Employment and MS: Self-Reported Cognitive Problems in the Unemployed

by Lisa Emrich Patient Advocate

Research shows that the majority of people with MS are no longer employed 10 years after disease onset. Executive abilities, often impaired in people with MS, may have a direct impact on the ability to maintain a job. Executive functions are the higher-level cognitive skills used to control and coordinate other cognitive abilities and behaviors.

Examples of executive functions:

  • Planning ability

  • Working memory

  • Attention

  • Problem solving

  • Inhibition

  • Mental flexibility


A recent Dutch study examined the relationship between subjective and objective executive functioning and employment status in relapsing-remitting MS patients (n=55; 85 percent female; mean age: 47 years; 36 percent employed). Patients underwent neurological, cognitive and psychological assessments at their homes, including an extensive battery of executive tests.

Compared to employed patients, those who were unemployed experienced:

  • Longer disease duration

  • Higher distractibility; difficulty sustaining attention

  • More cognitive fatigue

  • More difficulties with organizing and planning (reported by 60 percent of the unemployed patients, but only 25 percent of employed patients)

The employed group consisted of RRMS patients who had a paid job (n=20), either full-time (15 percent), part-time (55 percent), or less than 12 hours a week (25 percent). The unemployed group consisted of patients without a paid job, including homemakers, volunteers, patients receiving disability or unemployment benefits, patients on prolonged medical leave, or early retirement.

Researchers observed below average executive performance in 4-51 percent of the RRMS patients on some aspect of executive functioning, with the highest percentages related to decreased processing speed (in 20 percent of patients) and impaired performance related to visuospatial memory and response (in 51 percent). Possible influential factors such as age, educational level, physical functioning, and self-reported depression, anxiety, physical and social fatigue did not differ between groups.

Clinical Impact

Few differences in executive function were detected between RRMS patients with and without a paid job. However, non-employed MS patients did report more problems with organizing and planning skills and mentioned increased distractibility and cognitive fatigue. It is possible that self-perceived cognitive problems and related fatigue may be part of the reason that MS patients decide not to pursue a working career. Patients who continue to work outside of the home in an unpaid capacity, e.g. volunteering, may be better able to maintain executive functions.

Researchers stress that identification of subjective and objective cognitive difficulties and sources of fatigue may be particularly important for vocational rehabilitation or prevention of work problems. Solutions may be as simple as offering adaptions at work, such as use of organizing and planning tools or changing work schedules, or by psychological interventions aimed at coping with the experienced cognitive difficulties.


van der Hiele K, van Gorp D, Ruimschotel R, et al. Work Participation and Executive Abilities in Patients with Relapsing-Remitting Multiple Sclerosis. PLoS ONE 2015. 10(6): e0129228. doi:10.1371/journal.pone.0129228

Lisa Emrich
Meet Our Writer
Lisa Emrich

Living with multiple sclerosis and rheumatoid Arthritis, Lisa Emrich is an award-winning, passionate patient advocate, health writer, classical musician, and backroad cyclist. Her stories inspire others to live better and stay active. Lisa is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers. Lisa frequently works with organizations in support of better policies, patient-centered research, and research funding. Lisa serves on HealthCentral’s Health Advocates Advisory Board, and is a Social Ambassador for the MSHealthCentral Facebook page.