Cognitive Outcomes in Myelin Oligodendrocyte Glycoprotein-IgG Associated Disease Compared to Multiple Sclerosis

Little is known about cognitive outcomes in people with myelin oligodendrocyte glycoprotein-IgG associated disease (pwMOGAD). While there are similarities between MOGAD and multiple sclerosis (MS), further evaluation is needed to establish the distinct cognitive trajectories for each disease.

Retrospective review of subjective cognitive changes was performed for adult pwMOGAD. Subsets of pwMOGAD completed a cognitive screening measure and/or comprehensive neuropsychological testing. Their performance was compared to age, sex, and race matched people with MS (pwMS; 3:1 ratio).

Approximately half (51.6%) of pwMOGAD (n = 63) endorsed cognitive dysfunction. On a cognitive screening measure (Processing Speed Test [PST]), performance did not statistically differ between pwMOGAD (n = 36; M = -0.06, SD = 1.36) and pwMS (n = 108; M = -0.04, SD = 1.30), t(62.35) = 0.18, p = 0.86. Of the pwMOGAD who completed neuropsychological testing (total n = 14), 57% demonstrated cognitive impairment on at least one test, and 36% demonstrated impairment on two or more tests. These rates did not differ from pwMS. In pwMOGAD, deficits were most common in processing speed (38.5%) and verbal fluency, spatial judgment, and immediate list recall (14.3% each). PwMOGAD performed better than pwMS on measures of visuomotor processing speed (β = -0.378, t = -2.68, p = 0.01) and cognitive flexibility (β = -0.33, t = -2.27, p = 0.03) after controlling for age, sex, race, education, and disease duration.

Subjective cognitive complaints and objective cognitive deficits were common among pwMOGAD. Approximately one-third of pwMOGAD demonstrated clinically significant cognitive impairment (2+ tests impaired) and individual level deficits were most common on measures of processing speed, verbal fluency, spatial judgment, and word list recall.