By Dave DeFusco
As March marks Multiple Sclerosis Awareness Month, new research highlights an often overlooked challenge facing people living with Multiple Sclerosis: how changes in thinking and memory can affect the ability to stay employed.
A study published in Multiple Sclerosis and Related Disorders found that certain cognitive tests can help predict whether a person with MS is likely to remain in the workforce. The research compared two widely used tools: the Symbol Digit Modalities Test, a quick screening test commonly used in MS care, and the NeuroTrax computerized cognitive battery, a broader computerized assessment that measures multiple aspects of thinking.
The study included 109 people with MS receiving care at a comprehensive treatment center. Participants had an average age of 48, reflecting the fact that many people with MS are diagnosed and living with the condition during their prime working years. Approximately half of the participants were employed.
“Multiple Sclerosis typically impacts individuals who are still very much of working age,” said Dr. Marissa Barrera, director of the Katz School’s M.S. in Speech-Language Pathology, a Multiple Sclerosis certified specialist and part of the research team that conducted the study. “They’re young professionals, and employment is a very important factor. Looking at cognition and employment is hugely impactful, and that’s kind of what’s exciting about this particular research study.”
Cognitive impairment is common in MS, affecting as many as 70 percent of people with the disease. These changes can influence daily activities, quality of life and the ability to maintain steady employment, even when physical symptoms are relatively mild.
In the study, participants completed both cognitive tests. Researchers then examined whether scores could predict self-reported employment status. When analyzed separately, both tests were significant predictors. People who scored higher on either assessment were more likely to be employed but when researchers examined the results together, only the NeuroTrax global cognitive score remained a statistically significant predictor of employment.
The difference likely reflects the breadth of the computerized test. “The NeuroTrax global cognitive assessment looks at many different domains, so it’s a better representation of cognitive skills across many areas,” said Barrera.
Those domains include executive functioning, attention, memory and processing speed. Each plays a critical role in workplace performance.
“Executive functioning is literally the skills you need to live day to day,” said Barrera. “It involves memory, divided attention, sustained concentration and the ability to manage distractions which are critically important for workplace performance.”
The assessment also measures attention, memory formation and recall, and the speed at which the brain processes and analyzes information. Together, these abilities form the foundation of many everyday job tasks, from organizing projects to responding quickly to new information.
The Symbol Digit Modalities Test, by contrast, focuses mainly on processing speed and attention. It has long been considered a reliable and efficient screening tool in MS care.
“The SDMT is an oldie but goodie,” said Barrera. “It’s a very commonly used assessment of cognition. It’s a screening tool that gives us a glimpse of change associated with MS and many other disorders.”
Barrera noted, however, that the test captures only a narrow slice of cognition. “You just can’t compare it to the robustness of a multi-domain cognitive assessment like NeuroTrax,” she said.
Researchers found that participants who were unemployed tended to perform worse across multiple cognitive domains, especially executive function and attention. Many also showed impairments in several areas simultaneously, suggesting that the cumulative burden of cognitive difficulties may play a major role in work-related challenges.
The findings could help clinicians identify patients who may need additional support to remain in the workforce. Understanding a patient’s cognitive profile allows clinicians to design targeted rehabilitation strategies, which might include cognitive therapy, workplace accommodations or vocational counseling.
“Understanding these different cognitive domains helps us early identify vocational support, targeted rehabilitation and workplace accommodations,” she said. “It is to everyone’s benefit that individuals with MS remain in the workforce as long as possible.”
The research also underscores the potential value of computerized cognitive testing in routine MS care. NeuroTrax assessments can be administered by trained staff and generate reports that neurologists and rehabilitation teams can use to guide treatment decisions.
For Daija Jackson of the Department of Mental Health at Brooke Army Medical Center in San Antonio, the study highlights the importance of recognizing cognitive symptoms that might otherwise go unnoticed.
“Research like this helps clinicians better understand how cognitive changes influence real-world outcomes like employment,” said Jackson, who is lead author of the study. “By identifying these challenges earlier, we can begin to develop strategies that support patients’ independence, well-being and long-term participation in the workforce.”
