A new study compared the Symbol Digit Modality Test and a multidomain computerized assessment battery in routine multiple sclerosis care. The Symbol Digit Modality Test and NeuroTrax significantly predicted employment status when modeled separately. The NeuroTrax identified domain-specific and cumulative cognitive impairment linked to unemployment. The findings suggest multidomain assessment may add clinical insight beyond single-domain screening.

Cognitive impairment is prevalent in people with MS and influences employment outcomes independent of physical disability. Although links between multidomain cognitive impairment and employment have been established, less is known about the relative clinical utility of brief cognitive screening tools versus time-efficient multidomain computerized assessments that can be implemented in routine care.

Researchers set out to compare the Symbol Digit Modality Test and the NeuroTrax computerized cognitive battery as predictors of self-reported employment status in people with MS. The oral Symbol Digit Modality Test and NeuroTrax tests were administered to 109 people with MS as part of routine clinical care. Employment status was self-reported as “employed” or “unemployed.”

When modeled separately, both the Symbol Digit Modality Test and NeuroTrax global cognitive score predicted employment status. In the combined model, only the NeuroTrax global cognitive score remained a significant predictor. Unemployed people with MS performed significantly worse on the Symbol Digit Modality Test, NeuroTrax Global Cognitive Score, and all NeuroTrax domains. Effect sizes were largest for NeuroTrax Global Cognitive Score, executive function, and the Symbol Digit Modality Test. Unemployed people with MS were also more likely to exhibit cognitive impairment across multiple domains, with executive function and attention most frequently impaired.

While the Symbol Digit Modality Test remains a useful screening tool, the findings suggest NeuroTrax is clinically feasible for use in routine care providing incremental and domain-specific information beyond processing speed alone. Extending assessment in routine care beyond a single screening measure may better characterize cognitive profiles linked to unemployment and inform individualized vocational interventions in people with MS.

The findings were published in the journal Multiple Sclerosis and Related Disorders.