Learning and Cognitive Fatigue Trajectories in Multiple Sclerosis Defined Using a Burst Measurement Design

R.HoltzerDr. Roee Holtzer is an associate professor of psychology at the Ferkauf Graduate School of Psychology and of Neurology at the Albert Einstein College of Medicine of Yeshiva University. He holds an MA and a Ph.D. degree from the State University of New York at Binghamton. Dr. Holtzer completed his internship training in clinical psychology at the Rusk Institute of New York University. He also completed a T-32 post-doctoral fellowship in neuropsychology and cognition in aging and dementia at the cognitive neuroscience division of the Sergievsky Center of Columbia University Medical Center. He is licensed as a psychologist in New York State.

His research interests are in cognitive aging, dementia and in the interplay between cognition, mood and motor function vis-à-vis aging and diseases that affect the central nervous system. He recently published a paper titled: ‘Learning and cognitive fatigue trajectories in multiple sclerosis defined using a burst measurement design’ in the journal Multiple Sclerosis.

Background of the study

Cognitive fatigue is a critical and a very common symptom in Multiple Sclerosis. Cognitive fatigue has been defined as decline in performance over acute but sustained mental effort. However, measuring cognitive fatigue objectively (as opposed to self-report) has been both challenging and elusive. Poor ability to measure important symptoms such as cognitive fatigue comprises out ability to reliably assess and treat such symptoms. Therefore, the aim of this article was to implement an approach that will allow us to measure objectively cognitive fatigue in patients with Multiple Sclerosis. To accomplish this goal we used a burst design methodology, which involves the repeated administration of the same test. Furthermore, to increase the clinical applicability of our research we selected a brief test of attention and speed of processing that is commonly used in the assessment of patients with Multiple Sclerosis.


Repeated measurement within and across study visits allowed us to measure objectively cognitive fatigue. Specifically, we demonstrated that patients with Multiple Sclerosis were more vulnerable to the effect of cognitive fatigue as compared to healthy individuals


The burst design approach can be easily incorporated into standard clinical assessment of patients with MS (and other diseases as well). It offers clinicians and researchers a feasible and reliable approach to objectively assess cognitive fatigue. As noted in the study, the test we have used is commonly used in clinical practice and has already been incorporated into several longitudinal studies and clinical trials. Adapting the burst design method we have reported in this article can potentially improve the assessment of cognitive fatigue in clinical practice, research and clinical trials.

Additional research

Clearly replication of our findings is critical. In addition, it will be important to understand who, among patients with Multiple Sclerosis, is at greater risk for developing cognitive fatigue. So, in other words, identify factors that explain differences in cognitive fatigue among patients with Multiple Sclerosis. To achieve this goal cognitive fatigue, as defined in our study, should be examined in relation to established mechanisms and risk factors including but not limited to biomarkers and brain regions and functional networks (so neuroimaging studies) that are implicated in Multiple Sclerosis.

Increasing awareness

Continue to publish good research, collaborate with other researchers in the area who can replicate and extend the reported findings, reach out to care providers and use media outlets to advertise the research.