Cognitive Impairment in People with Multiple Sclerosis: Factors That Drive Perception of Impairment Differ for Patients and Clinicians

Background: Multiple sclerosis (MS) is a progressive neurological condition that impacts ability across a wide range of neurological functions. MS often causes cognitive impairment (CI), fatigue, and depression. These disease related factors have a significant impact on daily functioning and quality of life. Neurologists self-reported accuracy in assessing the presence of CI is reported to be often inaccurate. The accuracy of self-reported CI in PwMS might be suboptimal as well and literature has reported mixed results. Some research has suggested that there are external factors that affect perceived functioning. For instance, depression and fatigue may contribute to the perception of cognitive deficits. Importantly, studies have not explored how perceptions made by MS patients regarding their cognitive functioning compare to perceptions made by their clinicians.

Objectives: To investigate what factors influence self-reported perceived cognitive deficits among patients with Multiple Sclerosis (PwMS) and their clinicians in order to explore what factors drive these perceptions and if they differ between PwMS and clinicians.

Methods: PwMS were administered a computerized multi-domain cognitive screening battery and patient reported outcomes (PROs) for fatigue (MFIS), depression (BDI-II) and a Likert scale for quality of life. Physical disability was assessed by the patient’s clinician using the EDSS. Perceived cognitive deficits among clinicians and patients were self-reported along a Likert scale. Hierarchical regression analyses were performed.

Results: Cohort of PwMS (N=202, Age range: 20 to 88, Gender (71% female) reported Fatigue (p < .001) and cognitive scores (p < .05) significantly predicted patient perceived cognitive deficits, but not depression (p = .377) or physical disability (p = .213). Clinician perceived cognitive deficits were significantly predicted by multiple factors including cognitive scores (p < .001), depression (p < .001), physical disability (p < .05), age (p < .05), and self-reported quality of life (p < .05). Notably, fatigue did not significantly predict clinician perceived cognitive deficits (p = .535).

Conclusions: These findings provide further insight into the factors that impact a PwMS self-reported degree of CI and the variance from what factors drive a clinician’s perception of CI in PwMS. CI in PwMS impacts real world ability and identifying the presence of CI or change in CI in PwMS should not be left to perception alone. Future studies should explore whether patients or clinicians accurately perceive the patient’s CI.