Contribution of cognitive difficulties to disability in persons with multiple sclerosis

The effects of multiple sclerosis (MS) on cognition, thought to occur in 50-75% of persons with MS, have gained increasing recognition as one of the major disabling symptoms of the disease. While numerous studies have addressed the emotional and physical impact of MS, little attention has been given to the relationship of cognitive limitations to social and role functioning in persons with MS. The purpose of this study was to explore the relationships among functional limitations, neuropsychological competence in daily activities and social and role-related functioning. Participants completed a questionnaire battery as part of an ongoing study of quality of life among persons with MS. The battery included measures of illness and socio-demographic variables, functional limitations (physical and cognitive), depressive symptoms and the SF-36 subscales of social, role-emotional and role-physical functioning. The sample (N=417) ranged in age from 30 to 90 (mean 58.5) and had been diagnosed for a mean of 21.8 years. The majority is white/non Hispanic (87%), married (69%) and had completed high school (83%). Using stepwise multiple regression depressive symptoms, functional limitations and cognitive difficulties predicted social functioning scores (R²=. 42). Forty-six percent of the variance in emotional role functioning was explained by depressive symptoms, cognitive difficulties, functional limitations and length of diagnosis. Functional limitations, depressive symptoms and cognitive difficulties predicted physical role functioning (R²=. 42). Findings suggest the importance of addressing cognitive difficulties as well as physical and emotional distress to minimize disability in persons with MS. This project was supported by R01NR003195, NINR, NIH.