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Predictors of psychosocial functioning in multiple sclerosis : cognitive impairment, depression and physical disability Good, Kimberley Patricia


A number of reports suggests that multiple sclerosis (MS) leads to certain changes in psychosocial functioning. Whether these changes are the direct result of specific symptoms of MS such as: physical impairments, depression or deficits in cognitive function, is not yet clear. Few studies have examined the relative effects of each of these symptoms on various measures of social and vocational activities. Therefore, the purpose of this study was to determine: 1) in a sample of MS patients in the early stages of a relapsing-remitting disease course, the prevalence of cognitive impairment and depression; 2) whether these two dimensions were independent of physical disability; and 3) whether cognitive impairment, depression, or physical disability was most predictive of the decline of psychosocial functioning. In order to discover whether each of the symptoms existed within the sample, the MS group was divided according to cutting scores established by the performance of the normal control group. First, a group of MS patients who were cognitively impaired was identified by scoring lower than the fifth percentile of the normals' scores on the Word Fluency Test. Thirty seven patients (20%) of the MS group scored in the impaired range. Validation of this impairment was assessed by performance on other neuropsychological tests. Neither disease-related nor demographic variables could account for the deficit. Similarly, a group of patients with a high level of depressive symptoms was identified by using the ninety-fifth percentile of the normals' scores on the Beck Depression Inventory (BDI) as a cut-off. Thirty eight (21%) patients were classified as depressed according to the above criterion. Finally, those patients with highest levels of physical disability (top 20%) were identified from their scores on the Kurtzke EDSS. Thirty four (19%) of the MS group were considered physically impaired. Of the total MS sample, only 11% were impaired on a combination of two or more dimensions. The dependent variable for the final question, psychosocial functioning, was assessed by activity in the work force (employed vs unemployed), level of social/recreational activity, and outlook for the future (either optimistic or pessimistic). The results of this investigation suggest four things. First, cognitive impairment does exist in the early stages of MS and is independent of disease-related or demographic variables. Second, evidence for depressed mood was also found in a portion of this sample. Third, these observed symptoms as well as degree of physical disability are independent phenomena in the early stages of the disease. Fourth, being cognitively impaired is related to both a decrease in vocational and recreational activities and a greater pessimism towards the future. If a MS patient is depressed, it is more likely that he or she is unemployed and also less socially active. Interestingly, the degree of physically disability does not seem to be related to these three areas of psychosocial functioning.

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