Cognitive reserve is a determinant of social and occupational attainment in patients with pediatric and adult onset multiple sclerosis.

BACKGROUND

There is limited information on socio-professional attainment in pediatric-onset multiple sclerosis (POMS) compared with adult-onset MS (AOMS).

OBJECTIVES

To assess socio-professional outcomes in POMS and AOMS and variables influencing these outcomes.

METHODS

One-hundred-fifteen AOMS and 111 POMS patients underwent neuropsychological testing (Brief Repeatable Battery, Stroop test), assessment of cognitive reserve (CR) (education, National Adult reading Test -NART, Barratt Simplified Measure of Social Status), fatigue (Fatigue Severity Scale), depression (Montgomery-Åsberg Depression Rating Scale), socio-professional performance (Work and Social Adjustment Scale -WSAS). Prognostic factors were assessed using logistic and linear multivariable regression analyses.

RESULTS

34.5% of patients showed CI without significant differences between AOMS and POMS. Cognitively impaired patients were older (p=0.024), had higher EDSS scores (p=0.041) and lower IQ (p<0.001) compared with cognitively preserved patients. Better WSAS scores were associated with younger age (p=0.007), lower EDSS (p<0.001) and higher educational levels (p=0.001). Fourteen POMS (13%) and six AOMS (5%) achieved a lower educational level compared with their parents (p=0.06). POMS exhibiting a lower than expected educational level, had a lower median IQ compared with the remaining subjects (101 vs 106.5; p=0.03). Unemployment rate was predicted by higher disability (p=0.044) and lower educational levels (p<0.001). Occupational complexity was positively correlated to educational level (<0.001) and NART scores (<0.040).

CONCLUSION

This study underscores the complex relationships between cognition and educational, socioeconomic and professional attainment in MS and supports a protective role of CR in both POMS and AOMS.

Informations de copyright

Copyright © 2020 Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Simone M., Falautano M., Minacapelli E., Pippolo L., Viterbo R., Goretti B., Prestipino E., Niccolai C., Bellinvia A., Fonderico M, Tudisco L., Fratangelo R., Margari L., have nothing to disclose; Amato M.P., received research grants and honoraria as a speaker and member of advisory boards by Bayer, Biogen, Merck, Novartis, Sanofi Genzyme, Teva, Celgene and Roche; Patti F. reports personal fees from Almirall, personal fees from Bayer, grants and personal fees from Biogen, personal fees from Celgene, grants and personal fees from Merck, personal fees from Roche, personal fees from Sanofi, personal fees from Novartis, personal fees from TEVA, grants from Reload onlus, grants from FISM, grants from MIUR, outside the submitted work; Portaccio E. served on a scientific advisory board for Biogen and Merck Serono. He received honoraria from Biogen, Merck Serono, Teva, Genzyme . Chisari CG has received grants for congress participation from Almirall, Biogen, Merck Serono, Novartis, Roche, Sanofi Genzyme, and TEVA; Moiola L. received honoraria for speaking at scientific conferences and for participating to advisory board from Biogen-Idec, Serono, Sanofi, Novartis, TEVA, Roche; Ghezzi A. received honoraria for speaking and consultancy from Merck-Serono, Novartis, Biogen-Idec, Genzyme; Razzolini L. received research, editorial grants and honoraria as a speaker and member of advisory boards by:Bayer, Biogen, Merck, Novartis, Sanofi Genzyme, Teva, Almirall, Roche; Pastò L. received research, editorial grants and honoraria as a speaker and member of advisory boards by:Bayer, Biogen, Merck, Novartis, Sanofi Genzyme, Teva, Almirall, Roche; Cocco E. and Marrosu M. have received honoraria for consultancy or speaking from Bayer, Biogen, Novartis, Sanofi, Genzyme, Serono and Teva; Fenu G. received honoraria for consultancy from Novartis, Biogen and for speaking from Merck Serono and Teva.