MS Fatigue, Cognitive Impairments Are Main Reasons Patients Lose Their Jobs

Difficulties with cognitive function and fatigue are the main reasons patients with multiple sclerosis (MS) struggle to stay gainfully employed, a new study published in the December edition of the International Journal of MS Care has found. The study is titled “Factors Associated with Employment Status in Individuals with Multiple Sclerosis,” and authored by Margaret Cadden, MS, and Peter Arnett, PhD, from Pennsylvania State University.

Unemployment is a well-documented problem among MS patients, whose rate of joblessness is estimated to range between 22% and 80% and carries a substantial socioeconomic burden. Previous studies of MS patients have also reported that:

• Disease factors connected to employment status include fatigue, depression, cognitive problems, and motor hardships;
• Employment can begin to be negatively affected up to 8 years before diagnosis;
• Unemployed patients often struggle to regain full-time employment for fear of losing disability benefits, a predicament known as the “disability trap”;
• A longitudinal study reported that only 50% of participants were employed at baseline, and another 22% lost their jobs over the next 2.5 or so years.

Few studies, however, have scrutinized the factors that collectively best determine a patient’s employment prospects. Researchers, intending to fill this gap, enrolled 53 MS patients (eight men and 45 women) in a study of the cognitive, emotional, and social factors related to the disease and its impact on patients’ lives. Thirty-three of these participants were employed and 20 unemployed. Composite scores were created to represent cognition, fatigue, depression, and motor function. These composite scores, together with the Expanded Disability Status Scale score, were further analyzed as predictors of employment status.

Results showed that a model that included composite scores of motor function, cognition, depression and fatigue was able to significantly distinguish between patients who were unemployed and those who were employed. However, only the cognitive, motor and fatigue composite scores were found to be, individually, connected to unemployment. Further analysis suggested that the cognitive and fatigue composite scores were the most significant mediators of the disability’s impact on work status.

Researchers noted that their study was limited by its small size and nature (mainly women, predominantly relapse-remitting MS patients, no distinction between full- and part-time employment). Still, they recommend greater efforts be taken in devising interventions that target cognitive difficulties and fatigue in MS patients, which might improve their ability to maintain employment. They conclude, “More research and clinical trials for cognitive rehabilitation in the areas of memory, processing speed, and fatigue are needed.”