Worse Work Status in MS Tied to Subjective Cognitive Impairment

Patient-reported cognition problems predict work changes after 2 years

Joana Vindeirinho, PhD avatar

by Joana Vindeirinho, PhD |

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Patient-reported cognition difficulties — called subjective cognitive impairment (SCI) — are associated with current work status and with employment deterioration after two years in people with multiple sclerosis (MS), a new study reports.

Depression and anxiety also were linked with work status among these MS patients, but such mental health concerns were not significant predictors of future changes in employment for these individuals, according to researchers.

The findings suggest “that subjective measures of cognition are informative for predicting a change in employment status, highlighting the need for attention to subjective cognitive functioning in pwMS  [people with MS],” the team wrote.

Notably, subjective cognitive impairment among people with MS was not tied to any negative events in the workplace in this study.

The study, “Subjective cognitive impairment is related to work status in people with multiple sclerosis,” was published in the journal IBRO Neuroscience Reports.

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Subjective cognitive impairment found to impact employment

Unemployment rates are high — reaching up to 80% — among people with MS, research shows. In addition to mobility issues that prevent patients from performing everyday tasks, cognitive difficulties also can contribute to MS-related unemployment, particularly when executive functioning, memory, and attention are affected.

Many studies, however, do not make a distinction between subjective and objective measures of cognition, according to researchers. Subjective cognitive impairment or SCI refers to a patient’s self-reported experience of decline in cognitive abilities, whereas objective cognition impairment is measured with cognitive tests.

“Not all pwMS who experience cognitive difficulties also have measurable objective cognitive disturbances. Thus, for some pwMS, there is a discrepancy between how they experience their cognitive abilities and how they objectively perform on cognitive tests,” the researchers wrote.

In previous studies, more focus has been given to objective cognitive impairment measures than to subjective ones. To bridge this knowledge gap, a team of researchers in the Netherlands conducted a longitudinal study to assess the impact of SCI on the work status of MS patients.

The team gathered data from individuals who participated in the three-year observational [email protected] study at Leiden University. That study aimed to assess work-related factors affecting people with relapsing-remitting multiple sclerosis (RRMS) in the Netherlands.

A total of 287 participants currently working or within three years of their last employment were included in the analyses. Most were women (77.4%) and employed (87.1%), and a majority of working patients completed the assessments after two years.

The team’s main goal was to determine if SCI was linked to work status or negative work events at the study’s start (baseline). Negative work events were defined as performance problems and accommodations needed to the work environment due to MS.

A further aim was to determine if SCI could predict a deteriorating employment status, meaning stopping work due to MS or having work hours reduced by at least 20%, after two years.

Results showed that 76.5% of unemployed patients at baseline had self-reported cognition issues, compared with 27% of those who were employed. Among employed participants, SCI was more common in those who experienced some work deterioration after two years (48.6%) than in those with stable employment (20%).

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Worse cognition found among unemployed patients

When assessing SCI domains individually, researchers found that unemployed participants had significantly worse scores in all domains compared with those employed. These domains included attention and information processing, memory, personality and behavior, and other cognitive ability.

Similarly, compared with those with stable work, participants with deteriorating employment had worse scores for all SCI domains except for attention and information processing.

Discovering predictors of changes in [people with] MS’ work situation especially benefits the search for accurate intervention methods to prevent a deterioration in work status and thereby to improve [their] quality of life

The results showed that SCI at baseline was significantly associated with work status, and also a significant predictor of change from a stable to a deteriorating employment status. However, none of the individual SCI domains were associated with work status or its change.

By contrast, no association was observed between subjective cognitive impairment or any of its domains and the presence of negative work events either at baseline or after two years. According to the researchers, this might be due to the small number of participants who reported a negative work event, either at baseline or after two years, or because the definition of what is a negative work event was too limited for the study.

Given that SCI has been correlated with depressive symptoms, anxiety, and fatigue, the team also assessed the contribution of these factors to work status and negative work events.

Depression and anxiety were found to be associated with work status, but they were not predictors of change in employment status. Fatigue also was initially linked to work status, but that association lost significance when SCI was taken into account. Conversely, none of the factors was linked to negative work events or changes in employment.

These results highlight the relationship between SCI and stable employment in people with RRMS, and “emphasize the need for further research into subjective cognitive difficulties and their effect on work status among pwMS,” the researchers wrote.

“Discovering predictors of changes in pwMS’ work situation especially benefits the search for accurate intervention methods to prevent a deterioration in work status and thereby to improve [their] quality of life,” they concluded.

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