Using cognitive testing to predict employment status in multiple sclerosis: A comparative study of the SDMT and a computerized cognitive assessment tool

Background: Cognitive impairment (CI) is prevalent in people with multiple sclerosis (PwMS) and influences employment outcomes independent of physical disability. Although associations between multi-domain CI and employment have been established, less is known about the relative clinical utility of brief cognitive screening tools versus time-efficient multi-domain computerized assessments that can be implemented in routine care. Objectives: To compare the Symbol Digit Modality Test (SDMT) and NeuroTrax computerized cognitive battery (NT) as predictors of self-reported employment status in PwMS. Method: 109 PwMS (Mean age = 48 years, SD = 10.4; 74 % female) completed the oral SDMT and NT as part of routine clinical care. Employment status was self-reported as “employed” or “unemployed” (including early retirement if <55 years). Results: When modeled separately, both the SDMT and NT Global Cognitive Score (GCS) significantly predicted employment status (p < .001). In the combined model, only the NT GCS remained a significant predictor (p = .036). Unemployed PwMS performed significantly worse on the SDMT, NT GCS, and all NT domains (p < .05). Effect sizes were largest for NT GCS (r = 0.401), executive function (r = 0.400), and the SDMT (r = 0.351). Unemployed PwMS were also more likely to exhibit CI across multiple domains (X² (3) = 17.862, p < .001), with executive function and attention most frequently impaired. Conclusion: While the SDMT remains a useful screening tool, the NT appears clinically feasible for use in routine care and provides incremental and domain-specific information beyond processing speed alone. Extending assessment in routine care beyond a single screening measure may better characterize cognitive profiles associated with unemployment and inform individualized vocational interventions in PwMS.