MS cognitive problems linked to worse mental, physical life quality

Researchers relied on self-reported RAND-12, HUI-C assessments

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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People with multiple sclerosis (MS) who have cognitive impairment tend to report worse mental and physical quality of life than patients who don’t have cognitive issues, a study reports. Adults with MS who have cognitive problems are also less likely to be employed.

The study, “Association of patient-reported cognitive impairment with quality of life and employment in multiple sclerosis,” was published in Multiple Sclerosis and Related Disorders.

Cognitive problems, such as difficulty thinking or trouble with memory, are a common symptom of MS. Here, scientists in the U.S. and Canada analyzed the relationship between cognitive issues and quality of life for MS patients with a survey of 6,227 people conducted in 2019 using the North American Consortium of Multiple Sclerosis (NARCOMS) registry, a self-reporting registry for people with MS. Most respondents identified as white and female, and had an average age in the early 60s. Slightly more than half were ages 65 or younger.

The survey collected data on a range of demographic and clinical information, including measures of cognition and life quality. The researchers focused mainly on two standardized self-reported assessments of each outcome — the RAND-12 and the HUI-C. The RAND-12 measures life quality on a scale from 0 to 100, with higher numbers reflecting better quality. It includes two subscores, one for physical well-being and one for mental/emotional well-being. The HUI-C measures cognition on a scale from 0 to 1, a score of 1 reflecting normal cognition. Scores between 0.7 and 0.99 reflect mild or moderate cognitive problems and scores below 0.7 suggest severe cognitive issues.

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The researchers emphasized the HUI-C is a subjective measure that asks patients to self-report their experiences, whereas other cognitive assessments measure cognition by administering a test and derive performance based on how well patients score.

“Subjective cognitive measures, like the HUI-C when given in conjunction with other self-report measures of depression and fatigue, may be a helpful tool for clinicians to consider a patient’s perspective on their cognitive status,” they said.

Based on HUI-C scores, about half the patients (56.4%) had cognitive problems — 19.7% had mild impairment, 25.6% had moderate impairment, and 11.1% had severe impairment. The specific types of impairment varied; some only had memory problems, some only had thinking issues, and some had both.

The researchers found that there was a statistically significant positive correlation between RAND-12 and HUI-C scores; patients who reported better life quality were less likely to report cognitive issues, and vice versa. This association was seen for both RAND-12 subscores. For every 0.1-point lower score on the HUI-C, scores on the physical subscore were 0.41 points worse on average, and scores on the mental subscore were 0.37 points worse.

In further analyses, which focused on patients ages 65 or younger, the researchers found that those who reported any cognitive impairment were significantly less likely to be employed. Patients with no cognitive issues or only mild issues were 46.3% more likely to be working than those with more severe issues.

“We found patient-reported [cognitive impairment] as measured by the HUI-C to be associated with both physical and mental [quality of life] on the RAND-12. … Participants with self-evaluated higher cognition on the HUI-C were also more likely to be employed,” the scientists said. “After adjusting for depression, fatigue, disability, and other demographic factors these associations were still found.”