Characterizing cognitive deficits and potential predictors in multiple sclerosis: A large nationwide study applying Brief International Cognitive Assessment for Multiple Sclerosis in standard clinical care

Abstract

With the proposal of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, the need to screen for cognitive deficits within standard clinical care of patients with multiple sclerosis (MS) has been acknowledged. Data regarding how patient characteristics might predict low cognitive performance and therefore require particularly close monitoring is, however, limited so far. We investigated a large, nationwide patient cohort from ambulatory settings, representing the typical distribution of different subtypes, levels of physical disability, and disease durations. Besides cognitive testing with BICAMS, additional sampling of multiple demographics and clinical variables allowed us to characterize general and domain‐specific prevalence patterns of cognitive impairment (CI) as well as to delineate which factors are associated with cognitive performance. In a total of 1,094 patients, CI was present in 28% (using a conservative cut‐off of the 5th percentile below normative values), with information‐processing speed being most frequently affected. Impairment was overall higher in patients with primary progressive (PPMS) and secondary progressive MS than in patients with relapsing–remitting (RR)MS. Regression modelling revealed that disease subtype (i.e., PPMS), long disease duration, high physical disability, unemployment, low educational level, high age, male sex, and the absence of current disease‐modifying treatment were important predictors for worse BICAMS’ test performance. These results emphasize the importance of continuous cognitive assessment during regular neurological follow‐up visits, with a particular focus on patients being identified as high‐risk subjects for CI according to the reported factors.

The transitional phase of multiple sclerosis: Characterization and conceptual framework

“…With respect to the transitional phase, it is of interest that SPMS patients differed from RRMS patients most significantly in visuospatial short-term memory and learning. This may be regarded as the most sensitive cognitive change parameter to discriminate between RRMS and SPMS but also between SPMS and PPMS, as confirmed by recent data (Renner et al, 2020).…”

Iron Rims in Patients With Multiple Sclerosis as Neurodegenerative Marker? A 7-Tesla Magnetic Resonance Study

“…Patients with MS often suffer from neuropsychological deficits. They can be easily missed, particularly in the very early stages in patients with stable EDSS, and become more and more pronounced in the progressive stage according to the proceeding atrophy ( 92 , 93 ). Explicit neuropsychological deterioration in patients with RRMS is discussed as a conversion marker into the progressive stage of MS as a result of structural damage over time with increasing cognitive dysfunction causing the network to collapse ( 94 ).…”

Cognitive Impairment in Secondary Progressive Multiple Sclerosis: Effect of Disease Duration, Age, and Progressive Phenotype

“…A recent multicentre study conducted in Germany [ 16 ] used the BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) battery in a large sample of 978 patients with RRMS, 87 patients with SPMS, and 29 patients with PPMS. Progressive forms were associated with lower processing speed scores (SDMT), SPMS forms with lower visual learning scores (BVMT-R, Brief Visuospatial Memory Test Revised), and PPMS forms had a lower score on the verbal episodic memory test (VLMT, Verbaler Lern- und Merkfaehigkeitstest ).…”