Brain damage in MS predicts long-term employment outcomes

• Employment is an important issue for people with MS and contributes substantially to a sense of self and quality of life with MS
• A new study has shown that damage in the brain due to MS can predict a person’s employment status 12 years later
• Disease duration predicted a worse employment status at 12 years, with the risk of lower employment levels increasing by 10% with each additional year of living with MS
• Higher levels of active lesions, total lesion volume, or lower proportion of functional brain tissue as seen on magnetic resonance imaging (MRI) all individually predicted a worse employment status after 12 years

MS is a disease that often strikes people in their prime, at a time in their lives when they might be building their careers and starting a family. Living with the symptoms of MS can often lead people with MS to reduce their employment levels or leave the workplace altogether. Unemployment is linked to a person’s sense of self-worth, independence and belonging and it has also been linked to a reduced quality of life. Given the potential impact of unemployment for people living with MS, the MS International Federation has recognised opportunities for work as part of one of the seven principles to improve Quality of Life.

Previous studies have shown that, as well as physical disability, symptoms such as fatigue and difficulties with cognition and memory are commonly linked to lower levels of employment. Now, new research suggests that a contemporary snapshot of the brain damage caused by MS can predict an individual’s employment status 12 years later.

The study, led by researchers from Charles University and General University Hospital in the Czech Republic, examined a range of clinical and brain imaging factors to see if they were linked to employment over a number of years.

The researchers followed 145 people with early relapsing-remitting MS, providing them with MRI scans at baseline and again one year later. They then tracked employment levels in this group every three months over 12 years.

At the start of the study, 80% of the participants worked full time. At the 12 year mark, this number had dropped to 41%. Women with MS were more likely to have a lower employment status compared to men. The only other factor that was shown to be relevant to employment was the length of time a person had been living with MS; disease duration predicted a worse employment status at 12 years, with each additional year of living with MS increasing the risk of lower employment levels by 10%.

Having a higher amount of active lesions in the brain, higher overall lesion volume, or a lower proportion of functional brain tissue (as seen on MRI) all individually predicted a worse employment status over 12 years. Having an extra millilitre of active lesions increased the risk of a lower employment status by 53%. A 1% reduction in the proportion of functional brain tissue increased the risk of worse employment outcomes by 22%.

Although the relationship between cognitive decline and physical disability with worse employment outcomes is well known, this is one of the first times that the physical damage to the brain due to MS has been directly related to employment. This study shows that early monitoring of people with MS using MRI and clinical markers could help to identify people at a greater risk of reduced employment over the longer term. This will allow people with MS and MS employment support services to have a more targeted approach when preparing advice for people with potential employment changes due to their disease.

With thanks to MS Research Australia – the lead provider of research summaries on our website.