Photo Credit: Ivan Balvan
Patient-reported cognitive impairment based on the Health Utilities Index may serve as a quick ‘litmus test’ for assessing quality of life in patients with MS.
Patient-reported cognitive impairment, as determined with the Health Utilities Index (HUI3) assessment tool, can help clinicians assess cognitive impairment in MS, according to results published in Multiple Sclerosis and Related Disorders.
The HUI3 is a self-administered measure with 15 items that assess patient-reported vision, hearing, speech, mobility, dexterity, emotion, cognition, and pain. Two cognition-related questions focus on the ability to think and solve day-to-day problems and memory, and these measures generate a single-attribute utility score (HUI-C).
Researchers analyzed data from the North American Consortium of Multiple Sclerosis (NARCOMS) Registry. Of 6,227 respondents, 56.4% reported cognitive difficulty with the HUI-C. After adjusting for multiple covariates, cognitive difficulty was associated with a 1.2 point lower physical QOL for each 0.1 decrease in HUI-C (P<0.001). Mental QOL decreased by 2 points for each 0.1 decrease in HUI-C (P<0.001). In the multivariable model, cognitive difficulty was associated with 10% lower odds of employment (P<0.001).
Even after accounting for age, income, depression, fatigue, and disability associated with cognition, patient-reported CI was associated with lower health-related and employment outcomes.
Study author Samantha Lancia, MS, talked with Physician’s Weekly (PW) about how the HUI-C may help patients with MS improve employment options and QOL.
PW: What are the most important findings to emphasize?
Lancia: The HUI-C could be used to screen or monitor patient-reported cognitive impairment as part of a clinician’s practice. One advantage is that this could be used separately or as a part of the HUI3, possibly even before seeing the clinician.
Did the results surprise you?
We found that, among patients who reported CI in the HUI-C, 64.1% reported both memory and thinking impairment, 23.1% reported memory impairment only, and 12.8% reported thinking impairment only. We did not find either the memory or thinking domains of the HUI-C to be dominant.
Difficulty with thinking and memory are common in MS, affecting up to 70% of people in some studies, so this was not surprising. People with MS often have difficulty with more than one cognitive domain.
Why was it necessary to do this study?
How people with MS perceive their cognition is important to their overall quality of life. The advantage of using the HUI-C is that it can work as a quick ‘litmus test’ to assess a patient’s perceptions of cognition. Impairments seen in the HUI-C could prompt physicians to investigate their patient’s symptoms further.
This suggests additional information is needed, likely leading to a formal neuropsychological evaluation. Performance-based neuropsychological tests may differ from patients’ perceptions of their abilities.
The HUI-C could be used at follow-up to monitor changes in a patient’s perceptions following evaluation, cognitive rehabilitation (if needed), or other treatments for anxiety or depression.
How do the cognitive effects of MS impact a patient’s life?
Cognitive difficulties with MS are a leading cause of negative employment changes. In a 7-year longitudinal study, CI was associated with unemployment. In a cohort of 65 newly diagnosed MS patients 7 years after diagnosis, 37.5% were no longer working, and of those who were unemployed at follow-up, 72.7% were cognitively impaired. In a cross-sectional study of 111 participants with MS, perceived cognitive difficulties were linked with unemployment and fewer work hours, independent of depression and performance on cognitive testing. In another study, productivity loss in unemployed people with MS was associated with cognitive processing speed, and patient-reported fatigue has been significantly linked with work-related outcomes.
Early intervention with patients who perceive they have cognitive impairment or who have cognitive impairment may help them stay in the workforce longer, have better insurance, and maintain a better quality of life.
What is the neurologist’s role in managing work productivity?
Patients who remain employed report better quality of life and have access to better insurance and care. When impairments are found, early rehabilitation (with physical therapists, occupational therapists, and neuropsychologists) leads to greater work productivity. The neurologist has a critical role in identifying individuals who experience or who are at risk for work productivity difficulties, managing symptoms to address productivity concerns, and engaging rehabilitation providers.
What unanswered questions remain?
It would be good to evaluate changes in single-attribute scores such as the HUI-C. Other single-attribute scores have not been fully utilized in MS, and their relationships to quality of life, employment, and disability may be future avenues of research.
Is there anything else you’d like to mention?
Perceptions of a patient’s own cognitive abilities are an important part of monitoring the overall health of a patient with MS. These abilities are related to their employment and quality of life and should be evaluated and monitored at each visit. The HUI-C, a brief measure of perceived cognitive ability with thinking and memory, may be useful in a busy clinical environment.
