Lauren Strober

Unemployment in multiple sclerosis: the contribution of personality and disease

Background: Multiple sclerosis (MS) is the leading cause of neurological disability among young and middle-aged adults. One of the most devastating consequences of MS in this relatively young population group is unemployment. Although certain demographic and disease factors have been associated with employment, few studies have examined the contribution of person-specific factors, such as personality. Objective: The goal of this study was to determine the extent to which personality, demographics, and clinical measures contribute to unemployment in MS. Method: A total of 101 individuals with MS who were enrolled in a clinical trial on cognition underwent a brief neuropsychological battery and completed questionnaires related to vocation, mood, fatigue, and personality. Neurological impairment was measured with the Expanded Disability Status Scale (EDSS). Results: Employment status was related with disease duration, MS subtype, level of neurological impairment, fatigue, performance on measures assessing information processing speed (Symbol Digit Modalities Test (SDMT)), learning and memory (Selective Reminding Test), and the personality characteristic of persistence. Based on a forward logistic regression analysis, EDSS, SDMT, and persistence were the strongest predictors of employment status. Conclusions: These findings underscore the importance of personality on outcomes in MS and point to the need for more clinical attention and research in this area.

Unemployment in multiple sclerosis (MS): utility of the MS Functional Composite and cognitive testing

Unemployment is a significant concern among individuals with multiple sclerosis (MS). Determinations regarding ability to work are highly dependent on measurement tools used by neurologists and allied professionals. However, little is known of the usefulness of these tools when determining issues pertaining to employment status. The purpose of the present investigation was to examine the utility of the Multiple Sclerosis Functional Composite (MSFC) and a brief cognitive test battery when examining employment status in MS. Seventy-seven individuals with MS completed the MSFC and a brief cognitive test battery. On the MSFC, unemployed individuals demonstrated worse upper extremity functioning. There was no difference on the Paced Auditory Serial Addition Task (PASAT), the sole cognitive measure of the MSFC. On cognitive testing, unemployed individuals performed worse on measures of memory, information processing speed, and executive functioning. Through logistic regression analysis, the Symbol Digit Modalities Test (SDMT) was found to be the sole predictor of employment status among the significant disease, MSFC and cognitive variables. Consistent with previous findings, logistic regression found the SDMT to be a significant predictor of employment status. Given the lack of significant group differences on the PASAT, continued consideration of replacing the PASAT with the SDMT in the MSFC appears warranted.

Cognitive and neurobehavioral features in multiple sclerosis

Multiple sclerosis (MS) is the most common nontraumatic neurological condition of early and middle adulthood. Cognitive and neurobehavioral problems associated with this disorder are common. Approximately 50% of MS patients experience lifetime clinical depression, and at least 50% will experience significant cognitive difficulties. Fatigue is also extremely common and disabling in MS and appears to be associated with sleep problems and primary neurological features, in addition to secondary factors, including depression and pain. Quality of life is affected in MS by all of these factors and is an especially salient issue given that patients often live for many years following diagnosis. In this article, we explore the literature on cognitive and neurobehavioral features in MS, provide a commentary on the state of the literature and make suggestions for research directions over the next 5 years that would move the field forward significantly.

Factors That Moderate Activity Limitation and Participation Restriction in People With Multiple Sclerosis

We examined the variables most associated with activity limitation (i.e., cooking) and participation restriction (i.e., employment) in 72 people with multiple sclerosis (MS). Participants underwent a comprehensive neuropsychological test battery assessing memory, executive functions, visual perception, and processing speed and completed questionnaires assessing activity, participation, fatigue, and affective symptoms. Results showed that processing speed was the only variable consistently significantly related to both activity and participation. When examining specific aspects of activity and participation in isolation, employment status was significantly associated with education level, visual memory, fatigue, and processing speed. Cooking ability was associated with performance on tasks of working memory, verbal memory, and processing speed. These findings suggest that processing speed is a primary cognitive factor in MS influencing quality of both activity and participation in everyday life.

The Perceived Deficits Questionnaire

BACKGROUND Cognitive dysfunction affects approximately 43% to 70% of individuals with multiple sclerosis (MS) and is an important determinant of several functional outcomes in MS and quality of life. Brief neuropsychological test batteries have been developed specifically for use in MS and are widely used to aid clinicians in assessing levels of cognitive impairment in MS. Neuropsychologists and neurologists also frequently use briefer screening measures, such as the Perceived Deficits Questionnaire (PDQ), to assist in determining whether a more extensive neuropsychological evaluation is warranted. However, despite the ease of such measures, the relationship between self-report and objective cognitive impairment has been inconsistent, at best. Moreover, factors such as depression, fatigue, anxiety, and personality have been found to be more related to reports of cognitive difficulties. The purpose of the present study was to clarify the relationship between subjective cognitive concerns and objective cognitive impairment while accounting for related symptoms. METHODS We examined the association of self-reported cognitive concerns on the PDQ with objective cognitive measures, as well as depression, anxiety, fatigue, and self-efficacy. RESULTS There was no relationship between self-reported cognitive concerns and objective performance. Rather, reports on the PDQ were more correlated with reports of depression, anxiety, fatigue, and self-efficacy. CONCLUSIONS Depression and poor self-efficacy can contribute to reports of cognitive difficulties. Effective treatment to improve these factors seems warranted given the impact of perceived cognitive impairment on outcomes in MS and the potential for more accurate self-reports.

