Social Activity Participation Impacted by Invisible Symptoms of MS

February 26, 2021
Matt Hoffman
Matt Hoffman

Matt Hoffman, Senior Editor for NeurologyLive, has covered medical news for MJH Life Sciences, NeurologyLive’s parent company, since 2017. He hosts the NeurologyLive Mind Moments podcast, as well as Second Opinion on Medical World News. Follow him on Twitter @byMattHoffman or email him at

Data from a pair of posters suggest that cognition, fatigue, and depression all impact social activity limitations in people with MS, rather than walking impairment alone.

Data from a pair of poster presentations suggest that there is a strong need for further assessment of the limitations in social activity in individuals with multiple sclerosis (MS) due to the negative impacts stemming from invisible symptoms of the disease, such as cognition, fatigue, and depression.1,2

The first of the posters identified that severe impairment in walking ability, as measured by Patient Determined Disease Steps (PDDS), is not the sole contributing factor in limited social activities among these individuals. The findings showed that social roles and activities had a strong correlation with Hospital Anxiety and Depression Scale (HADS) and Modified Fatigue Impact Scale (MFIS) anxiety and depression scores. These scores, as well as Ability to Participate in Social Roles and Activities–Short Form (SRA) scores, all began to worsen by the time patients with MS identified as having “moderate” disability (but excluding walking ability limitations [PDDS group 2-3]).1

The second poster displayed data that indicate the need for further evaluations of cognition in those with MS as it relates to the ability to participate in social roles and activities. Cognition was deemed to impact SRA scores as they began to decline, and multiple individual cognitive domains were significantly related with SRA scores.2

Both posters were presented virtually at the Americas Committee for Treatment and Research in MS (ACTRIMS) Forum 2021, February 25-27, by Olivia Kaczmarek, BS, clinical research coordinator, South Shore Neurologic. “Disease burden and progression in people with [MS] is traditionally measured by reported relapse, [Expanded Disability Status Scale], and MRI change. Disease impact on…lifestyle and independence, including participation in social roles and activities has been associated with severe impairment in mobility, with EDSS scores of over 7, and are not typically assessed during routine care visits,” Kaczmarek and colleagues wrote.

“Analysis of depression, anxiety, and fatigue in relation to disease burden and disability and the impact on social role participation may provide novel insight and early detection for intervention,” they added.

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The posters pooled data in retrospective fashion from charts of 339 patients with MS (73.5% women) with a mean age of 50.5 years (±11.9). All patients had completed cognitive testing and patient-reported outcomes (PRO) as part of routine care on the same day. The NeuroTrax Cognitive Assessment Battery (NT-CAB) was used to assess cognition, consisting of 7 domains: memory, executive function, attention, information processing speed, visual-spatial, verbal function, and motor skills, as well as a global cognitive summary score (GCS).

In the first poster, regression analysis identified significant relationships (P <.05) for a number of PRO scores with SRA outcomes. Those included MFIS scores (r = 0.75), HADS-depression scores (r = 0.7), and HADS-anxiety scores (r = 0.5).1

Additionally, grouped PDDS scores had significant differences compared to SRA grouped scores (PDDS 0-1 vs PDDS 2-3; and PDDS 0-1 vs PDDS 4-5), HADS-anxiety scores (PDDS 0-1 vs PDDS 2-3; PDDS 0-1 vs PDDS 4-5; PDDS 0-1 vs PDDS 6-7), HADS- depression scores (PDDS 0-1 vs PDDS 2-3; PDDS 0-1 vs PDDS 4-5; PDDS 0-1 vs PDDS 6-7), and MFIS scores (PDDS 0-1 vs PDDS 2-3; PDDS 0-1 vs PDDS 4-5; PDDS 0-1 vs PDDS 6-7). There were no significant differences observed between other PDDS groupings for each PRO.

Likewise, in the second poster, significant relationships (P <.05) were displayed via regression analysis with SRA scores in the following cognitive domains: GCS (r = 0.32), memory (r = 0.22), executive function (r = 0.35), attention (r = 0.34), information processing speed (r = 0.27), visual spatial (r = 0.17), verbal function (r = 0.11), motor skills (r = 0.31), and cognitive domains impaired (domain scores <85; r = 0.26).2

Conducting t-test analysis between grouped PDDS scores and social roles revealed significant differences between the PPDS 0-1 group and the PDDS 2-3, PDDS 4-5, and PDDS 6-7 groups, individually. No significant differences were observed between other PDDS groupings.

“These findings indicate a need for a closer look at cognition in [people with] MS in relation to the ability…to participate in social roles and activities. Severe impairment in walking ability is not the only factor contributing to limited social activity in [people with] MS,” Kaczmarek and colleagues concluded.

For more coverage of ACTRIMS Forum 2021, click here.

1. Kaczmarek O, Petroski J, Bumstead B, et al. Multiple Sclerosis and the Ability to Participate in Social Roles and Activities: Disease Impact Beyond Physical Disability. Presented at ACTRIMS 2021 Forum; February 25–27, 2021. Abstract P207.
2. Kaczmarek O, Petroski J, Kodym C, et al. Multiple Sclerosis, Cognition and the Ability to Participate in Social Roles and Activities: Disease Impact Beyond Physical Disability. Presented at ACTRIMS 2021 Forum; February 25–27, 2021. Abstract P208.