An Examination of Prospective Memory and Employment in MS

Dr Rhonda Brown

University of New England

| Better treatments | Social And Applied Research | Project | 2009 | Investigator Led Research |


Dr Brown and her colleagues are examining factors that are likely to account for an MS patient’s early departure from work. Some of these factors may involve subjective difficulties experienced in the workplace including perceived physical and cognitive (e.g. memory) difficulties. It is important that clinicians use tools that are sensitive enough to detect such impairments, and which can predict workplace difficulties. This research therefore aims to trial a promising new tool, the Cambridge Prospective Memory (CAMPROMPT) test which may prove useful in this regard.

MS usually strikes during a person’s working years and may affect their ability to remain employed. It is estimated that whilst 90% of MS patients worked prior to their MS diagnosis, approximately 70-80% will become unemployed within 5 years. Although this change in work status may be partly explained by the patient's physical impairments, it may also be explained by impaired cognitive functioning, since approximately 58% of patients in Australia experience some form of cognitive dysfunction.

Cognitive impairments can severely limit the daily functioning of MS patients, and in turn, their quality of life. Thus, a more thorough understanding of the types of impairments that may occur, how this dysfunction may be best assessed, and how the impairments might relate to functional aspects of day to day living in MS patients is required. Such neuropsychological tools need to be sensitive enough to detect even mild impairments which may impact adversely on day-to-day living in some MS patients. This knowledge is paramount for the development of more effective cognitive treatments and rehabilitative programs for MS patients.

This study will increase a clinicians’ understanding and awareness of the types of functional limitations that may occur in association with cognitive impairment in MS patients. In addition, it will also help clinicians better appreciate the types of subjective difficulties that are experienced in the workplace. Subjective cognitive difficulties will be assessed by questionnaire and objective cognitive difficulties will be assessed by face-to-face neuropsychological tests. The results of these tests are expected to be highly related to changes in vocational status (e.g. premature departure from work), which may in turn contribute greatly to an MS patient's reduced quality of life.

Progress to Date

Dr Rhonda Brown working at the University of New England has now completed her three year research project examining prospective memory in multiple sclerosis, difficulties in the workplace, and early departure from work. Dr Brown’s interesting and important findings have been presented at two conferences and submitted for publication to the Journal of Multiple Sclerosis.

“MS usually strikes during a person’s working years and may affect their ability to remain employed. In particular, whilst the vast majority of people with MS are working prior to their diagnosis, many withdraw from the workforce within only a few years of this diagnosis being made and at a rate higher than any other chronic disease state,” reports Dr Brown.

This project has examined some of the reasons why people with MS withdraw from employment early, reduce their working hours, or change the type of work performed. Some of these reasons include difficulties that might be experienced in the workplace environment itself as a result of the physical and/or mental symptoms of MS, or other work-related difficulties such as lack of support or workplace inaccessibility.

A further aim of this study is to trial a promising new measure of prospective memory (or memory for future events) for use in an Australian MS population. This tool is not only expected to be useful in the diagnosis of everyday memory difficulties, but may also be a useful in the prediction of workplace difficulties, and in turn, changes in employment status.

Recruitment for this project is complete. The results indicate that a person’s perceptions of their physical difficulties or psychological and cognitive difficulties in the workplace are related to past withdrawal from work and expectations about future employment. Difficulties relating to external factors such as financial concerns and work-home life balance do not appear to be related to past withdrawal from work. While all types of workplace difficulties are related to expectations about reducing work hours in the future due to MS, physical difficulties are more important in determining expectations about withdrawing from work entirely in the future, whereas psychological and cognitive difficulties are more important in determining expectations about changing the type of work performed in the future. Perceived cognitive workplace difficulties relate to workplace outcomes independently of actual cognitive performance. Some of these results are partially explainable by higher levels of depression.

The results provide invaluable information about the types of factors that are most relevant in predicting work changes or expectations about future work. This understanding is important for the provision of more effective vocational and rehabilitative programs for those who experience difficulties in the workplace as a result of their MS.

The Multiple Sclerosis Work Difficulties Questionnaire developed as part of this research is now being used by other Australian researchers with an interest in employment and MS, and is also in use by MS researchers in several countries around the world.

Further information on the results of this study are also available in an MS Research Australia website news article here


Honan, C. A., Brown, R. F., & Hine, D. W. Vowels, L. Wollin, J.A. Simmons, R. D. & Pollard, J.D. The Multiple Sclerosis Work Difficulties QuestionnaireMultiple Sclerosis Journal 2011 Dec 19.

Honan, C.A, Brown, R.F., Hine, D.W. The Multiple Sclerosis Work Difficulties Questionnaire: Development of A Shortened Questionnaire. Disabil Rehabil 2013 June 20

Honan-Lowe CA, Brown RF, Hine DW, Vowels L, Wollin JA, Simmons RD, Pollard JD. 2012. Development and validation of the Multiple Sclerosis Work Difficulties Scale: full and short version. Multiple Sclerosis Journal, 18, 871-880.

Longley WA, Tate RL, Brown RF. 2012. A protocol for measuring direct psychological benefit of neuropsychological assessment with feedback in multiple sclerosis. Brain Impairment: Clinical Trials Forum, 13, 238-255.

Honan CA, Brown RF, Hine DW, Batchelor J, Pollard JD. 2013. The Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ): development of a shortened scale. Disability & Rehabilitation

Honan CA, Brown RF, Batchelor J, Pollard JD. The contribution of perceived and actual neuropsychological difficulties to employment outcomes in people with multiple sclerosis and the intervening role of depression. The Clinical Neuropsychologist(underway).

Longley WA, Tate RL, Brown RF. Spontaneous memory compensation in people with multiple sclerosis: A preliminary investigation. NeuroRehabilitation (underway).

Joyce S, Honan CA, Sherman KA, Brown RF. The relationship between cognitive fatigue, cognitive functioning, depression and accuracy of appraisals regarding cognition in people with multiple sclerosis. Practical Neurology (underway)

Conference Presentations

Honan, C. A., Brown, R. F., & Hine, D. W. (2009). Development and validation of the Multiple Sclerosis Work Difficulties Questionnaire – Preliminary Results. Poster presented at the MS Research Australia Progress in MS Research Scientific Conference, October 2009, Sydney, Australia.

Honan, C. A., Brown, R. F., & Hine, D. W. (2010). The importance of perceived workplace difficulties in those with Multiple Sclerosis in determining work outcomes. Individual oral presentation at the 27th International Congress of Applied Psychology, July 2010, Melbourne, Australia.

Updated: 26/06/2013

Updated: 06 January, 2009


Grant Awarded

  • Project grant

Total Funding

  • $72,000


  • 2 years

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An Examination of Prospective Memory and Employment in MS