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Updated: Aug 20, 2025
The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
Disability outcomes in early-stage African American and White people with multiple sclerosis
Maria Petracca1, Raffaele Palladino2, Amgad Droby3
1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Human Neurosciences, Sapienza University, Rome, Italy.
Background:
Factors driving differences in disease burden between African American and White people with multiple sclerosis (pwMS) remain unclear. Here, we explored whether differences in disability outcomes could be observed after controlling for major sociodemographic factors and comorbidities, and assessed the presence of a possible interaction between MS and race.
Methods:
In this cross-sectional study, 120 pwMS within 6 years from disease onset and 82 healthy controls between 18 and 70 years of age, self-identified as either African American or White, were prospectively enrolled. Inclusion criteria for pwMS were: diagnosis of MS according to the revised McDonald criteria, relapsing-remitting phenotype and Expanded Disability Status Scale (EDSS) < 6.5. Study outcomes included: (i) global disability (EDSS); (ii) quantitative mobility and leg function (Timed 25 Foot Walk Test-T25FWT); (iii) quantitative finger dexterity (9-Hole Peg Test-9HPT); (iv) cognitive efficiency and speed performance (Symbol Digit Modalities Test-SDMT). Differences in disability outcomes were assessed employing multivariable linear regression models. Based on their association with MS or disability, covariates included age, gender, race, years of education, total income, body mass index, comorbidities. The interaction between MS and race on disability outcomes was estimated via relative excess risk of interaction and attributable proportion.
Results:
Accounting for age, gender, total income, education, body mass index and comorbidities, African American pwMS showed significantly worse performances in manual dexterity and cognition than White pwMS (White pwMS coeff. 3.24, 95% CI 1.55, 4.92 vs African American pwMS coeff. 5.52, 95% CI 3.55, 7.48 and White pwMS coeff. -5.87, 95% CI -8.86, -2.87 vs African American pwMS coeff. -7.99, 95% CI -11.58,-4.38). MS and race independently contributed to the observed gradient in disability severity.
Conclusions:
Complex social disparities and systemic racism might contribute to clinical heterogeneity in MS.
Insights
African American people with multiple sclerosis (pwMS) experience worse manual dexterity and cognition than White pwMS, even after accounting for sociodemographic factors. Race and MS independently impact disability severity, suggesting social disparities contribute to MS heterogeneity.
Area of Science:
- Neurology
- Immunology
- Public Health
Background:
- Differences in multiple sclerosis (MS) disease burden between African American and White populations are not fully understood.
- Sociodemographic factors and comorbidities may influence these disparities.
Purpose of the Study:
- To investigate differences in disability outcomes between African American and White people with MS (pwMS).
- To assess the impact of sociodemographic factors and comorbidities on MS disability.
- To examine the interaction between MS and race on disability.
Main Methods:
- Cross-sectional study of 120 pwMS and 82 healthy controls, aged 18-70.
- Inclusion criteria: MS diagnosis, relapsing-remitting phenotype, Expanded Disability Status Scale (EDSS) < 6.5.
- Outcomes measured: global disability (EDSS), mobility (Timed 25 Foot Walk Test), dexterity (9-Hole Peg Test), cognition (Symbol Digit Modalities Test).
- Multivariable linear regression and interaction analyses were used.
Main Results:
- African American pwMS showed significantly worse manual dexterity and cognitive performance compared to White pwMS, after controlling for covariates.
- Both MS and race independently contributed to disability severity.
- Specific coefficients indicated worse outcomes for African American pwMS in dexterity and cognition.
Conclusions:
- Clinical heterogeneity in MS may be influenced by complex social disparities and systemic racism.
- Further research is needed to address the impact of social determinants on MS progression.
