Examining the Impact of Perceived and Objective Cognitive Function on Social Participation in Individuals With Multiple Sclerosis.

Abstract

This study explores the association between objective and subjective cognitive function and social participation in a diverse sample of individuals with multiple sclerosis (MS). Cross-sectional. Multisite university laboratories. A total of 274 persons with MS (N=274) (PwMS) completed the study (age: 50.9±11.9y; 77% women; education:15.7±4.1y; median Patient Determined Disease Steps [PDDS], 2). Not applicable. Participants completed a comprehensive neuropsychological test battery, including pen-and-paper tests, the National Institutes of Health Toolbox Cognitive Battery, and perceived cognitive functioning. To evaluate social participation, participants completed the Quality of Life in Neurological Disorders Ability to Participate in Social Roles and Activities 8a, which assesses the ability to engage in social roles and activities. Sixteen linear regression analyses were performed for each cognitive test, controlling for age, sex, education, and ambulation disability (PDDS). The Benjamini-Hochberg procedure was used to control the false discovery rate for multiple comparisons. The regression analysis revealed that the initial model, accounting for age, sex, education, and PDDS, was significant (R²=0.31), with PDDS as the strongest predictor, such that higher PDDS scores were associated with lower social participation. After controlling for covariates and multiple comparisons, higher self-reported cognition (Patient-Reported Outcome Measures Information System (PROMIS) Cognitive Abilities and Cognitive Concerns; R²=.46; R² change=.15; standardized beta coefficient=0.40) and better attention (Flanker test; R²=.34; R²change=.03; standardized beta coefficient=0.21) were associated with greater social participation. Our study highlights the role of cognitive functioning in social participation among PwMS. Specifically, our findings indicate that subjective cognitive performance may be particularly important to assess when considering social participation in cognitively unimpaired PwMS. These findings underscore the need for assessments that integrate both subjective and objective measures to better support social participation.