Background: The association between cognitive impairment, health-related quality of life (HRQoL) and vocational status has been studied in recent years in cross-sectional studies in MS, but longitudinal data are still lacking.
Objective: To assesses cognitive impairment in MSers followed longitudinally.
Method: This study assesses this association in a sample of 65 newly diagnosed MSers followed longitudinally. Each MSers underwent a standardised clinical assessment, cognitive tests and the HRQoL SEP-59 questionnaire six months after the MS diagnosis (baseline) and seven years later (y7).Vocational status was also established at baseline and at year 7.
Results: The HRQoL at baseline was severely reduced in MSers compared with healthy subjects. The independent predictors for HRQoL composite scores at year 7 were the baseline depression score and the memory Z-score. Accordingly, 81.5 % of MSers worked at baseline and only 54.4 % worked at year 7. Among the MSers who did not work at year 7, 72.7 % of them were cognitively impaired, while 27.3 % were unimpaired at baseline. The vocational status at year 7 was significantly associated with the baseline IPS Z-score, EDSS and age.
Conclusions: Vocational status at year 7 and its change over 7 years was significantly associated with cognitive deterioration. IPS or memory dysfunction in the early stages of MS is correlated with a decreased level in health perception, independent of fatigue, depression and physical disability. Cognitive impairment at the diagnosis of MS increases the risk of changing vocational status in MSers seven years later.
"For those of you who don't like bad news this study is just that. MS is a bad disease and leads to cognitive impairment that correlates with unemployment. The fact that almost 50% of this study population were unemployed at 7-8 years after diagnosis is in line with other studies. It is also not surprising that cognitive impairment correlates with depression and physical disability."
"How do we treat cognitive impairment in MS? We don't have any medication for this problem, i.e. no pills to pop, all we have at our disposal is behavioural therapy. In short behavioural therapy teaches you how to cope with your cognitive problems."
"On a more positive note there is some emerging evidence that DMTs may delay the development of cognitive impairment. We are also hoping that the newer agents that slow the rate of brain atrophy will do the same. My stance on this problem is as always, prevention is better than cure!"
"Big Pharma, potentially, have the drugs to help MSers with cognitive problems. Several of them are currently exploring the possibility of doing trials in this area. For those of us who attack Big Pharma, please remember they are realistically the only ones with the wares and deep enough pockets to be able to tackle this challenge. Love them, or hate them, we need them!" Other posts on this blog in relation to unemployment:
Social consequences of multiple sclerosis (1): early pension and temporary unemployment--a historical prospective cohort study. Mult Scler. 2010 Jan;16(1):121-6. "This study confirms other data sets in the literature that MS is ...
Methods: MS'ers and disease characteristics associated with transitions to unemployment or employment were evaluated cross-sectionally and prospectively over the course of two assessment periods (mean interval of ~18 ...