Race, ethnicity, and cognition in persons newly diagnosed with multiple sclerosis

Abstract

ObjectiveTo determine whether black or Hispanic patients with newly diagnosed multiple sclerosis (MS) are more likely to have cognitive impairment than white patients when compared to controls matched on age, sex, and race/ethnicity. Whether black or Hispanic patients have a more aggressive MS disease course than white patients remains unclear. No prior studies have examined differences in early cognitive impairment. The oral Symbol Digit Modalities Test (SDMT) is sensitive to early cognitive impairment in MS but normative data in nonwhite patients are limited.MethodsWe studied 1,174 adults who enrolled in the MS Sunshine Study. SDMT and verbal fluency were measured in 554 incident cases of MS or clinically isolated syndrome (CIS) and 620 matched controls. Multivariable regression was used to examine correlates of abnormal SDMT in the entire cohort.ResultsThe strongest independent predictors of lower oral SDMT scores in rank order were having MS/CIS, lower educational attainment, and being black or Hispanic. Black and Hispanic patients and controls had lower SDMT scores than white participants even after controlling for age, sex, and education. However, no interaction between race/ethnicity and MS case status on SDMT scores was detected. Easy-to-use reference scores stratified by age and educational attainment for black and Hispanic patients are provided.ConclusionPersons with newly diagnosed MS/CIS are more likely to have subtly impaired cognitive function than controls regardless of race/ethnicity. Lower absolute SDMT scores among black and Hispanic patients compared to white patients highlight underlying US population differences rather than differences in MS disease severity.

Assessment of Racial/Ethnic Disparities in Volumetric MRI Correlates of Clinical Disability in Multiple Sclerosis: A Preliminary Study

“…18,19 However, due to the lack of significant socioeconomic disparities between our matched study cohorts, the racial/ethnic differences we identified cannot be ascribed to socioeconomic factors alone, and may be better explained by a complex interaction between genetic predisposition and environmental factors. 20 This study investigated the relationship between regional MRI volume measures and clinical disability and explored their relevance as potential predictors of disease progression in a retrospective cohort of Hispanic and Caucasian individuals with MS. Our results showed significant cross-sectional differences in baseline MRI volume measures and in MRI-based volumetric correlates of MS-related disability between the two groups. Baseline T2 lesion volume was associated with EDSS scores in Hispanic patients only, and white matter volume was moder-ately associated with disability scores in the Caucasian group.…”

Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis

“…The contributions of race and ethnicity in early MS cognitive involvement have been studied less extensively. While Black and Hispanic persons with MS had lower scores on the oral SDMT compared to White persons with MS, Amezcua et al 20 attributed these findings to underlying population differences (eg, sociodemographic factors) rather a more severe disease course. The authors highlighted the importance of using appropriate normative data to identify persons in the early stages of MS who are exhibiting cognitive involvement.…”

“… 33 , 46 , 78 , 89 , 113 , 121 , 129–131 As some studies were investigating the signs of cognitive involvement soon after the onset of initial symptoms, persons with CIS suggestive of MS were included, either comprising the entire early stage group 17 , 21 , 26 , 37 , 47 , 48 , 54 , 57 , 58 , 61–64 , 66 , 68 , 71 , 79 , 84 , 92–94 , 99 , 101 , 103 , 107 , 137 , 142 , 148 , 153 , 156 or as part of a mixed sample with persons with early RRMS. 12 , 18 , 20 , 22 , 28 , 44 , 53 , 56 , 67 , 73 , 75 , 77 , 80 , 82 , 83 , 87 , 105 , 106 , 108 , 109 , 112 , 122 , 143 , 145 , 146 In contrast, studies that have examined early MS in relation to late MS have defined the latter as a disease duration of >10 23 or >12 years. 19 , 104 …”

Advancing Care and Outcomes for African American Patients With Multiple Sclerosis

“…32 Lower socioeconomic status (e.g., education level and income) was associated with greater health disparities, including higher disease burden and more cognitive/psychiatric symptoms. [32][33][34][35][36][37] The reasons for these disparities and inequities are likely multifactorial (Figure 1), including but not limited to gaps between need of and access to medical care and supportive services, [38][39][40] societal/cultural constructs (e.g., systemic/unconscious bias and racism), and lack of culturally competent care. Further observational, epidemiologic, and long-term longitudinal studies (taking into consideration both the genetic ancestry and social determinants of health) will be important for developing optimal treatment strategies for the Black and African American patient population with MS, with increased efforts to better understand and help alleviate the racial/ethnic disparities and inequities in clinical care in the United States.…”