Clinical Characteristics, MRI Markers Predict Worsening Cognition Over 10 Years in MS

Six panels of an MRI scan.
Study researchers examined whether baseline MRI-markers and demographic and clinical data can help predict cognitive worsening patients with multiple sclerosis.

Baseline age, disability, whole brain volume (WBV), and T2 lesion volume were significant predictors of long-term worsening information processing speed (IPS) in patients with multiple sclerosis (MS), according to study results published in Multiple Sclerosis Journal — Experimental, Translational and Clinical.

This study included 76 Norwegian patients diagnosed with MS from 1998 to 2000. All participants underwent neurologic examination, 1.5 T magnetic resonance imaging (MRI) of the brain, and clinical assessments at baseline. These assessments were performed again at 5 years and 10 years. Study researchers also assessed physical disability at each visit using the Expanded Disability Status Scale (EDSS). In addition, they calculated global and tissue-specific volumes at each visit. Using the Symbol Digit Modalities Test (SDMT), they measured changes in IPS.

Approximately 49% (n=37) of patients were considered cognitively impaired at baseline. Among participants available for assessment, at the 5- and 10-year follow up the rates of cognitive impairment fluctuated to 47% and 37%, respectively.

At the 5-year follow up, factors predictive of worsening SDMT in the multivariable analysis include baseline age (β, -1.8; -4.5-0.9; P =.20), EDSS (β, -1.8; 95% CI, -3.9-0.3; P =.084), SDMT (β, -0.20; 95% CI, -0.40 to -0.01; P =.043), WBV (β, 0.042; 95% CI, 0.009-0.076; P =.015), and T2 lesion volume (β, -0.35; 95% CI, -0.55 to -0.16; P =.001). The study researchers noted that these predictive variables explained 30.2% of the variance of SDMT.

Baseline predictors of change in SDMT during the studied 10 years included age (β, –3.0; 95% CI, -6.4-0.4; P =.083), EDSS (β, 1.7; 95% CI, -0.7-4.0; P =.16), grey matter volume (β, 0.08; 95% CI, 0.02-0.13; P =.007), and T1 lesion volume (β, -1.1; 95% CI, -1.5 to -0.7; P <.001), which explained 39.4% of the variance of change in SDMT.

Limitations of this study included the relatively small size of the cohort as well as the high dropout rate over the 10-year period.

Using these identified predictors, the study researchers concluded that “identifying patients at higher risk of developing cognitive difficulties could help clinicians initiate proper follow-up” and aid treatment decisions.

Disclosure: This clinical trial was supported by Novartis. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Jacobsen C, Zivadinov R, Myhr KM, et al. Brain atrophy and clinical characteristics predicting SDMT performance in multiple sclerosis: A 10-year follow-up study. Mult Scler J Exp Transl Clin. Published online February 8, 2021. doi:10.1177/2055217321992394