Exploring the role of cognition in coping of multiple sclerosis

Abstract

Background: The prevalence rate of multiple sclerosis (MS) has been growing in Hong Kong. Cognitive deficit is well-documented in the Western literature. However, the neurocognitive functioning profiles of Chinese suffering from MS remains unexplored. Also, much less is understood about its effect on coping and psychological adjustment in MS. Aim: First, the current study sought to establish the preliminary profiles of cognitive functioning of Chinese persons with MS in Hong Kong. Second, it endeavored to understand the details of stressors encountered by the patients in daily lives. Third and more significantly, it aimed at exploring the roles played by different domains of cognition in coping processes and psychological outcomes in these patients. Method: This cross-sectional study recruited 72 Chinese participants with MS in the neurology clinics of local hospitals. A mixed method of qualitative and quantitative approaches was employed. The themes of MS-induced stressors were identified by semi-structured interviews. The core quantitative method consisted of a battery of neuropsychological tests assessing verbal and visual memory, executive functioning, attention and information processing speed, psychomotor functioning, verbal fluency, as well as visuospatial ability, and several validated scales that measured coping strategies, coping resources in terms of perceived social support and illness acceptance, and psychological health - depressive symptoms and general life satisfaction. Results: First, the participants performed comparably poorly on all cognitive tests when compared to the local norm with comparable age and education level. The effect sizes ranged from medium to large. Second, MS posed a wide range of dramatic stressors in life such as unpredictability of illness trajectory and economic difficulties. Third, specific cognitive domains exerted influences on the choices of coping strategies. Executive functioning positively predicted the use of active problem solving. Verbal memory predicted increased use of seeking social support. Fourth, social support and illness acceptance were supported to be important in promoting better psychological adjustment even in the face of stressors. More specifically, acceptance acted as a partial mediator between subjective stressor and depression. Patients with less stressor tended to maintain greater acceptance towards the disease, which, in turn, decreased the level of depression. Lastly, path analysis informed the specific role of verbal memory in enhancing the levels of perceived social support and acceptance, which ultimately led to reduced depressive symptoms and higher satisfaction in life. Discussion: The study was the first systematic attempt to explore the relationships among neurocognition, stress and coping in a Chinese context. Developing optimal coping is of paramount importance in the rehabilitation of a chronic illness like MS. Both executive functioning and verbal memory were found to affect the coping process. Future development of effective coping intervention for MS individuals should take the effects of cognitive deficits into serious consideration. Furthermore, apart from the use of problem-focused coping methods, the significance of coping resource like acceptance was also highlighted. Results were discussed in the context of incorporating cognitive assessment together with the management of stress and developing effective coping in the integrative care for MS for both Chinese and non-Chinese populations.