Domain-Specific Cognitive Associations With Standing Balance in Multiple Sclerosis

Balance impairments and cognitive deficits are both prevalent in individuals with multiple sclerosis (MS) and contribute to elevated fall risk. Although prior studies have examined global cognition and balance, few have investigated the relation between specific cognitive domains and balance performance under progressively challenging static conditions.

Fifty-four ambulatory individuals with MS completed 4 standing balance tasks that increased in difficulty by altering visual input (eyes open/closed) and stance (feet apart/together). Sway velocity was measured using inertial sensors. Participants also completed assessments of processing speed (Symbol Digit Modalities Test [SDMT]), attention and cognitive flexibility (Trail Making Test parts A [TMT-A] and B), verbal and visuospatial memory (California Verbal Learning Test, Brief Visuospatial Memory Test-Revised), and concern about falling (Falls Efficacy Scale-International [FES-I]). Spearman correlations and linear regressions, adjusted for age, sex, and disability level, were used to examine associations between cognitive/psychological variables and balance performance.

Processing speed (SDMT) was significantly associated with sway during the least complex condition (eyes open, feet apart). Under more challenging conditions (eyes closed), attention (TMT-A) and concern about falling (FES-I) emerged as significant predictors of balance performance. They remained significant after adjusting for disability level.

Domain-specific cognitive performance and concern about falling are associated with postural control in people with MS, particularly under sensory-conflicting conditions. These findings highlight the multifactorial nature of balance impairment in MS and suggest that cognitive and psychological assessments may aid in identifying individuals at increased fall risk.