Perceived Cognitive Difficulties and Cognitive Test Performance as Predictors of Employment Outcomes in People with Multiple Sclerosis

Abstract

Perceived cognitive difficulties and cognitive impairment are important determinants of employment in people with multiple sclerosis (pwMS). However, it is not clear how they are related to adverse work outcomes and whether the relationship is influenced by depressive symptoms. Thus, this study examined perceived and actual general cognitive and prospective memory function, and cognitive appraisal accuracy, in relation to adverse work outcomes. The possible mediating and/or moderating role of depression was also examined. A cross-sectional community-based sample of 111 participants (33 males, 78 females) completed the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ), Beck Depression Inventory - Fast Screen (BDI-FS), and questions related to their current or past employment. They then underwent cognitive testing using the Screening Examination for Cognitive Impairment, Auditory Consonant Trigrams test, Zoo Map Test, and Cambridge Prospective Memory Test. Perceived general cognitive and prospective memory difficulties in the workplace and performance on the respective cognitive tests were found to predict unemployment and reduced work hours since MS diagnosis due to MS. Depression was also related to reduced work hours, but it did not explain the relationship between perceived cognitive difficulties and the work outcomes. Nor was it related to cognitive test performance. The results highlight a need to address the perceptions of cognitive difficulties together with cognitive impairment and levels of depression in vocational rehabilitation programs in pwMS.

Cognitive impairment among patients with multiple sclerosis: associations with employment and quality of life

“…Previous work examining cognitive impairment in relation to employment in MS had identified the SDMT to also be one of the main predictors of employment status;6 7 28 the CVLT-II has also predicted reduced employment status in a longitudinal study 7. Although simple strategies may overcome memory deficits, at least when they are mild, the ‘bandwidth’ limitations of reduced information processing speed are less easy to manage.…”

“…A better understanding of the specific cognitive deficits in MS has led to more sensitive patient-reported measures being developed in which relatively close correlation is seen between subjective measures of cognitive impairment and objective outcomes 23. Recent work has also suggested that patient-reported perceptions of cognitive difficulties may be predictive of unemployment status independent of mood and objective memory performance 6. This finding may reflect a relative insensitivity of standard tests to subtle cognitive impairments at a time when ‘subclinical’ cognitive impairment is beginning to cause difficulties with work.…”

“…Perhaps the most severe and far-reaching effect is unemployment, which results in extensive personal, social and financial costs. Cognition has been linked to unemployment in many countries 6 7. Cognition has been shown to mediate the effects of disability on employment status 8.…”

Perceived Cognitive Deficits in a Sample of Persons Living With Multiple Sclerosis

“…We would argue that both perceived and performance-based cognitive measures have clinical significance. For example, Honan et al 26 found that both perceived and performance-based cognitive measures significantly predicted employment outcomes in persons with MS. Also, findings from Pardini et al 27 suggest that the PDQ may serve as a proxy measure of subtle structural damage to the memory network of the hippocampus.…”

Association of Fatigue Intensification with Cognitive Impairment during Radiation Therapy for Prostate Cancer

“…In addition, cognitive deficits in cancer patients are typically assessed using the standard paper-and-pencil tests or in-person interviews, which are time-consuming and labor intensive for patients who are already fatigued [19, 20]. Further, self- reported (or perceived) cognitive deficits do not always reflect a subject’s performance on neuropsychological (or objective) tasks [21-23]. Therefore, there is a need to develop objective cognitive tests that correspond to subjective cognitive impairments that can be useful for cancer patients.…”