assessment of risk factors potentially modifiable for cognitive decline in patients with multiple sclerosis

BACKGROUND

The modifiable risk factors for dementia are already well documented, as are those for brain health in Alzheimer's disease, but we still don't know the impact of these factors on cognition in other diseases, such as Multiple Sclerosis (MS). The prevalence of cognitive impairment in MS is 30-45% in the relapsing-remitting (RRMS) form4 and the cognitive domains most commonly affected are processing speed, episodic memory and executive function.² The Symbol Digit Modalities Test (SDMT) is the gold standard test for assessing cognition in patients with MS4. The risk factors described in the literature for cognitive decline in MS are: early age of disease onset, male sex, smoking, secondary progressive course and number of brain lesions.

METHODS

This study consisted of a prospective cohort in which patients who met the inclusion criteria were consecutively recruited from September to December 2025 in the neurology department. These patients had a confirmed diagnosis of RRMS, aged between 18 and 50 years and a disease duration of less than or equal to 6 years. Patients with a prior diagnosis of dementia, stroke and decompensated psychiatric disorders were excluded, as well as those who experienced a disease relapse within the last three months. Patient data were collected based on the items of the Brain Care Score³, through an individual interview, and cognitive assessment was performed by administering the SDMT on the same day as the interview. 

RESULTS

A total of 39 patients were included in the study, of whom 26 were female. The mean age was 31.3 years and the mean years of education was 14.1. Cognitive decline was observed in 35.8% of patients, which is consistent with the prevalence reported in the literature. Seven of the fourteen potentially modifiable risk factors for dementia¹ were analyzed, with stress and overweight/obesity being the most prevalent among patients with cognitive impairment.

DISCUSSION

The most frequent risk factors for cognitive decline in our study were overweight/obesity and stress. Further studies with larger populations are needed to clarify which potentially modifiable factors are more associated with a higher risk of cognitive impairment in patients with RRMS.