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It has been suggested that bilingualism is beneficial for executive control and could have positive long-term effects by delaying the onset of symptoms of degenerative diseases. This research investigates, for the first time, the impact of bilingualism on executive control (monitoring and inhibitory control) in individuals with Multiple Sclerosis (MS), a neurodegenerative disease which commonly causes deficiencies in the cognitive system. Bilingual and monolingual adults, with and without an MS diagnosis, performed a flanker task with two degrees of monitoring demands (high monitoring vs. low monitoring). Results showed that bilingual MS patients had inhibitory control and monitoring abilities that were similar to healthy bilingual controls. In contrast, monolingual MS patients showed similar inhibitory control but significantly worse monitoring abilities compared to monolingual healthy controls. We propose that the similar behaviour between bilingual groups suggests that bilingualism might counteract cognitive deficits related to MS, especially with respect to monitoring. The high monitoring cost observed in monolingual patients seems related to underlying deficits in monitoring and possibly switching, executive control abilities commonly impaired in MS patients from early stages. Our findings provide some preliminary evidence for the cognitive reserve hypothesis in bilingual MS patients.

Background: The stigma associated with neurologic disorders plays a part in poor health-related quality of life. The eight-item Stigma Scale for Chronic Illness (SSCI-8) is a brief self-assessment tool for measuring perceived level of stigma. The psychometric performance of the SSCI-8 in people with multiple sclerosis (MS) was assessed. Methods: A multicenter, cross-sectional study in adults with relapsing-remitting or primary progressive MS was performed. A nonparametric item response theory procedure, Mokken analysis, was done to preliminarily study the dimensional structure of the SSCI-8. A confirmatory factor analysis (CFA) model was then fit, and the behavior and information covered by the eight items were assessed by parametric item response theory analysis. Results: A total of 201 patients (mean ± SD age, 43.9 ± 10.5 years; 60.2% female; 86.1% with relapsing-remitting MS) were studied. The Mokken analysis found that the SSCI-8 is a unidimensional strong scale (scalability index H = 0.56) with high reliability (Cronbach α = 0.88). The CFA model confirmed the unidimensionality (comparative fit index = 0.975, root mean square error of approximation = 0.077). The information covered by the SSCI-8 items ranges from 3.79 to 13.52, for a total of 66.56. More than half (66%) of the SSCI-8 overall information is conveyed by four items: 1 (“Some people avoided me”), 2 (“I felt left out of things”), 3 (“People avoided looking at me”), and 7 (“People were unkind to me”). Conclusions: The SSCI-8 shows appropriate psychometric characteristics and is, therefore, a useful instrument for assessing stigma in people with MS.

BACKGROUND: The stigma associated with neurologic disorders plays a part in poor health-related quality of life. The eight-item Stigma Scale for Chronic Illness (SSCI-8) is a brief self-assessment tool for measuring perceived level of stigma. The psychometric performance of the SSCI-8 in people with multiple sclerosis (MS) was assessed. METHODS: A multicenter, cross-sectional study in adults with relapsing-remitting or primary progressive MS was performed. A nonparametric item response theory procedure, Mokken analysis, was done to preliminarily study the dimensional structure of the SSCI-8. A confirmatory factor analysis (CFA) model was then fit, and the behavior and information covered by the eight items were assessed by parametric item response theory analysis. RESULTS: A total of 201 patients (mean ± SD age, 43.9 ± 10.5 years; 60.2% female; 86.1% with relapsing-remitting MS) were studied. The Mokken analysis found that the SSCI-8 is a unidimensional strong scale (scalability index H = 0.56) with high reliability (Cronbach α = 0.88). The CFA model confirmed the unidimensionality (comparative fit index = 0.975, root mean square error of approximation = 0.077). The information covered by the SSCI-8 items ranges from 3.79 to 13.52, for a total of 66.56. More than half (66%) of the SSCI-8 overall information is conveyed by four items: 1 (“Some people avoided me”), 2 (“I felt left out of things”), 3 (“People avoided looking at me”), and 7 (“People were unkind to me”). CONCLUSIONS: The SSCI-8 shows appropriate psychometric characteristics and is, therefore, a useful instrument for assessing stigma in people with MS.

