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Lost in dichotomization: Preserving statistical power and sensitivity in MS cognitive research
Jeroen Van Schependom1,2, Gary Cutter3
1Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium.
Multiple Sclerosis (Houndmills, Basingstoke, England)
|August 12, 2025
Summary
Simplifying cognitive impairment in multiple sclerosis (MS) to a single score reduces statistical power and obscures complex deficits. Treating cognitive data as continuous and domain-specific improves biomarker discovery and intervention strategies.
Area of Science:
- Neuroscience
- Clinical Psychology
Background:
- Cognitive impairment in multiple sclerosis (MS) is often oversimplified into dichotomous categories (impaired vs. intact).
- This simplification, while clinically useful, hinders the development of sensitive and specific cognitive biomarkers for MS.
- Existing research frequently overlooks the multidimensional nature of cognitive dysfunction in MS.
Purpose of the Study:
- To argue against dichotomizing continuous cognitive measures in multiple sclerosis research.
- To highlight the reduction in statistical power and obscuring of cognitive patterns caused by data simplification.
- To advocate for domain-specific and continuous variable approaches for improved biomarker discovery.
Main Methods:
- Perspective piece based on existing research and theoretical arguments.
- Analysis of the impact of dichotomization on statistical power and interpretation of cognitive data.
- Emphasis on domain-specific assessment of cognitive functions.
Main Results:
- Dichotomizing cognitive measures significantly reduces statistical power.
- Collapsing cognitive domains masks the complexity of MS-related cognitive dysfunction.
- Overlooking nuanced patterns of impairment can mischaracterize underlying neural mechanisms.
Conclusions:
- Assessing cognitive data as continuous variables is recommended for MS research.
- Adopting domain-specific approaches enhances statistical sensitivity without increasing errors.
- Nuanced understanding of cognitive impairment is critical for biomarker discovery and targeted interventions in MS.
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