Work status and cognitive performance in patients with relapsing remitting multiple sclerosis
2019
Employment 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.
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