Self And Relative Reported Executive Dysfunction In Multiple Sclerosis: Prevalence And Relationship With Mood And Health Status

Introduction Research indicates that cognitive impairment in multiple sclerosis (MS) may occur in approximately half of cases and may have detrimental effects on an individual’s general health status and mood. This study explores the usefulness of subjective measures of cognitive impairment in enhancing our knowledge of the relationships between these variables. Of particular interest was the self-reporting of executive dysfunction, an under-researched area in MS. Method One hundred and forty-seven individuals with MS completed a postal questionnaire survey measuring self-reported memory impairment, executive dysfunction, mood and health status. Eighty-two of their relatives completed a postal questionnaire survey, rating the patients’ memory impairment and executive dysfunction. Comparative samples were a traumatic brain injury (TBI) population and healthy controls. Results The amount of executive dysfunction reported by patients was lower than in a TBI population but not significantly different from that reported by healthy controls. Relatives reported lower levels of executive dysfunction than in a TBI population but significantly higher levels than healthy controls. There was no significant difference between patient and relatives’ reports of executive dysfunction in the group overall but detailed analyses highlighted sub-groups where significant differences were found. The sample was split into individuals who over-report and under-report executive difficulties in comparison to their relatives. Over-reporters were found to be more likely to have relapsing-remitting MS, report higher levels of anxiety, report higher levels of memory impairment and have lower levels of relative-reported memory impairment, compared to under-reporters. The discrepancy score (a tendency to over-report executive dysfunction) was also found to be a predictor of depression. Subjective reports of cognitive impairment were not found to predict health status (measured by social functioning and employment status). However, self-reports of executive dysfunction were found to be the strongest predictors of depression and anxiety. Conclusions These results are interpreted and possible implications for theory and clinical practice suggested. The findings highlight relationships between subjective reports of cognitive impairment and mood and health status that have not been investigated before in MS. A number of hypotheses are proposed for the relationship between these variables, but clarification of these relationships is not possible in the current design. Therefore, avenues are suggested for future research