title: Age and disability drive cognitive impairment in multiple sclerosis across disease subtypes.
abstract: BACKGROUND
  There is limited and inconsistent information on the clinical determinants of cognitive impairment (CI) in multiple sclerosis (MS).
  
  
  OBJECTIVE
  The aim of this study was to compare the prevalence and profile of CI across MS disease subtypes and assess its clinical determinants.
  
  
  METHODS
  Cognitive performance was assessed through the Brief Repeatable Battery and the Stroop test in consecutive patients with MS referred to six Italian centers. CI was defined as impairment in ⩾ 2 cognitive domains.
  
  
  RESULTS
  A total of 1040 patients were included, 167 with clinically isolated syndrome (CIS), 759 with relapsing remitting (RR), 74 with secondary progressive (SP), and 40 with primary progressive (PP) disease course. The overall prevalence of CI was 46.3%; 34.5% in CIS, 44.5% in RR, 79.4% in SP, and 91.3% in PP. The severity of impairment and the number of involved domains were significantly higher in SP and primary progressive multiple sclerosis (PPMS) than in CIS and RR. In multivariable logistic regression analysis, the presence of CI was significantly associated with higher Expanded Disability Status Scale (EDSS) and older age.
  
  
  CONCLUSIONS
  CI is present in all MS subtypes since the clinical onset and its frequency is increased in the progressive forms, but these differences seem to be more associated with patient age and physical disability than to disease subtype per se.
authors.affiliation: EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal/Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal/Entre Douro e Vouga Hospital Centre, Santa Maria da Feira, Portugal.
authors.forename: Luis
authors.initials: L
authors.lastname: Ruano
authors.affiliation: University of Florence, Florence, Italia.
authors.forename: Emilio
authors.initials: E
authors.lastname: Portaccio
authors.affiliation: University of Florence, Florence, Italia.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Goretti
authors.affiliation: University of Florence, Florence, Italia.
authors.forename: Claudia
authors.initials: C
authors.lastname: Niccolai
authors.affiliation: EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal/Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.affiliation: University of Catania, Catania, Italia.
authors.forename: Francesco
authors.initials: F
authors.lastname: Patti
authors.affiliation: University of Catania, Catania, Italia.
authors.forename: Sabina
authors.initials: S
authors.lastname: Cilia
authors.affiliation: University of Padova, Padova, Italia.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gallo
authors.affiliation: University of Padova, Padova, Italia.
authors.forename: Paola
authors.initials: P
authors.lastname: Grossi
authors.affiliation: Gallarate Hospital, Gallarate, Italia.
authors.forename: Angelo
authors.initials: A
authors.lastname: Ghezzi
authors.affiliation: Gallarate Hospital, Gallarate, Italia.
authors.forename: Marco
authors.initials: M
authors.lastname: Roscio
authors.affiliation: Spedali Civili Brescia, Brescia, Italia.
authors.forename: Flavia
authors.initials: F
authors.lastname: Mattioli
authors.affiliation: Spedali Civili Brescia, Brescia, Italia.
authors.forename: Chiara
authors.initials: C
authors.lastname: Stampatori
authors.affiliation: University of Bari, Bari, Italia.
authors.forename: Maria
authors.initials: M
authors.lastname: Trojano
authors.affiliation: University of Bari, Bari, Italia.
authors.forename: Rosa Gemma
authors.initials: RG
authors.lastname: Viterbo
authors.affiliation: University of Florence, Florence, Italia.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Amato
mesh_terms: D000328:Adult; D060825:Cognitive Dysfunction / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications / Q000503:physiopathology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000503:physiopathology*
keywords: Multiple sclerosis; cognitive impairment; disease course; epidemiology