Psychosocial Predictors of Metacognition in Multiple Sclerosis

Background: Metacognition, or self-perceived cognitive functioning, has been studied in a variety of patient populations including multiple sclerosis. Many studies found patient reported difficulties highly correlated with depression rather than objective neuropsychological data. Recent research in MS suggests depression may not be the only confounding variable.

Objectives: Investigate the influence of demographics and psychosocial variables on self-reported cognition.

Methods: The sample included 407 community-dwelling adults in the Pacific Northwest with a diagnosis of MS. Participants completed a series of mailed self-report surveys over 3 years. The main outcome, metacognition, was split into “general cognitive concerns” and “perceived executive functioning” and measured by the Neuro-QOL Applied Cognition–Executive Function–Short Form (NeuroQOL-EF) and the Applied Cognition–General Concerns–Short Form (NeuroQOL-GC).

Results: Univariate linear regression identified statistically significant predictors of perceived cognition. Potential demographic predictors (age, gender, education, ethnicity, EDSS, years with MS, and MS type) measured at baseline did not predict self-reported general cognitive concerns or executive dysfunction 3 years later. Conversely all considered psychosocial variables (fatigue, depression, anxiety, perceived stress, wakefulness, sleep disturbance and pain) significantly predicted perceived cognition in the univariate analyses, and were forced into a single-step multiple linear regression model. The final model predicted 44% of the variance in general cognitive concerns, F (7, 392) = 44.2, p < .0001.  Fatigue (beta = -.47, p <.0001), anxiety (beta = -.18, p < .001), and daytime sleepiness (beta = -.12, p <.05) were statistically significant predictors of general cognitive concerns. Similarly, the final model with NeuroQOL-EF as an outcome variable  predicted 41% of the variance in perceived executive functioning scores, F (7, 392) = 38.64, p < .0001.  Fatigue (beta = -.4, p < .0001) and depression (beta = -.14, p< .05) significantly predicted self-reported executive functioning.

Conclusions: In MS metacognition is frequently linked to depression without consideration of other possible contributors. This study suggests that fatigue is more strongly associated with self-reported cognition than depression. Additionally, the cognitive difficulties reported by individuals with MS may be driven by a number of psychological variables.