Work status and cognitive performance in patients with relapsing remitting multiple sclerosis

Abstract

espanolLa discapacidad fisica y el curso de la enfermedad son fuertes predictores del estatus laboral en los pacientes con Esclerosis Multiple (EM). Sin embargo, la cognicion no tiene el mismo grado de evidencia. Este estudio plantea el objetivo de investigar la relacion entre la situacion laboral y el rendimiento cognitivo en la EM. Se recogieron los datos de 61 pacientes con EM de curso recurrente-remitente (EMRR) que fueron a atenderse en un hospital publico entre abril de 2014 y abril de 2015. El 29.5% estaban desempleados, el 54.1% estaban empleados y el 10.4% eran estudiantes o amas de casa. Se implementaron como test neuropsicologicos la Bateria Neuropsicologica Breve para Esclerosis Multiple y el test Simbolo-Digito. Ademas se administraron la Escala de Estatus de Discapacidad Expandida y el Inventario de Depresion de Beck II. La evaluacion se realizo de forma individual en dos sesiones, una con el neurologo y otra con el neuropsicologo en un consultorio privado. Las diferencias no fueron significativas en edad y anos de instruccion entre los pacientes con y sin empleo. En cambio, los pacientes desempleados tenian un puntaje mas bajo en el Simbolo-Digito, asi como la Escala de Estatus de Discapacidad Expandida y un Inventario de Depresion de Beck mas altos que aquellos con trabajos. Los pacientes con EMRR que estaban desempleados tenian un peor desempeno en la velocidad de procesamiento de la informacion, mas depresion y discapacidad fisica que aquellos que conservan sus trabajos. EnglishEmployment is a very important aspect of a person’s life, and that is why any health-related factor that can interfere in such activity must be identified. The reality of a Latin American country is different and should be approached as a separate object of study. Many factors that contribute to a patient losing the job can be identified in time in order to be reversed or compensated. Thus, identifying the vulnerability profile of the patients with multiple sclerosis (MS) who are at risk of losing their jobs is an important task for researchers. Physical disability and disease course are both strong predictors of work status in MS patients, however, cognition and affective variables do not have the same degree of evidence. This study raises the aim of investigating the relationship between employment status and cognitive performance in MS. With this knowledge, it would be possible to design a neuropsychological rehabilitation plan for patients, which focuses on compensating and recovering from cognitive impairment, as well as on serving as orientation for the person who is at risk of losing their job. A group difference design was used. The sample units were selected through a non-probability accidental sampling. We collected the data of 61 patients with relapsing-remitting MS (RRMS) who had attended consultation between April 2014 and April 2015, in a public hospital. 29.5% were unemployed; 54.1% were employed; and 10.4% were students or housewives. The Brief Repeatable Battery of Neuropsychology Tests adapted for Argentine population; Symbol Digit Modalities Test (SDMT), Expanded Disability Status Scale (EDSS) and Beck Depression Inventory-II (BDI-II), were administered individually in two sessions, one with a neurologist and one with the neuropsychologist in a private consulting room. Age and years of instruction differences between patients with and without employment were not significant. There were 60.8% of patients with cognitive impairment. Among them, 38.7% were unemployed. The relationship between cognitive deterioration and work status was not significant, c2 = .404, df = 1, p = .371. When comparing the groups in the cognitive battery, a meaningful difference in cognitive performance was observed between the subjects who had a job with those who were unemployed in SDMT (t = -2.421, df = 49, p = .019); performance being higher among the former. No other cognitive score showed significant results. Unemployed patients had higher EDSS and depression, than those with jobs. The cognitive tests administered, together with the BDI-II and EDSS, were included in the binary logistic regression analysis. The second model retained the SDMT and the BDI-II; both tests were able to correctly classify almost 80% of the cases. Also, both SDMT (s = .080, p = .014) and BDIII (s = -.098, p = .022) shown significant effects on work status. This study is one of the first attempts in Argentina to analyze the possible determinants of unemployment, which is extremely important in the context of a lack of determining literature about the issue in Latin America. According to results, patients with RRMS who are unemployed have worse performance in speed of information processing, more depression and physical disability than those who retain their jobs. Results are in line with previous studies, although in the present research a cognitive variable showed a greater negative influence on employment status over motor difficulties or physical disability. Clinicians would be able to identify patients whose profile shows a higher tendency towards work life decline, so that they can receive early treatment and delay that progression. It is suggested the realization of a multicentric Latin American study, blind to the patients labor status, with the aim of broadening the results by improving the study methodology. Key words: Multiple sclerosis; Cognition; Disability evaluation; Unemployment; Attention.