Social, economic factors linked to poorer cognitive performance in MS
US study: Association more pronounced among non-white people
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A physician holds a tablet while conferring with a patient, who sits with their hands clasped together. (Photo by iStock)
- Social and economic factors are linked to poorer cognitive skills in adults with multiple sclerosis.
- These negative cognitive associations are significantly more pronounced among non-white individuals.
- Clinical risk assessments must incorporate social context and structural inequities to improve care management.
Social and economic factors, including unemployment, being unmarried, or living in disadvantaged neighborhoods, are linked to poorer cognitive skills in adults with multiple sclerosis (MS), especially among non-white people, according to a U.S. study.
The findings add to earlier evidence that patients with a lower socioeconomic status, tend to have more severe MS symptoms.
“These findings underscore the importance of incorporating social context into cognitive risk assessment and addressing structural inequities in MS care and research,” researchers wrote.
The study, “Social and socioeconomic factors and cognitive outcomes in multiple sclerosis,” was published in the journal Multiple Sclerosis and Related Disorders.
MS can cause difficulties with thinking, reasoning, learning
MS is a disease in which the immune system mistakenly damages the brain and spinal cord. In addition to problems with movement and sensation, MS can also cause difficulties with thinking, reasoning, learning, problem-solving, and planning.
Researchers have been studying how social, economic, and demographic factors may influence health outcomes in MS, finding that a lower socioeconomic status and being non-white is linked to faster disability progression.
“These disparities may be attributed to differences in healthcare access, knowledge level, social and economic conditions, and diagnostic delay, rather than biological or genetic differences,” the researchers noted
In the study, the researchers sought to understand whether socioeconomic status and race specifically affect cognitive outcomes in MS. It included 274 adults with MS living in urban areas or surrounding suburban communities in the U.S.
Participants’ mean age was 50.9 years, and they had been living with MS for a mean of 15.3 years. Most were women (77.4%), white (72.3%), and had relapsing–remitting MS (83.6%).
Neighborhood disadvantage linked to poorer performance
The researchers examined several socioeconomic factors, including education, employment, marital status, and neighborhood disadvantage, which is essentially the degree of socioeconomic disadvantage a person has based on the neighborhood or community where they live. It considers indicators like income, education, employment, and housing quality in the area.
Cognition was evaluated using a range of outcome measures that assessed information processing speed, attention and working memory, verbal learning and memory, and overall cognitive abilities.
“Our study examined social and socioeconomic factors in relation to cognitive outcomes in MS and evaluated whether these associations differed by race,” the researchers wrote. “Their relevance may be particularly important in MS because cognitive impairment has direct consequences for everyday functioning, including self-management and independence.”
The participants generally had cognitive scores within normal ranges. However, patients who lived in more disadvantaged neighborhoods performed worse on the NIH Toolbox Cognition Battery, a measure of overall cognitive function. Non-white patients and those with fewer years of education also had worse cognitive scores.
Non-white patients and those with less education or who were unemployed performed significantly worse on the Symbol Digit Modalities Test (SDMT), a measure of how quickly a person can process new information. Neighborhood disadvantage was linked to worse scores on the SDMT among non-white, but not white, patients.
Findings highlight the importance of addressing social and structural factors in managing cognitive health in MS, particularly for racially marginalized groups.
Similar observations were made in the Paced Auditory Serial Addition Test (PASAT), a measure of attention and working memory, or the ability to temporarily hold and use information. Worse PASAT performance was linked to living in more disadvantaged neighborhoods, being unmarried, or not living with a partner among non-white patients, while fewer years of education were linked to worse performance regardless of race.
On the Rey Auditory Verbal Learning Test, which measures how well a person learns and remembers spoken words, non-white patients who were unmarried or not cohabitating showed worse performance, as did people with lower educational attainment.
“Overall, non-White race and adverse social and socioeconomic factors, including lower educational level, unemployment, unmarried status, and greater neighborhood disadvantage, were associated with poorer cognitive performance,” the researchers wrote, adding that “the impact of some social and socioeconomic factors varied by race.”
Addressing these factors is a key next step, according to the authors.
“Findings highlight the importance of addressing social and structural factors in managing cognitive health in MS, particularly for racially marginalized groups,” they wrote. “Such steps are critical for developing equitable, effective care in MS.”
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