Multiple sclerosis and demyelinating disorders.

Multiple Sclerosis and Demyelinating Disorders publishes high-quality, original, basic, and clinical research in the field of multiple sclerosis, neuromyelitis optica and all other demyelinating diseases of the central nervous system. Integrating topics including genetics, health services research, neurology, psychiatry, and therapeutics, the journal’s ultimate goal is to create an interdisciplinary exchange platform that researchers, physicians, nurses, and patient advocates will find essential for keeping up to date with the latest developments in the field to facilitate their complex work in support of multiple sclerosis patients and ensuring the best possible care.

Using EP50 to forecast treatment adherence in individuals with multiple sclerosis

Much like delay discounting, probability discounting may be related to a host of pro-health behaviors. In a recent report, a Medical Decision Making Questionnaire (MDMQ) was developed that leveraged this insights of probability discounting to both describe ways that multiple sclerosis (MS) patients weigh costs and benefits when making adherence choices, and predicted their self-reported treatment adherence. The current re-analysis of those data use a novel EP50 measure as a framework of a model that predicted the cost/benefit ratios necessary for the choices of typically non-adherent patients to become indistinguishable from those of typically adherent patients (and vice versa). These analytic tools may aid in the development/evaluation of both novel therapeutics and treatment adherence strategies for chronic conditions.

Sleep Changes in Multiple Sclerosis: from the Individuals Perspective

Sleep Changes in Multiple Sclerosis: from the Individual’s Perspective Sleep difficulties are common in multiple sclerosis (MS), with prevalence rates ranging from 36% to 62%. Sleep problems have been shown to have a grave impact on individuals in the general population and to contribute to reports of fatigue and reduced quality of life in MS. However, despite these high rates and overall impact, sleep problems in MS frequently go unrecognized. The present investigation sought to examine sleep changes among a sample of 97 individuals with MS and to gain a better appreciation as to what individuals with MS report as contributing to their change in sleep. Approximately 58% of participants complained of changes in their sleep. Among these 56 participants, bladder incontinence, muscle stiffness and leg spasms were most often endorsed as a contributor, with rates ranging from 57% to 63%. When asked about the primary attribution of their sleep change, the majority of individuals (43%) described problems with bladder incontinence. Following this, 17% and 15% reported worry and problems with leg spasms as the primary contributors, respectively. Furthermore, those who rated worry as their primary reason for change in their sleep also endorsed greater symptomatology of depression and anxiety. These findings suggest that sleep difficulties in MS may be a result of many physical and/or psychological symptoms. Proper identification of the etiology of sleep changes in MS is warranted in order to treat these problems and hopefully ameliorate individuals’ difficulty with sleep and fatigue.

Subjective well-being differs with age in multiple sclerosis: A brief report.

Objective: Increased age is associated with improved subjective well-being in the general population. However, there are conflicting findings regarding this association in individuals with multiple sclerosis (MS). In the present study, we examined differences in depression and quality of life (QOL) among 3 age groups of individuals with MS. Method: Participants consisted of 57 individuals with MS who were divided into 3 age groups: 35–44, 45–54, and 55–65 years. Outcome measures included the Mood and Evaluative scale t scores on the Chicago Multiscale Depression Inventory (CMDI) and the Physical and Mental scale scores on the Multiple Sclerosis Quality of Life Instrument (MSQOL-54). Results: After controlling for disease duration, individuals in the oldest group reported significantly less severe depressive symptoms and better physical QOL than the youngest group. Conclusions: Results are consistent with theoretical predictions and observations of improved subjective well-being with age in the general population. Younger individuals with MS may be at higher risk for depression and poor QOL. Additional research is needed to model the findings in larger samples and clarify the theoretical mechanisms of the observed associations.

Progressive resistance exercise training and changes in resting-state functional connectivity of the caudate in persons with multiple sclerosis and severe fatigue: A proof-of-concept study

ABSTRACT Fatigue is one of the most disabling symptoms of multiple sclerosis (MS). While progressive resistance training (PRT) has been shown to reduce fatigue in persons with MS, it is not clear why these reductions occur. One hypothesis is that PRT may induce functional changes to the caudate, a region highly implicated in MS fatigue. The aim of the current study was to study the effects of PRT on overall fatigue impact and resting-state functional connectivity of the caudate in persons with MS reporting severe fatigue. Participants were semi-randomly assigned to either a 16-week home-based PRT (n = 5) or stretching control (n = 5) condition. Both groups demonstrated reductions in overall fatigue impact (main effect of time: F = .84, d = .65). Significant group × time interactions were found, with the PRT group demonstrating post-training increases in functional connectivity between the caudate and left inferior parietal (F = 66.0, p < .001), bilateral frontal (both p < .001), and right insula (F = 21.8, p = .002) regions compared to the stretching group. Furthermore, greater post-training increases in functional connectivity between the caudate and left inferior parietal region were associated with greater decreases in cognitive fatigue (r = −.52) specifically. This study provides initial evidence for the caudate as a potential neural substrate for the beneficial effects of PRT on fatigue in persons with MS.