Multitasking Ability in Multiple Sclerosis
Authors:   , Morse Chelsea Lodge , Schultheis Maria Teresa 
Published: September 2022

Cognitive dysfunction is one of most disabling features of MS, occurring in about 43-65% of MS individuals, and has been shown to be associated with difficulty maintaining employment in MS. A review of the literature demonstrates that previous domain-specific approaches to examining the effects of cognitive impairment on employment have not adequately explained high unemployment rates in MS. Performance on a more complex task that integrates multiple cognitive domains may be a useful predictor of vocational functioning among individuals with MS. Evidence for a more complex and integrated cognitive task comes from studies assessing patient self-report, which demonstrate that individuals with MS have difficulties with job functions including planning, problem solving, and organizing. Together these abilities support a function termed multitasking. Multitasking ability has not been fully examined in MS, and this study will initiate the first examination of the relationship between multitasking and vocational functioning. The study consisted of two specific aims; 1) to examine multitasking ability in MS, and 2) to examine the relationship between multitasking ability and vocational functioning. It was hypothesized that a percentage of individuals would be impaired on the multitasking measure. It was hypothesized that an inverse relationship would exist between multitasking ability and self-reported level of difficulty multitasking at work. Finally, it was hypothesized that individuals who were unemployed at the time of the study would demonstrate significantly more multitasking impairment and report higher level of difficulty with multitasking related tasks and abilities at work than individuals who were employed. Demographic and disease characteristics were coded, and the measures analyzed in the present study included: 1) neuropsychological measures of executive functioning (PASAT; Trail Making Test; COWAT; Oral Symbol Digit Modalities Test; Zoo Map Test); 2) measure of multitasking ability (Modified Six Elements Test, SET); 3) measures of physical functioning (Nine-Hole Peg Test; Timed Walk Test); 4) measure of difficulty experienced with multitasking at work (Structured Interview of Multitasking at Work); and 5) measures of psychosocial functioning (Beck Depression Inventory-II; Chicago Multiscale Depression Inventory; Fatigue Severity Scale; MS Quality of Life-54). Vocational groups were analyzed by two methods: 1) unemployed (UE) and employed (E) individuals; and 2) individuals who had reduced their work hours since being diagnosed with MS (CB), and those who had not reduced their work hours (S). In a sample of 30 participants with confirmed MS, multitasking ability was characterized by three performance measures shown to be independent of each other and sensitive to multitasking impairment. No significant relationship was found between performance on the SET and self-reported level of difficulty multitasking at work. Both UE and CB participants demonstrated more multitasking impairment than respective E and S participants (p=.05). Significant group differences in level of difficulty beginning new projects at work and rate of performance at work were found between UE and E participants. Significant group differences in fatigue and rate of performance at work were found between CB and S participants. Together, level of fatigue interference and multitasking ability predicted vocational group placement with 76.7-77.8% accuracy. The current study initiated the first theoretically based characterization of multitasking ability in MS. Multitasking was identified as a significant and independent predictor of vocational functioning, whereas performance on neuropsychological measures were not. Results can be utilized in vocational rehabilitation efforts to both modify the structure of an individual's work environment and in making recommendations for vocational placement. Future research could continue to explore the clinical utility of measuring multitasking ability as related to employment, using more ecologically valid measures of multitasking ability and extending studies to examine the contribution of multitasking to other activities of everyday functioning.