Multiple Sclerosis, Cognition and the Ability to Participate in Social Roles and Activities: Disease Impact Beyond Physical Disability

Background: Multiple Sclerosis is central demyelinating disease that often results in visible motor and coordination or ambulation impact and examination defined visual or sensory disturbance, but often overlooked cognitive impairment. Disease burden and progression in people with Multiple Sclerosis (PwMS) is traditionally measured by reported relapse, EDSS, and MRI change. Disease impact on PwMS’s lifestyle and independence, including participation in social roles and activities has been associated with severe impairment in mobility, with EDSS scores of over 7 and are not typically assessed during routine care visits. Analysis of cognition in relation to disease burden/disability and the impact on social role participation may provide novel insight and early detection for intervention for PwMS.

Objectives: To examine the relationship between cognition, patient reported outcomes of patient determined disease steps (PDDS), and Ability to Participate in Social Roles and Activities- Short Form (SRA).

Methods: Retrospective chart review of PwMS that completed cognitive testing and patient reported outcomes (PRO) as part of routine care on the same day. PRO’s include Patient Determined Disease Steps (PDDS), and Ability to Participate in Social Roles and Activities- Short Form (SRA). NT-CAB includes the following 7 cognitive domains: memory (Mem), executive function (Exe), attention (Att), information processing speed (Inf), visual spatial (Vis), verbal function (Ver), motor skills (Mot) as well as a global cognitive summary score (GCS). Cognitive domains impaired (CDI, domain score’s <85) are also calculated.

Results: 339 PwMS (73.5% female, average age 50.5+/- 11.9 years). Significant relationships (p<0.05) were identified through regression analysis with Pearson’s correlation coefficient (r) for the following Cognitive Domain scores with SRA: GCS (r=0.32), Mem (r=0.22), Exe (r=0.35), Att (r=0.34), Inf (r=0.27), Vis (r=0.17), Ver (r=0.11), Mot (r=0.31), CDI (r=0.26). T-test analysis between grouped PDDS scores and social roles identified significant differences between the following groups 0-1 vs 2-3, 0-1 vs 4-5, and 0-1 vs 6-7. No significant differences were found between other PDDS groupings.

Conclusions: Cognition in PwMS impacts SRA as scores begin to decline by the time PwMS identify themselves as having moderate disability, not including limitations in walking ability (PDDS group 2-3). SRA had a significant relationship with multiple individual cognitive domains. These findings indicate a need for a closer look at cognition in PwMS in relation to the ability of PwMS to participate in social roles and activities. Severe impairment in walking ability is not the only factor contributing to limited social activity in PwMS.