Pauline Anderson – July 08, 2022
Cognitive impairment is a good predictor of physical disability progression in patients with multiple sclerosis (MS), new research suggests.
In an analysis of more than 1600 patients with secondary-progressive MS (SPMS), the likelihood of needing a wheelchair was almost doubled in those who had the worst scores on cognitive testing measures compared with their counterparts who had the best scores.
“These findings should change our world view of MS,” study investigator Gavin Giovannoni, PhD, professor of neurology, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, United Kingdom, told attendees at the Congress of the European Academy of Neurology (EAN) 2022.
On the basis of the results, clinicians should consider testing cognitive processing speed in patients with MS to identify those who are at increased risk for disease progression, Giovannoni noted.
“I urge anybody who runs an MS service to think about putting in place mechanisms in their clinic” to measure cognition of patients over time, he said.
Expand Data
Cognitive impairment occurs very early in the course of MS and is part of the disease, although to a greater or lesser degree depending on the patient, Giovannoni noted. Such impairment has a significant impact on quality of life for patients dealing with this disease, he added.
EXPAND was a phase 3 study of siponimod. Results showed the now-approved oral selective sphingosine 1–phosphate receptor modulator significantly reduced the risk for disability progression in patients with SPMS.
Using the EXPAND clinical trial database, the current researchers assessed 1628 participants for an association between cognitive processing speed (CPS), as measured with the Symbol Digit Modality Test (SDMT), and physical disability progression, as measured with the Expanded Disability Status Scale (EDSS). A score of 7 or more on the EDSS indicates wheelchair dependence.
Giovanonni noted that CPS is considered an indirect measure of thalamic network efficiency and functional brain reserve.
Investigators looked at both the core study in which all patients continued on treatment or placebo for up to 37 months, and the core plus extension part in which patients received treatment for up to 5 years.
They separated SDMT scores into quartiles: from worst (n = 435) to two intermediate quartiles (n = 808) to the best quartile (n = 385).
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