The Association between Cognition, Fatigue, and Social Role Participation Among Patients with Multiple Sclerosis

Background: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, which manifests in both externally evident and invisible impairments. External symptoms of MS typically present physically, such as gait disturbance or muscle weakness, whereas “invisible” symptoms may present in a variety of ways such as fatigue, mood disturbance, or cognitive impairment. Furthermore, research has demonstrated that these “invisible” symptoms have a tremendous impact on the functioning of people with MS (PwMS), despite gaps in awareness and treatment. Increasing research on these impairments has further demonstrated that social role participation (SRP) is another important, but rarely considered, aspect of daily living affected by MS. Social role participation refers to an individual’s ability to meet social expectations (e.g., familial, occupational) and has been demonstrated to be negatively impacted in PwMS.

Objectives: To examine the predictive impact of “invisible” symptoms (e.g., cognitive impairment) and patient related outcomes (PROs) in PwMS to further investigate the impact of this disease on SRP.

Methods: Patients with MS (n = 434) were assessed using a computerized cognitive testing battery (CCTB) and self-report measures to evaluate cognition, physical PROs, mental health PROs (e.g., depression, anxiety, social role participation), and fatigue PROs.

Results: A hierarchical regression analysis was conducted to determine the predictive impact of demographic factors, cognition, and PROs (physical, mental, fatigue) on SRP. Analyses found that the addition of PROs to a hierarchical model increased predictive power from 25% to 75%, suggesting that physical, mental, and fatigue symptoms of MS may impact PwMS’s ability to engage in typical social roles.

Conclusions: The findings of this study support the importance of considering impairments to SRP in MS, both generally and in combination with other symptoms. Future studies should continue to explore the impact of MS on SRP as it allows for more comprehensive understandings and interventions to support PwMS.