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Cognitive impairment among patients with multiple sclerosis: associations with employment and quality of life
  1. J Campbell1,
  2. W Rashid2,
  3. M Cercignani1,
  4. D Langdon3
  1. 1Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, UK
  2. 2Department of Neurology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  3. 3Department of Neuropsychology, Royal Holloway, University of London, Egham, Surrey, UK
  1. Correspondence to Dr J Campbell, Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer BN1 9RH, UK; jamie.campbell{at}


Objectives To explore the relationship between cognitive impairment and conventional measures of disability in multiple sclerosis (MS), quality of life (QOL) and employment status using the brief international cognitive assessment for multiple sclerosis (BICAMS) in the routine outpatient clinic.

Methods 62 patients with MS were assessed on the BICAMS test battery for cognitive impairment. Data were obtained on employment status and a number of questionnaires completed including fatigue severity score, multiple sclerosis neuropsychological questionnaire, hospital anxiety and depression scale, the functional assessment of multiple sclerosis (FAMS) as well as on the EuroQOL five dimension questionnaire (EQ-5D). Other assessments include the patient activation measure and unidimensional self-efficacy scale for multiple sclerosis.

Results Cognitive assessment revealed 44 subjects (65%) had evidence of cognitive impairment on formal testing. In comparison with patients without evidence of cognitive impairment, cognitively impaired patients exhibited significantly higher rates of unemployment (p=0.009). The symbol digits modalities test was the most significant predictor of unemployment. Cognitive impairment was associated with lower QOL scores on the FAMS (p=0.001) and EQ-5D (p<0.001).

Conclusions BICAMS provides a sensitive and easy to administer screening test for cognitive impairment within the outpatient setting. Cognitive impairment is common in our cohort of patients with MS attending outpatients and appears to be associated with increased rates of unemployment and lower measures of QOL.


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  • Contributors JC is the lead author on this work and takes full responsibility for the data, analysis, interpretation and presentation. Each author has full access to the relevant data and has reviewed the work prior to submission. All authors have agreed to conditions outlined in the guidance for authors.

  • Funding Brighton and Sussex University Hospitals NHS Trust.

  • Competing interests WR has accepted educational grants and travel bursaries from Genzyme, Biogen-Idec, Novartis and Teva and has also participated on advisory boards with Bayer, Novartis, Biogen-Idec and Genzyme. DL has received research grants from Bayer, Novartis, Biogen and has also participated on advisory board with Bayer, Novartis, Teva. DL is also in the speaker Bureau for Teva, Roche, Bayer, Novartis, Biogen.

  • Ethics approval Northern Ireland Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All pertinent data contained within the manuscript.