title: Cognitive Impairment and Community Integration Outcomes in Individuals Living With Multiple Sclerosis.
abstract: OBJECTIVE
  To determine the association between unique domains of cognitive impairment and community integration in individuals with multiple sclerosis (MS), and to determine the contributions of cognitive impairment to community integration beyond the influence of demographic and clinical variables.
  
  
  METHODS
  Cross-sectional analysis of objective neuropsychological assessment and self-report data. Data were collected during baseline assessment of a randomized, multisite controlled trial of ginkgo biloba for cognitive impairment in MS. Hierarchical regression analyses examined the association between subjective and objective measures of cognitive impairment and 3 domains of community integration, adjusting for relevant covariates.
  
  
  METHODS
  Two Veterans Affairs medical center MS clinics.
  
  
  METHODS
  Adults (N=121; ages 24-65y) with a confirmed MS diagnosis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Primary outcomes were scores on the Home Integration (CIQ-H), Social Integration (CIQ-S), and Productivity (CIQ-P) domains of the Community Integration Questionnaire (CIQ).
  
  
  RESULTS
  Cognitive impairment was associated with lower scores on the CIQ-H and CIQ-S, but not the CIQ-P. Greater levels of subjective cognitive impairment were associated with lower scores on the CIQ-H and CIQ-S. Greater levels of objective cognitive impairment, specifically slower processing speed and poorer inhibitory control, were related to lower CIQ-S scores. Subjective and objective measures of cognitive impairment were significantly and independently associated with CIQ-S.
  
  
  CONCLUSIONS
  Objective cognitive impairment may interfere with participation in social activities. Subjective cognitive impairment is also important to assess, because individuals who perceive themselves to be cognitively impaired may be less likely to participate in both home and social activities. Clinical interventions to enhance community integration in individuals with MS may benefit from addressing objective and subjective cognitive impairment by integrating cognitive rehabilitation approaches with self-efficacy-enhancing strategies.
authors.affiliation: Multiple Sclerosis Center of Excellence West, Veterans Affairs Puget Sound Health Care System, Seattle Division, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA. Electronic address: ajhughes@uw.edu.
authors.forename: Abbey J
authors.initials: AJ
authors.lastname: Hughes
authors.affiliation: Multiple Sclerosis Center of Excellence West, Veterans Affairs Puget Sound Health Care System, Seattle Division, Seattle, WA.
authors.forename: Narineh
authors.initials: N
authors.lastname: Hartoonian
authors.affiliation: Veterans Affairs Puget Sound Health Care System, American Lake Division, Tacoma, WA.
authors.forename: Brett
authors.initials: B
authors.lastname: Parmenter
authors.affiliation: Multiple Sclerosis Center of Excellence West, Veterans Affairs Puget Sound Health Care System, Seattle Division, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Jodie K
authors.initials: JK
authors.lastname: Haselkorn
authors.affiliation: Department of Neurology, Louisiana State University Health Science Center, New Orleans, LA.
authors.forename: Jesus F
authors.initials: JF
authors.lastname: Lovera
authors.affiliation: Multiple Sclerosis Center of Excellence West, Veterans Affairs Portland Health Care System, Portland, OR; Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: Dennis
authors.initials: D
authors.lastname: Bourdette
authors.affiliation: Multiple Sclerosis Center of Excellence West, Veterans Affairs Puget Sound Health Care System, Seattle Division, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Turner
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D062309:Community Integration / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000534:rehabilitation*; D009483:Neuropsychological Tests; D011594:Psychometrics; D011788:Quality of Life; D012720:Severity of Illness Index; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Community integration; Multiple sclerosis; Neurobehavioral manifestations; Rehabilitation