Association of patient-reported cognitive impairment with quality of life and employment in multiple sclerosis

Samantha Lancia; Ruth Ann Marrie; Gary Cutter; Robert J Fox; Amber Salter

doi:10.1016/j.msard.2024.105675

Association of patient-reported cognitive impairment with quality of life and employment in multiple sclerosis

Mult Scler Relat Disord. 2024 Jul:87:105675. doi: 10.1016/j.msard.2024.105675. Epub 2024 May 11.

Authors

Samantha Lancia¹, Ruth Ann Marrie², Gary Cutter³, Robert J Fox⁴, Amber Salter⁵

Affiliations

¹ UT Southwestern Medical Center, Neurology, Section on Statistical Planning and Analysis, Dallas, TX, USA. Electronic address: samantha.lancia@utsouthwestern.edu.
² Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. Electronic address: rmarrie@hsc.mb.ca.
³ University of Alabama Birmingham, Department of Biostatistics, Birmingham, AL, USA. Electronic address: cutterg@uab.edu.
⁴ Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: foxr@ccf.org.
⁵ UT Southwestern Medical Center, Neurology, Section on Statistical Planning and Analysis, Dallas, TX, USA. Electronic address: amber.salter@utsouthwestern.edu.

PMID: 38763037
DOI: 10.1016/j.msard.2024.105675

Abstract

Background: Cognition is frequently affected in persons with multiple sclerosis (MS). Cognitive impairment (CI) is associated with decreased quality of life (QOL) and employment status. Yet, CI assessed using patient-reported outcome measures is not as well studied and is thought to be influenced by other symptoms. Health Utilities Index 3 (HUI3) is a multi-attribute health-status classification system that assesses 8 different single attributes, including cognition.

Methods: The North American Consortium of Multiple Sclerosis (NARCOMS) Registry, a voluntary, self-report registry for persons with MS, Spring 2019 survey collected the HUI3 and self-reported assessment of health-related QOL (RAND-12), cognitive status, depression, fatigue, disability, employment, disease-modifying therapy use, and sociodemographic data. We assessed the relationship between patient-reported cognitive CI from the HUI3 (HUI-C), QOL, and employment while adjusting for factors previously associated with the outcomes. For employment outcomes, the cohort was limited to participants 65 years of age or younger.

Results: Of the 6,227 respondents, 56.4 % reported cognitive difficulty with the HUI-C. After adjusting for multiple covariates, cognitive difficulty was associated with 1.2 point lower physical QOL for each 0.1 decrease in HUI-C (p < 0.0001). Mental QOL decreased by 2 points for each 0.1 decrease in HUI-C (p < 0.0001). Cognitive difficulty was associated with a 10 % decreased odds of employment in the multivariable model (p < 0.0001).

Discussion: Patient-reported CI was associated with lower health-related and vocational outcomes for MS patients, even after accounting for age, income, depression, fatigue, and disability associated with cognition. The HUI-C is a single attribute score derived from the HUI3 that may facilitate the evaluation of CI in MS.

Keywords: Cognition; Employment; Health utilities index; Multiple sclerosis; NARCOMS; Quality of life.

MeSH terms

Adult
Aged
Cognitive Dysfunction* / etiology
Employment* / statistics & numerical data
Female
Humans
Male
Middle Aged
Multiple Sclerosis* / complications
Multiple Sclerosis* / psychology
Patient Reported Outcome Measures*
Quality of Life*
Registries*
Self Report