Volume 30, Issue 2 (June 2026)                   Physiol Pharmacol 2026, 30(2): 159-167 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Esmaeili Ranjbar F, Assadollahi Z, RanjbarKarimi ShahamAbadi M, Toyserkani F, Heidari Z, ayoobi F, et al . Foot mental rotation deficits in relapsing-remitting multiple sclerosis and their relationship with cognitive function. Physiol Pharmacol 2026; 30 (2) :159-167
URL: http://ppj.phypha.ir/article-1-2557-en.html
Foot mental rotation deficits in relapsing-remitting multiple sclerosis and their relationship with cognitive function
Faezeh Esmaeili Ranjbar , Zahra Assadollahi , MohmmadJavad RanjbarKarimi ShahamAbadi , Fatemeh Toyserkani , Zeinab Heidari , Fatemeh Ayoobi , Mostafa Hadavinejad , Mahdieh Azin
Abstract:   (619 Views)

Introduction: Mental rotation (MR) of body parts relies not only on visuospatial processing but also on motor imagery mechanisms involving premotor cortical areas. Therefore, impairment in MR tasks may reflect both cognitive and motor dysfunction. We studied whether there is an impairment in reaction time and response accuracy rate of foot mental rotation (FMR), Paced Auditory Serial Addition (PASAT) score and walking time in individuals with relapsing-remitting multiple sclerosis (RRMS). The study also examined potential links between walking duratioN, FMR, and PASAT accuracy.
Methods: Basic procedures: 37 RRMS patients and 40 healthy subjects performed FMR tasks, Physical activity and auditory information processing were assessed by Timed25-Foot Walk (T25-FW) and PASAT tests.
Results: The average reaction time to stimuli of both legs and walking time in the RRMS group significantly increased compared with control group. The mean PASAT score of control group was significantly higher than the RRMS. There was no notable correlation between walking time and response accuracy rate in FMR task. Meanwhile there was a negative correlation between walking time and the number of correct responses in PASAT and positive correlation between walking time and reaction time in FMR.
Conclusions: The present study demonstrates that RRMS patients exhibit significant impairments in both motor and cognitive performance compared with healthy subjects. These findings suggest that RRMS affects not only motor functions but also cognitive-motor integration processes such as MR. These findings suggest that rehabilitation especially a combination of motor imagery exercises and physical therapy may help walking improvement in RRMS.
 

Keywords: Multiple sclerosis, Foot Mental Rotation, Motor imagery, Walking Time, Paced Auditory Serial Addition, Relapsing-remitting multiple sclerosis
Full-Text [PDF 913 kb]   (27 Downloads)    
Type of Manuscript: Clinical research article | Subject: Neurophysiology/Pharmacology
References
1. Amato M P, Zipoli V, Portaccio E. Multiple sclerosis-related cognitive changes: a review of cross-sectional and longitudinal studies. Journal of the Neurological Sciences 2006; 245: 41-46. [DOI:10.1016/j.jns.2005.08.019]
2. Azin M, Zangiabadi N, Iranmanesh F, Baneshi M R, Banihashem S. Effects of intermittent theta burst stimulation on manual dexterity and motor imagery in patients with multiple sclerosis: a quasi-experimental controlled study. Iranian Red Crescent Medical Journal 2016a; 18: e27056. [DOI:10.5812/ircmj.27056]
3. Azin M, Zangiabadi N, Tabrizi Y M, Iranmanesh F, Baneshi M R. Deficiency in mental rotation of upper and lower-limbs in patients with multiple sclerosis and its relation with cognitive functions. Acta Medica Iranica 2016b: 510-517.
4. Benedict R H, Amato M P, DeLuca J, Geurts J J. Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. The Lancet Neurology 2020; 19: 860-871. [DOI:10.1016/S1474-4422(20)30277-5]
5. Bersier N M, Fornari E, Rumiati R I, Ionta S. Cognitive traits shape the brain activity associated with mental rotation. Cerebral Cortex 2025; 35: bhaf069. [DOI:10.1093/cercor/bhaf069]
6. Biggio M, Pedulla L, Albergoni A, Bellosta A, Tacchino A, Podda J, et al. Motor imagery training promotes motor learning and brain plasticity without fatigability in people with progressive multiple sclerosis. European Journal of Physical and Rehabilitation Medicine 2026; 61: 831. [DOI:10.23736/S1973-9087.25.09116-6]
7. Brenton J N, Koshiya H, Woolbright E, Goldman M D. The multiple sclerosis functional composite and symbol digit modalities test as outcome measures in pediatric multiple sclerosis. Multiple Sclerosis Journal-Experimental, Translational and Clinical 2019; 5: 2055217319846141. [DOI:10.1177/2055217319846141]
8. Daprati E, Nico D, Duval S, Lacquaniti F. Different motor imagery modes following brain damage. Cortex 2010; 46: 1016-1030. [DOI:10.1016/j.cortex.2009.08.002]
9. Duarte-Mendes P, Ramalho A, Bertollo M, Neiva H P, Marinho D A. To move without moving: a perspective article on motor imagery. Frontiers in Psychology 2025; 16: 1697086. [DOI:10.3389/fpsyg.2025.1697086]
10. Fischer J, Rudick R, Cutter G, Reingold S, Force N M S C O A T. The Multiple Sclerosis Functional Composite measure (MSFC): an integrated approach to MS clinical outcome assessment. Multiple Sclerosis Journal 1999; 5: 244-250. [DOI:10.1177/135245859900500409]
11. Gómez-Melero S, Caballero-Villarraso J, Escribano B M, Galvao-Carmona A, Túnez I, Agüera-Morales E. Impact of cognitive impairment on quality of life in multiple sclerosis patients-a comprehensive review. Journal of Clinical Medicine 2024; 13: 3321. [DOI:10.3390/jcm13113321]
12. Haghdoost A. Do you want to gain a profound insight into sample size and statistical power. Iranian Journal of Epidemiology 2009; 5: 57-63.
