Cognitive functioning as a predictor of employment status in relapsing-remitting multiple sclerosis: a 2-year longitudinal study

Background Cognitive functioning has been linked to employment outcomes in multiple sclerosis (MS) in cross-sectional studies. Longitudinal studies are however lacking and previous studies did not extensively examine executive functioning. Objectives We examined whether baseline cognitive functionin...

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Published in:	Neurological sciences 2019-12, Vol.40 (12), p.2555-2564
Main Authors:	van Gorp, Dennis A.M., van der Hiele, Karin, Heerings, Marco A.P., Jongen, Peter J., van der Klink, Jac J.L., Reneman, Michiel F., Arnoldus, Edo P.J., Beenakker, Ernesto A.C., van Eijk, Jeroen J.J., Frequin, Stephan T.F.M., de Gans, Koen, Hoitsma, Elske, Mostert, Jop P., Verhagen, Wim I.M., Zemel, Désirée, Visser, Leo H., Middelkoop, Huub A.M.
Format:	Article
Language:	eng
Subjects:	Adult Attention - physiology Cognitive ability Cognitive Dysfunction - physiopathology Employment Executive function Executive Function - physiology Fatigue Fatigue - physiopathology Female Humans Longitudinal Studies Male Medicine Medicine & Public Health Middle Aged Mood Multiple sclerosis Multiple Sclerosis, Relapsing-Remitting - physiopathology Neurology Neuroradiology Neurosurgery Original Original Article Psychiatry Regression analysis Severity of Illness Index Studies Young Adult
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Summary:	Background Cognitive functioning has been linked to employment outcomes in multiple sclerosis (MS) in cross-sectional studies. Longitudinal studies are however lacking and previous studies did not extensively examine executive functioning. Objectives We examined whether baseline cognitive functioning predicts a change in employment status after 2 years, while taking into account mood, fatigue and disability level. Methods A total of 124 patients with relapsing-remitting MS (pwMS) and 60 healthy controls were included. They underwent neurological and neuropsychological examinations and completed online questionnaires. PwMS were divided into a stable and deteriorated employment status group (SES and DES), based on employment status 2 years after baseline. We first examined baseline differences between the SES and DES groups in cognitive functioning, mood, fatigue and disability level. A logistic regression analysis was performed, with change in employment status (SES/DES) as dependent variable. Results The DES group included 22% pwMS. Group differences were found in complex attention, executive functioning, self-reported cognitive functioning, fatigue and physical disability. More physical disability (OR = 1.90, p = 0.01) and lower executive functioning (OR = 0.30, p = 0.03) were retained as independent predictors of DES ( R 2 = 0.22, p ≤ 0.001). Conclusions Baseline physical disability and executive functioning, but none of the other variables, moderately predicted a deterioration in employment status 2 years later. Trial registration This observational study is registered under NL43098.008.12: ‘Voorspellers van arbeidsparticipatie bij mensen met relapsing-remitting Multiple Sclerose’. This study is registered at the Dutch CCMO register ( https://www.toetsingonline.nl ).
ISSN:	1590-1874 1590-3478