regression models.
Results:
Progressive phenotypes, particularly PPMS, showed significantly higher maladaptive metacognitive beliefs than RRMS. RRMS individuals exhibited greater cognitive self-consciousness and need for control, whereas PPMS was associated with lower cognitive confidence and stronger negative beliefs about uncontrollability. No subtype differences emerged in positive beliefs. Maladaptive metacognition correlated with lower cognitive performance, greater fatigue, depressive symptoms, reduced quality of life, and lower self-efficacy. In regression models, depression was the strongest negative predictor of self-efficacy, while cognitive self-consciousness was a positive predictor. Clinical and psychological variables together explained 60% of the variance in self-efficacy. Metacognitive beliefs and fatigue also predicted higher neurological disability (EDSS).
Conclusions:
Metacognitive belief patterns differ across MS phenotypes and significantly impact both functional and neurological outcomes. These findings support incorporating metacognitive assessment into routine MS care and underscore the need for tailored psychological interventions addressing cognitive-emotional regulation.
