Associations between medication use and multiple domains of cognitive function in people with multiple Sclerosis

People with multiple sclerosis (MS) often use multiple medications concurrently to manage a wide range of symptoms. Although polypharmacy is associated with cognitive impairment, the effects of specific medication classes on cognitive outcomes in MS remain poorly understood. This study examined associations between commonly used medications and both objective and subjective measures of cognitive function in people with MS.

A secondary analysis of baseline data from a longitudinal study in 260 individuals with MS was conducted. Current medication use was self-reported. Objective cognitive function was assessed across multiple domains using the NIH Toolbox Cognitive Battery and the Symbol Digit Modalities Test, Paced Auditory Serial Addition Test, and Rey Auditory Verbal Learning Test. Subjective cognitive function was measured using the PROMIS Cognitive Function Abilities Short Form. Multivariable linear regression analyses were performed, adjusting for demographic and clinical covariates.

Participants reported a median of 6 medications (IQR: 6; range: 1-22). Opioid analgesic use was significantly associated with poorer executive function. Antidepressant use was positively associated with processing speed, and corticosteroid use was linked to improved memory across multiple domains. No significant associations were observed for non-opioid analgesics, cannabinoids, psychostimulants, antispasmodics, benzodiazepines, sedatives, anticonvulsants, or disease-modifying therapies.

These findings underscore the importance of considering cognitive health when making pharmacologic decisions for this population.