13. Iezzoni L I, Rao S R, Kinkel R P. Patterns of mobility aid use among working-age persons with multiple sclerosis living in the community in the United States. Disability and Health Journal 2009; 2: 67-76. [DOI:10.1016/j.dhjo.2008.12.001]
14. Jeannerod M. Neural simulation of action: a unifying mechanism for motor cognition. Neuroimage 2001; 14: 103-109. [DOI:10.1006/nimg.2001.0832]
15. Kurtzke J F. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33: 1444. [DOI:10.1212/WNL.33.11.1444]
16. Lacourse M G, Orr E L, Cramer S C, Cohen M J. Brain activation during execution and motor imagery of novel and skilled sequential hand movements. Neuroimage 2005; 27: 505-519. [DOI:10.1016/j.neuroimage.2005.04.025]
17. Lambert K J, Singhal A, Leung A W. Parkinson's disease impairs the controllability of imagined action sequences. Experimental Brain Research 2025; 243: 120. [DOI:10.1007/s00221-025-07071-2]
18. Lin D, Eaves D L, Franklin J D, Robinson J R, Binks J A, Emerson J R. Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis. Frontiers in Neurology 2025; 16: 1567421. [DOI:10.3389/fneur.2025.1567421]
19. Matute-Blanch C, Montalban X, Comabella M. Multiple sclerosis, and other demyelinating and autoimmune inflammatory diseases of the central nervous system. Handbook of clinical neurology 2018; 146: 67-84. [DOI:10.1016/B978-0-12-804279-3.00005-8]
20. Motl R W, Sosnoff J J, Dlugonski D, Pilutti L A, Klaren R, Sandroff B M. Walking and cognition, but not symptoms, correlate with dual task cost of walking in multiple sclerosis. Gait & posture 2014; 39: 870-874. [DOI:10.1016/j.gaitpost.2013.11.023]
21. Mulder T, Hochstenbach J, Van Heuvelen M, Den Otter A. Motor imagery: the relation between age and imagery capacity. Human Movement Science 2007; 26: 203-211. [DOI:10.1016/j.humov.2007.01.001]
22. Parsons L M. Imagined spatial transformations of one's hands and feet. Cognitive psychology 1987; 19: 178-241. [DOI:10.1016/0010-0285(87)90011-9]
23. Pierpaoli C, Ferrante L, Foschi N, Lattanzi S, Sansonetti R, Polonara G, et al. Mental rotation ability: right or left hemisphere competence? what we can learn from callosotomized and psychotic patients. Symmetry 2020; 12: 1137. [DOI:10.3390/sym12071137]
24. Polman C H, Reingold S C, Banwell B, Clanet M, Cohen J A, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Annals of Neurology 2011; 69: 292-302. [DOI:10.1002/ana.22366]
25. Rahn K, Slusher B, Kaplin A. Cognitive impairment in multiple sclerosis: a forgotten disability remembered. Cerebrum 2012; 2012: 14.
26. Rezaeinasab M, Fotooh E M, Akbari C S, Shamsizadeh A, Assadollahi Z, Hasanshahi A, Azin M. Effect of tactile stimulation on hand mental rotation among young healthy adults: A randomized controlled trial. Archives of Neuroscience 2020; 7: e99078. [DOI:10.5812/ans.99078]
27. Rosti E, Hämäläinen P, Koivisto K, Hokkanen L. The PASAT performance among patients with multiple sclerosis: analyses of responding patterns using different scoring methods. Multiple Sclerosis Journal 2006; 12: 586-593. [DOI:10.1177/1352458506070624]
28. Ruggieri R, Palermo R, Vitello G, Gennuso M, Settipani N, Piccoli F. Cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis with EDSS≤ 3.5. Acta Neurologica Scandinavica 2003; 108: 323-326. [DOI:10.1034/j.1600-0404.2003.00157.x]
29. Saiote C, Tacchino A, Brichetto G, Roccatagliata L, Bommarito G, Cordano C, et al. Resting-state functional connectivity and motor imagery brain activation. Human Brain Mapping 2016; 37: 3847-3857. [DOI:10.1002/hbm.23280]
30. Tabrizi Y M, Mazhari S, Nazari M A, Zangiabadi N, Sheibani V. Abnormalities of motor imagery and relationship with depressive symptoms in mildly disabling relapsing-remitting multiple sclerosis. Journal of Neurologic Physical Therapy 2014; 38: 111-118. [DOI:10.1097/NPT.0000000000000033]
31. Tacchino A, Saiote C, Brichetto G, Bommarito G, Roccatagliata L, Cordano C, et al. Motor imagery as a function of disease severity in multiple sclerosis: an fMRI study. Frontiers in Human Neuroscience 2018; 11: 628. [DOI:10.3389/fnhum.2017.00628]
32. Tombaugh T N. A comprehensive review of the paced auditory serial addition test (PASAT). Archives of Clinical Neuropsychology 2006; 21: 53-76. [DOI:10.1016/j.acn.2005.07.006]
33. Wajda D A, Sosnoff J J. Cognitive-motor interference in multiple sclerosis: A systematic review of evidence, correlates, and consequences. BioMed Research International 2015; 2015: 720856. [DOI:10.1155/2015/720856]
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.