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Objective: Many persons with multiple sclerosis (pwMS) experience cognitive impairment which negatively impacts their quality of life. Recent studies suggest that objective and subjective measures of cognitive function are not closely related. Stigma is one of many factors that may account for the discrepancy in measures of cognitive function in pwMS. Stigma exists when people distinguish human differences based on perceptions of undesirable characteristics. We hypothesized that stigma has an impact on the discrepancy between objective and subjective cognitive function in pwMS.
Methods: 345 pwMS participating in the SysteMS: A Systems Biology Study of Clinical, Radiological, and Molecular Markers in Subjects with Multiple Sclerosis at the Brigham and Women’s Hospital completed two objective measures of cognitive function, the Symbol Digit Modalities Test (SDMT), a measure of processing speed, and the California Verbal Learning Test-II (CVLT-II), a measure of verbal learning. Participants also completed the Quality of Life in Neurological Disorders (Neuro-QoL). The Neuro-QoL cognitive function domain measures perceived difficulties in cognitive abilities (e.g., memory, attention, and decision making). The Neuro-QoL stigma domain measures stigma as perceptions of self and publicly enacted negativity, prejudice, and discrimination because of disease-related manifestations. Pearson’s correlation coefficient was used to estimate the associations between Neuro-QoL cognitive function, SDMT, CVLT, and stigma. The discrepancy between subjective and objective measures of cognitive function was quantified using a sensitivity score. Sensitivity was calculated by z-transforming the raw scores for objective and subjective cognitive measures, scaling the results into a value of 0-10, and subtracting the re-scaled subjective score from the re-scaled objective score.
Results: There was a strong negative association between Neuro-QoL self-reported cognitive function and Neuro-QoL stigma scores (r = -0.522, 95% CI: -0.595, -0.441). Higher stigma scores were associated with lower scores on SDMT (r = -0.319, 95% CI: -0.411, -0.221) and CVLT (r = -0.222, 95% CI: -0.320, -0.119). Stigma positively predicted a higher sensitivity score for both SDMT (r = 0.161, 95% CI: 0.056, 0.262) and CVLT (r = 0.184, 95% CI: 0.080, 0.284), with positive sensitivity scores reflecting lower self-reported cognitive function than objective cognitive function.
Conclusion: Stigma was more closely associated with self-reported cognitive function than objective cognitive test performance. Subjects with higher stigma scores had lower self-reported cognitive function compared to objective cognitive test performance. Stigma may help explain the discrepancy between subjective and objective cognitive function. Interventions targeted at reducing the internalization of stigma in pwMS may lead to more accurate assessments of cognitive function.
References
Carone, D. A., et al. “Interpreting Patient/Informant Discrepancies of Reported Cognitive Symptoms in MS.” Journal of the International Neuropsychological Society, vol. 11, no. 5, 1 Sept. 2005, pp. 574–583, www.cambridge.org/core/journals/journal-of-the-international-neuropsychological-society/article/interpreting-patientinformant-discrepancies-of-reported-cognitive-symptoms-in-ms/1DFD6EB1D75EFA90FAFAFC45C5A38C61, https://doi.org/10.1017/S135561770505068X. Accessed 20 June 2020.
Hahm, S., Muehlan, H., Stolzenburg, S., Tomczyk, S., Schmidt, S., & Schomerus, S. (2020). How Stigma Interferes With Symptom Awareness: Discrepancy Between Objective and Subjective Cognitive Performance in Currently Untreated Persons with Mental Health Problems [Review of How Stigma Interferes With Symptom Awareness: Discrepancy Between Objective and Subjective Cognitive Performance in Currently Untreated Persons with Mental Health Problems]. American Psychological Association, 5(2), 146–157. APA PsycNet. https://doi.org/10.1037/sah0000184
Link, B. G., & Phelan, J. C. (2001). Conceptualizing Stigma. Annual Review of Sociology, 27(1), 363–385. https://www.jstor.org/stable/2678626
Meca-Lallana, V., Gascón-Giménez, F., Ginestal-López, R. C., Higueras, Y., Téllez-Lara, N., Carreres-Polo, J., Eichau-Madueño, S., Romero-Imbroda, J., Vidal-Jordana, Á., & Pérez-Miralles, F. (2021). Cognitive impairment in multiple sclerosis: diagnosis and monitoring. Neurological Sciences, 42(12), 5183–5193. https://doi.org/10.1007/s10072-021-05165-7
