{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:12:23Z","timestamp":1787019143328,"version":"build-2736575974"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>People with multiple sclerosis (PwMS) frequently experience invisible symptoms, including cognitive impairment, fatigue, depression, anxiety, and psychosocial factors such as stigma, which can substantially affect social role participation (SRP). These factors are often under-recognized in clinical care despite their functional impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To examine the unique contributions of invisible MS-related symptoms to SRP after accounting for demographic characteristics and objective cognitive performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A cross-sectional sample of 434 PwMS was recruited from a large outpatient neurology clinic specializing in MS care. The sample was predominantly female (75%), largely white (85%), and middle-aged (M\u2009=\u200951.0, SD\u2009=\u200911.7), with mild-to-moderate disability. Participants completed a computerized cognitive battery and validated patient-reported outcome measures assessing disease impact, mood, fatigue, stigma, and SRP. Hierarchical regression models evaluated the variance explained by demographics, cognitive performance, and patient-reported symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Demographic variables were not significant predictors of SRP. Cognitive performance accounted for 13.3% of the variance. Adding patient-reported outcomes increased explained variance to 70.6%. Depression, disease impact, fatigue, and executive functioning remained significant predictors, whereas stigma did not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Patient-reported symptom burden showed strong associations with SRP and explained more variance than demographic factors and most cognitive measures, while executive functioning also contributed independently.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261459835","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T17:30:02Z","timestamp":1783099802000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Invisible symptoms in multiple sclerosis and their impact on social role participation: A multidimensional analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5176-0884","authenticated-orcid":false,"given":"Catherine","family":"Bergmann","sequence":"first","affiliation":[{"name":"Washington Neuropsychology Research Group, Fairfax, VA, USA; Department of Psychology, Ave Maria University, Ave Maria, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daija","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Behavioral Health, Brooke Army Medical Center, San Antonio, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Philadelphia VAMC, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Bleyer","sequence":"additional","affiliation":[{"name":"Department of Psychology, Ave Maria University, Ave Maria, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Wilken","sequence":"additional","affiliation":[{"name":"Washington Neuropsychology Research Group, Fairfax, VA, USA; Department of Neurology, Georgetown University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Bumstead","sequence":"additional","affiliation":[{"name":"NYU Langone South Shore Neurologic Associates, Patchogue, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijean","family":"Buhse","sequence":"additional","affiliation":[{"name":"NYU Langone South Shore Neurologic Associates, Patchogue, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myassar","family":"Zarif","sequence":"additional","affiliation":[{"name":"NYU Langone South Shore Neurologic Associates, Patchogue, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris-Katharina","family":"Penner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1016-5859","authenticated-orcid":false,"given":"Laura M","family":"Hancock","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0545-7627","authenticated-orcid":false,"given":"Daniel","family":"Golan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen M","family":"Doniger","sequence":"additional","affiliation":[{"name":"NeuroTrax Corporation, Newark, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Bogaardt","sequence":"additional","affiliation":[{"name":"Speech Pathology, University of Adelaide, Adelaide, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa A","family":"Barrera","sequence":"additional","affiliation":[{"name":"Katz School of Science and Health, Yeshiva University, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J","family":"Covey","sequence":"additional","affiliation":[{"name":"Division of Cognitive and Behavioral Neurosciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7522-6440","authenticated-orcid":false,"given":"Sarah A","family":"Morrow","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7810-4991","authenticated-orcid":false,"given":"Mark","family":"Gudesblatt","sequence":"additional","affiliation":[{"name":"NYU Langone South Shore Neurologic Associates, Patchogue, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(08)70259-X"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.33.11.1444"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-021-00239-2"},{"issue":"3","key":"e_1_3_3_5_2","article-title":"Which symptoms contribute the most to patients\u2019 perception of health in multiple sclerosis?","volume":"3","author":"Green R","year":"2017","unstructured":"Green R, Cutter G, Friendly M, et al. 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