Uncovering heterogeneous cognitive trajectories in relapsing-remitting multiple sclerosis: a longitudinal study

Area of Science:

• Neuroscience
• Clinical Neurology
• Medical Research

Background:

• Cognitive impairment (CI) is common in relapsing-remitting multiple sclerosis (RRMS) but often considered irreversible.
• Recent studies suggest CI in RRMS is heterogeneous, not uniformly progressive.
• Limited research exists on baseline predictors of cognitive decline in RRMS, especially using patient-reported outcome measures (PROMs).

Purpose of the Study:

• To investigate cognitive status changes in RRMS patients over 36 months after initiating new disease-modifying treatments.
• To identify baseline predictors of future cognitive decline, including PROMs.

Main Methods:

• Prospective study of 59 RRMS patients over 36 months.
• Yearly multiparametric assessments: clinical, neuropsychological, MRI metrics, and self-reported questionnaires.
• Longitudinal logistic regression analysis to identify baseline predictors of cognitive decline.

Main Results:

• 33 (56%) patients had CI at baseline; 17 (35%) at 36 months.
• Of those with baseline CI, 20 showed cognitive improvement or fewer impaired domains at follow-up.
• Baseline physical disability (EDSS) was the strongest predictor of future cognitive decline (OR: 2.17; p=0.03).
• PROMs did not predict future cognitive decline.

Conclusions:

• Cognitive impairment in MS is a dynamic and heterogeneous process.
• Baseline physical disability is a key predictor of cognitive decline in RRMS.
• PROMs are not currently predictive of cognitive decline in this population.