Investigating the complementary value of OCT to MRI in cognitive impairment in relapsing-remitting multiple sclerosis

Cognitive decline in multiple sclerosis (MS) is associated with neuro-axonal loss, quantifiable by optical coherence tomography (OCT). Associations between OCT measures and cognition in relapsing-remitting MS (RRMS) remain incompletely investigated, particularly the added value of OCT when combined with magnetic resonance imaging (MRI). We investigated the contributions of OCT and MRI while applying stringent criteria to control for subclinical optic neuropathy.

In this cross-sectional study, 137 RRMS patients underwent OCT, Brief International Cognitive Assessment for MS (BICAMS), Expanded Disability Status Scale (EDSS) and brain MRI (lesion load, grey and white matter volume); associations were explored using linear regression models.

RRMS patients (aged 40.88 ± 10.6 years; disease duration 7.95 ± 7.39 years; EDSS 2; 0-6.5) were studied. Of BICAMS, 50.36% showed impaired Symbol Digit Modalities Test (SDMT), 37.23% impaired Brief Visuospatial Memory Test and 5.11% impaired California Verbal Learning and Memory Test; better SDMT performance was associated with thicker ganglion cell-inner plexiform (GCIPL) layers for eyes unaffected by optic neuritis (B = 0.23, 95% CI = (0.01-0.44), p = 0.03), but not when MRI measures were included (B = 0.18, CI = (-0.03 to 0.38), p = 0.09).

GCIPL thinning correlates with SDMT, supporting OCT as a biomarker of cognitive dysfunction. However, GCIPL did not uniquely predict SDMT performance when including MRI measures, suggesting limited utility of OCT in predicting cognitive performance over MRI in RRMS.