Fighting Fatigue in Multiple Sclerosis: TMS vs. tDCS Efficacy.

The MFIS is a 21-item self-report questionnaire designed to assess how fatigue impacts the daily lives of people living with Multiple Sclerosis (MS). It consists of 21 items divided into three subscales: Physical subscale (9 items)Cognitive subscale (10 items)Psychosocial subscale (2 items). Items are rated based on the patient's experiences over the past 4 weeks using a 5-point Likert scale (from 0 = "Never" to 4 = "Almost always"). Total score ranges from 0 to 84, with higher score indicating more severe fatigue.

It is a 20-item scale assessing two dimensions of MS-related fatigue: cognitive and motor. Patients rank statements on a scale from "Does not apply" to "Applies completely". Cut-off values were used to classify patients as experiencing mild, moderate or severe fatigue. Higher scores indicating a greater impact of fatigue.

It is a 9-item (7-point Likert scale), self-report, questionnaire designed to measure the severity of fatigue and its impact on daily activities. It is one of the most widely used and validated scales for patients with Multiple Sclerosis. Higher score Indicates more severe fatigue and interference with the patient's daily responsibilities, work, or social life.

The SDMT measures information processing speed, visual scanning, working memory, and sustained attention. It is widely considered the gold standard for detecting and tracking cognitive impairment in patients with Multiple Sclerosis. The total score ranges from 0 to 110, with higher score indicating better cognitive performance.

It is a highly comprehensive, disease-specific health-related quality of life instrument designed for patients with Multiple Sclerosis. It consists of 54 items divided into 12 distinct subscales alongside 2 single items.The 12 Subscales: Physical function, role limitations (physical), role limitations (emotional), pain, emotional well-being, energy/fatigue, health perceptions, social function, cognitive function, health distress, sexual function, and satisfaction with sexual function. Total score ranges from 0 to 100, where higher scores indicate a better quality of life.

It is an 18-item clinician-administered assessment designed to measure a patient's level of disability and track their functional changes during rehabilitation. It quantifies how much assistance a person requires to perform essential activities of daily living safely. It is divided into two main subscales: Motor Subscale (13 items): Covers self-care, sphincter control, transfers, and locomotion; and Cognitive Subscale (5 items): Covers communication and social cognition (problem-solving, memory). Total score ranges from 18 to 126. Higher scores indicate greater functional independence.

The Barthel Index is an internationally recognized, clinician-administered or self-report rating scale used to measure a patient's performance in activities of daily living. It consists of 10 items evaluating basic self-care and mobility tasks. The 10 Items: Feeding, bathing, grooming, dressing, bowel control, bladder control, toilet use, transfers (bed to chair), mobility (on level surfaces), and stairs. Total score ranges from 0 to 100; higher scores indicate greater independence.

The SRT is a highly sensitive neuropsychological verbal memory test designed to assess verbal learning and long-term memory. It is uniquely structured to differentiate between a patient's ability to store information over the long term versus their ability to retrieve it at any given moment. It is widely used to detect cognitive impairment in Multiple Sclerosis. It consists of 6 consecutive learning trials, followed by a delayed recall trial (administered 15 to 30 minutes later) and a final recognition trial. Instead of a single final number, the SRT generates multiple crucial metrics: Long-Term Storage (LTS): The number of words that have entered long-term memory.Consistent Long-Term Retrieval (CLTR): The words consistently recalled across consecutive trials without being reminded.Short-Term Storage (STS): Words recalled only after just being read. Higher scores in all indices indicate better verbal memory and learning capacity.

The 10/36 SPART is a highly sensitive neuropsychological test used to evaluate visuospatial learning and long-term visual memory. It includes two different scores: immediate recall ranges from 0 to 30; and delayed recall ranges from 0 to 10. Higher scores always indicate better visuospatial memory.

The PASAT is used to assess auditory information processing speed, sustained attention, divided attention, and working memory. The final score ranges from 0 to 60, with higher scores indicate better processing speed and working memory.

The WLG is a brief, widely used verbal fluency test designed to assess a patient's spontaneous word production, executive functioning, and mental flexibility. It includes both phonemic (phonetic) and semantic (categorical) verbal fluency tasks. The final score is simply the total number of correct, unique words produced within the time limit. Higher scores indicate better verbal fluency and executive functioning.

The Stroop Test is used to evaluate executive functioning, specifically selective attention, cognitive flexibility, and processing speed. It measures a person's ability to inhibit an automatic response (reading a word) in favor of a novel, controlled response (naming the ink color). The standard clinical version consists of three separate trials, each presented on a page with columns of items:Word Page (W): Color words (e.g., RED, GREEN, BLUE) printed in black ink. The patient reads the words as fast as possible.Color Page (C): Rows of symbols (like XXXX) printed in colored ink. The patient names the ink colors as fast as possible.Color-Word Page (CW / Interference): Color words printed in conflicting ink colors (e.g., the word RED printed in BLUE ink). The patient must name the color of the ink and ignore the written word. The Interference Score indicate resistance to interferences, with higher scores indicating better cognitive control and stronger resistance to interference.

The Trail Making Test (TMT) is a widely used neuropsychological assessment designed to evaluate visuospatial scanning, processing speed, and executive functioning (specifically cognitive flexibility and set-shifting).

Part A (TMT-A): The patient is presented with a sheet containing the numbers 1 through 25 scattered inside circles. They must draw a continuous line connecting the numbers in sequential order (1-2-3-4...). It primarily measures visual scanning, motor speed, and basic processing speed.

Part B (TMT-B): The patient is presented with numbers (1 to 13) and letters (A to L) scattered inside circles. They must draw a continuous line alternating between numbers and letters in ascending order (1-A-2-B-3-C...). It measures complex executive control, working memory, and cognitive flexibility (set-shifting).

The score for each part is the total time in seconds taken to complete the task. Lower times indicate better cognitive performance (faster speed and efficiency).

The HADS is a widely used 14-item (rated on a 4-point Likert scale, 0 to 3) self-report questionnaire designed to screen for anxiety and depression in patients with physical medical conditions. Its primary methodological advantage is that it strictly excludes somatic symptoms (such as fatigue, pain, or sleep disturbances). This prevents a patient's physical illness-such as Multiple Sclerosis-from artificially inflating their psychological scores.

It features two independent subscales of 7 items each:HADS-A (Anxiety): Evaluates cognitive and emotional states of tension, worry, and panic.HADS-D (Depression): Heavily focused on anhedonia (the loss of the ability to enjoy things) rather than physical lethargy.

Each subscale is calculated separately and ranges from 0 to 21. Higher scores indicate worse psychological distress.