RELATIONSHIP OF COGNITIVE PERFORMANCES AND EMPLOYMENT STATUS IN PEOPLE WITH RELAPSING MULTIPLE SCLEROSIS

Background: Multiple sclerosis (MS) is thè most frequent neurologic disorders in young adults, which may detrimentally affect employment. It is important to identify people with MS who may be at risk of unemployment in order to put in place appropriate management strategies. Objectives: to evaluate clinical factors associated to a higher risk of unemployment in people with relapsing MS (RRMS). Methods: Consecutive RRMS patients attending the scheduled follow-up visit at our outpatient MS clinic were enrolled. Clinical characteristics including the EDSS score were recorded. Data were obtained on employment status. Cognitive functioning was assessed using the brief international cognitive assessment for MS (BICAMS). The presence of fatigue and of depressive symptoms was assessed us¬ing the Modified Fatigue Impact Scale (MFIS) and the Beck Depression Inventory (BDI-II), respectively. Patients with at least one cog¬nitive impaired test out of the three cognitive tests which composed the BICAMS were classified as cognitively impaired. Demographic and clinical predictors of unemployment were assessed through a multivariate logistic regression model, including as covariates age, sex, disease duration, EDSS score, MFSI score, BDI-II score, cognitive impairment status. Results: As of May 2019, 200 RRMS patients have been enrolled, 88 (44%) were unemployed at the time of the evaluation. The male/ female ratio, the mean (standard deviation - SD) age and the mean (SD) disease duration did not differ (p=n.s.) between employed and unemployed patients [32/80 vs 21/67; 41.4 (10.2) vs 41.0 (13.1) years and 11.9 (8.7) vs 12.2 (9.0) years, respectively], Unemployed RRMS patients were signifìcantly more disabled [median (range) EDSS score: 2.5 (0-7.5) vs 2.0 (0-6), p<0.0001], more frequently cognitively im¬paired (64/24 vs 51/61, p<0.0001) than employed patients. Moreover, unemployed patients reported signifìcantly higher scores at BDI-II and MFIS than patients still at work [BDI-II: 10.6 (7.5) vs 8.6 (8.3), p=0.026; MFIS: 32,7 (20) vs 23.7 (20.3), p=0.002], The multivariate logistic regression model revealed that the only significant predictors of unemployment status were the presence of cognitive impairment in at least one BICAMS test [Odds Ratio (OR) (95% Confidence Interval) (CI): 2.602 (1.349-5.018), p=0.004] and a higher EDSS score [OR 95% CI: 1.520 (1.146-2.015), p=0.004], Conclusions: Our results confirmed the impact of cognitive and physical disabilities on employment status in RRMS patients. Moreo¬ver, our data stress the importance of routinely evaluate cognitive functions in order to minimize their impact on social and working abilities in RRMS patients.