Related Experiment Video
Updated: Aug 9, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Brain MRI disease burden and sex differences in cognitive performance of patients with multiple sclerosis
Jiri Motyl1, Lucie Friedova1, Ranjani Ganapathy Subramanian2
1Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Multiple Sclerosis Center, Charles University and General University Hospital, Katerinska 30, 120 00, Prague, Czech Republic.
Background:
Although there is evidence that shows worse cognitive functioning in male patients with multiple sclerosis (MS), the role of brain pathology in this context is under-investigated.
Objective:
To investigate sex differences in cognitive performance of MS patients, in the context of brain pathology and disease burden.
Methods:
Brain MRI, neurological examination, neuropsychological assessment (Brief International Cognitive Assessment in MS-BICAMS, and Paced Auditory Verbal Learning Test-PASAT), and patient-reported outcome questionnaires were performed/administered in 1052 MS patients.
Results:
Females had higher raw scores in the Symbol Digit Modalities Test (SDMT) (57.0 vs. 54.0; p < 0.001) and Categorical Verbal Learning Test (CVLT) (63.0 vs. 57.0; p < 0.001), but paradoxically, females evaluated their cognitive performance by MS Neuropsychological Questionnaire as being worse (16.6 vs 14.5, p = 0.004). Females had a trend for a weaker negative correlation between T2 lesion volume and SDMT ([Formula: see text] = - 0.37 in females vs. - 0.46 in men; interaction p = 0.038). On the other hand, women had a trend for a stronger correlation between Brain Parenchymal Fraction (BPF) and a visual memory test (Spearman's [Formula: see text] = 0.31 vs. 0.21; interaction p = 0.016). All these trends were not significant after correction for false discovery rate.
Conclusions:
Although, females consider their cognition as worse, males had at a group level slightly worse verbal memory and information processing speed. However, the sex differences in cognitive performance were smaller than the variability of scores within the same sex group. Brain MRI measures did not explain the sex differences in cognitive performance among MS patients.
Insights
In multiple sclerosis (MS), men showed slightly worse verbal memory and processing speed, despite women perceiving their cognition as poorer. Brain imaging did not explain these sex differences in cognitive performance.
Area of Science:
- Neurology
- Neuropsychology
- Medical Imaging
Background:
- Cognitive deficits are common in multiple sclerosis (MS), with some evidence suggesting worse outcomes in males.
- The influence of brain pathology on sex-based cognitive differences in MS remains underexplored.
Purpose of the Study:
- To examine sex-based differences in cognitive performance among MS patients.
- To investigate the relationship between brain pathology, disease burden, and cognitive function in relation to sex.
Main Methods:
- A cohort of 1052 MS patients underwent comprehensive assessments.
- Methods included brain Magnetic Resonance Imaging (MRI), neurological examination, neuropsychological testing (using BICAMS and PASAT), and patient-reported outcomes.
Main Results:
- Females scored higher on the Symbol Digit Modalities Test (SDMT) and Categorical Verbal Learning Test (CVLT).
- Paradoxically, females reported worse cognitive performance.
- Brain MRI measures (T2 lesion volume, Brain Parenchymal Fraction) showed trends in correlation with cognitive tests, but did not significantly explain observed sex differences after statistical correction.
Conclusions:
- While males exhibited slightly poorer verbal memory and information processing speed at a group level, the cognitive differences between sexes were less pronounced than individual score variability.
- Brain pathology, as assessed by MRI, did not account for the observed sex differences in cognitive performance in this MS cohort.
