title: The relationship between subjective and objective cognitive functioning in Multiple Sclerosis; the role of self-efficacy
Creators: name: Ford, Debra
Publisher: name: University of Liverpool Repository
Year: 2015

description: Multiple Sclerosis (MS) is an autoimmune disease involving demyelination and neurodegeneration of the central nervous system (Compston &amp; Coles, 2002). In the UK it is the most common form of non-traumatic neurological disability in young adults (Compston &amp; Coles, 2008). Common symptoms of MS include sensory disturbance in limbs, visual loss, fatigue, mood disturbance and motor disturbance (Bobholz &amp; Gremely, 2011). MS is often categorised depending on symptoms. The most common type is relapsing remitting, experienced by approximately 80% of people at onset (NICE, 2014). It is characterised by relapses, where new or existing symptoms become more severe, and remissions, a partial or total recovery of symptoms. Other types of MS include secondary progressive (gradual progression of symptoms and only partial recovery during remissions) and primary progressive (no periods of remission and gradual progression of symptoms). There is currently no cure for MS, current treatments include medications aimed at modifying disease activity and symptom management. Approximately 50% of people with MS experience cognitive symptoms (NICE, 2014). Cognitive difficulties in people with MS have been shown to effect social functioning and quality of life (Rao et al., 1991). Clinicians often rely on MS patients’ subjective reports of their difficulties in cognitive functioning. However, studies have shown that the relationship between MS patients’ self-reported cognitive difficulties and their objective cognitive functioning, as measured by neuropsychological tests, is inconsistent. Several studies have demonstrated a discrepancy between self-reported cognitive functioning and objective performance on neuropsychological tests (Carone, Benedict, Munschauer, Fishman, &amp; Weinstock-Guttman, 2005; Julian, Merluzzi, &amp; Mohr, 2007; Lovera et al., 2006; Middleton, Denney, Parmenter, &amp; Lynch, 2006). Both fatigue (Kinsinger, Lattie, &amp; Mohr, 2010) and depression (Kinsinger et al., 2010; Maor, Olmer, &amp; Mozes, 2001) have been shown to influence MS patients’ self-reported cognitive functioning, more than their objective functioning. MS patients with higher levels of depression and fatigue report more subjective cognitive difficulties. Chapter 1 of this thesis systematically reviews the literature examining the relationship between subjective and objective cognitive functioning, and examines whether depression and fatigue influence MS patients ability to accurately perceive their cognitive functioning. The systematic review demonstrated inconsistent findings when examining the relationship between subjective and objective cognitive functioning. Both fatigue and depression were found to be associated with subjective cognitive functioning, explaining some of the variance. However, other variables are likely to influence this relationship and these influential variables are investigated in Chapter 2. Self-efficacy has previously been shown to play an important role in the MS population. It can be described as a level of self-confidence about an individual’s ability to manage specific situations or conditions, relating to perceptions of competency, rather than actual performance (Ng et al., 2013). A recent study by Schmitt, Goverover, DeLuca, and Chiaravalloti (2014) demonstrated that self-efficacy influences MS patients subjective cognitive functioning, after controlling for both depression and functional impairment. Chapter 2 builds upon the findings of the review paper and additionally examines the role of self-efficacy as a predictor of subjective cognitive functioning and quality of life. The empirical paper has demonstrated that self-efficacy is a significant predictor of subjective cognitive functioning and quality of life even after controlling for age, MS duration, depression, anxiety, fatigue and objective cognitive functioning. People with MS reporting higher levels of self-efficacy reported fewer cognitive difficulties and greater quality of life. As self-efficacy was shown to be a significant predictor of subjective cognitive functioning and quality of life, even after controlling for other influential variables, it seems prudent for future research to target self-efficacy for intervention. Interventions aimed at improving self-efficacy in people with MS could potentially improve their accuracy at appraising their cognitive functioning and improve their quality of life.