Background Primary progressive multiple sclerosis (PPMS) has long been defined by progressive disability accrual in the absence of initial relapses. However, its underlying neurodegenerative process seems to be accompanied by central nervous system inflammation. A new classification defined multiple sclerosis courses according to clinical/radiological activity and progression. We provide further insight into PPMS activity according to this classification and other daily living aspects. Methods This was a multicentre, prospective, cohort study including 55 adult patients with PPMS according to 2010 McDonald criteria, within ten years from neurologic symptom onset and not receiving disease-modifying therapies during the past six months, who were followed up for 12 months. The primary study endpoint was the percentage of patients with active disease based on clinical relapses and/or magnetic resonance activity. Disability progression, cognitive function, physical/psychological impact, depression symptoms, stigma and employment were secondary endpoints. Results Eleven (25.6%) patients exhibited multiple sclerosis activity throughout the 12-month study follow-up. Fourteen showed non-active multiple sclerosis without progression, 11 non-active multiple sclerosis with progression, 6 active multiple sclerosis without progression and 4 active multiple sclerosis with progression; one patient with disease activity was not assessable for progression. Cognitive function scores remained unchanged or increased, disease physical impact was maintained and disease psychological impact significantly decreased. The proportion of patients with depression symptoms or stigma remained without significant changes as well as employment outcomes. Conclusion This study shows that one-fourth of PPMS patients may exhibit disease activity over one year, with disability progression in approximately one-third but without worsening of cognitive function, disease impact, depression, stigma or employment outcomes.

Introduction In Multiple Sclerosis (MS), withdrawal from employment is a critical problem. This study explores relationships between disease characteristics, work difficulties, health-related quality of life, depression, and stigma and how these factors affect employment status. Methods A multicenter, non-interventional, cross-sectional study was conducted in adults with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS). Patient-reported questionnaires included: 23-item Multiple Sclerosis Work Difficulties Questionnaire, 29-item Multiple Sclerosis Impact Scale, Stigma Scale for Chronic Illness, and Beck Depression Inventory-Fast Screen. Results A total of 199 individuals (mean age = 43.9 ± 10.5 years, 60.8% female, 86.4% with RRMS) participated in the study. Mean time from diagnosis was 9.6 ± 7.2 years and median Expanded Disability Status Scale score was 2.0 (interquartile range: 1.0–3.5). Employment rate was 47.2% (n = 94). Mean physical and psychological MSIS-29 impact sub-scores were 40.38 ± 17.1 and 20.24 ± 7.8, respectively. Forty patients (19.9%) had at least one SSCI-8 item with a score of 4 or 5, suggesting the presence of stigma often or always. Eighty-one patients (40.7%) were depressed and 25 (12.6%) had moderate-to-severe depression. Work difficulties were higher in those with worse functional status, a diagnosis of PPMS, and lower educational levels. Employed participants had lower perceptions of stigma and depressive symptoms than those not employed. Higher perceptions of stigma were also strongly linked to higher physical and psychological impact on health-related quality of life and greater work difficulties. Depressive symptoms were also strongly related to work-related problems. Conclusions Work difficulties, stigma and poor quality of life are common in MS patients, even in a population with low physical disability. Evaluation of these dimensions in clinical practice would allow the development of targeted rehabilitation and specific work plans for MS employers.

Introduction Unemployment is a significant problem for people with multiple sclerosis (MS). The MS Work Difficulties Questionnaire (MSWDQ-23) is a self-report tool to assess work-related problems in people with MS across three domains: physical, psychological/cognitive, and external barriers. The aim of this study was to assess the psychometric properties of the Spanish version of the MSWDQ-23. Methods A multicentre, non-interventional, cross-sectional study in adult patients with relapsing-remitting multiple sclerosis (RRMS) or primary progressive (PPMS) multiple sclerosis (McDonald 2010 criteria) was conducted. Socio-demographic and clinical characteristics as well as health-related quality of life using the 29-item Multiple Sclerosis Impact Scale (MSIS-29) were collected. Results A total of 201 subjects were studied (mean age: 43.9 years, 60% female, 86% with RRMS). Median Expanded Disability Status Scale (EDSS) (score: 2.0 [IQR: 1.0–3.5]). The employment rate was 47.3% (n = 95). The MSWDQ-23 was feasible (90% response rate), with high internal consistency and test-retest reliability (Cronbach's alpha = 0.94 and intraclass correlation coefficient-ICC > 0.87). MSWDQ-23 scores significantly and positively correlated with EDSS and both MSIS-29 physical and psychological subscales scores, showing an adequate convergent validity. Regarding construct validity, scores of patients with PPMS were higher than those of patients with RRMS, reaching statistically significance in MSWDQ-23 physical barriers domain and total scores. Conclusion The Spanish version of the MSWDQ-23 shows appropriate feasibility, reliability, and discriminative performance as a patient-reported outcome. MSWDQ-23 may be a valuable addition to measure the impact of a comprehensive spectrum of difficulties experienced by people with MS in the workplace.

Stigma associated with neurological disorders may contribute to a poor health-related quality of life. However, limited information is available in primary progressive multiple sclerosis. We investigated the presence and impact of stigma in patients with primary progressive multiple sclerosis. A non-interventional, cross-sectional study was conducted. A total of 55 primary progressive multiple sclerosis patients were studied (mean age 55.8±9.5 years, 56.4% male). The median Expanded Disability Status Scale score was 5.5 (4.0–6.5). Stigma prevalence was 78.2% ( n=43). Twenty-four patients (43.6%) were classified as depressed. Scores on the eight-item Stigma Scale for Chronic Illness correlated with physical (rho=0.464, p