Brain damage in MS predicts long term employment outcomes

14 May, 2018
  • Employment is an important issue for people with MS and contributes substantially to their sense of self and quality of life.
  • A new study has shown that damage in the brain due to MS can predict the employment status 12 years later.
  • Disease duration predicted a worse employment status at 12 years, with each additional year of MS increasing the risk of lower employment levels by 10%.
  • Higher levels of active lesions, total lesion volume or a lower proportion of functional brain tissue as seen on MRI all individually predicted a worse employment status after 12 years.

MS is a disease that strikes people in their prime, at a time in their lives when they are often building their careers and starting a family. Living with the symptoms of MS often leads to people with MS reducing their employment levels or leaving the workforce. Unemployment has been linked to a lower quality of life and given the impact it can have, the MS International Federation has recognised opportunities for work as one of the seven principles to improve quality of life for people with MS.

While research published last year by researchers at Monash University in collaboration with the Australian MS Longitudinal Study shows that employment rates for Australians with MS have greatly improved since 2010, there is still more work to be done.

Previous studies have shown that not only physical disability, but also symptoms such as fatigue and problems with thinking and memory are commonly linked to reduced employment. Now, new research from researchers at Charles University and General University Hospital in the Czech Republic suggests that a current snapshot of the damage to the brain caused by MS can also help predict an individual’s employment status 12 years later.

The researchers tracked a range of clinical and brain imaging factors in 145 people with early relapsing-remitting MS with to see if they were linked to employment over many years. Brain magnetic resonance imaging (MRI) scans were taken at baseline and one year later, and then employment status was recorded 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 degradation in their employment situation compared to men, and the length of time a person had been living with MS was also linked to reduced employment.

However, looking at the MRIs provided a more concrete predictor of future employment status. 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 at baseline and one year, all individually predicted a worse employment status over 12 years. Having one extra millilitre of active lesion 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%.

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

As well as supporting the Australian MS Longitudinal Study’s (AMSLS) research into economic and employment impacts of MS, MS Research Australia has supported a number of research studies targeted at improving employment retention for people with MS. Monash University researchers showed that disclosing a diagnosis of MS in the work place can be associated with job retention and Drs Rhonda Brown and Cynthia Honan looked at how rehabilitation for thinking skills can support people with MS in employment. More recently MS Research Australia funded a pilot study conducted by Dr Diana Dorstyn at the University of Adelaide to test an online vocational rehabilitation and training intervention. The study showed promising results and Dr Dorstyn hopes to roll out a larger trial in the future.

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