ACTRIMS 2026 | Patient-reported cognitive concerns and objective impairment in multiple sclerosis
David Freedman, MD, University of Toronto, Toronto, Canada, shares details of a study investigating patient-reported cognitive concerns and their association with an increased odds of cognitive impairment in multiple sclerosis. The research shows that patient-reported cognitive concerns are linked to objective cognitive impairment only when they exceed a critical threshold, helping to clarify previously inconsistent findings in the literature. This interview is part of our coverage of the 11th Annual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum, held in San Diego, CA.
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Transcript
So, in multiple sclerosis, there has been a weak and inconsistent link demonstrated between self-reported cognitive concerns and performance-based cognitive dysfunction. We wondered whether this inconsistency in the literature may be due to not evaluating for a nonlinear link between these variables, or in other words, whether there is a threshold above which self-reported cognitive concerns are associated with performance-based cognitive dysfunction...
So, in multiple sclerosis, there has been a weak and inconsistent link demonstrated between self-reported cognitive concerns and performance-based cognitive dysfunction. We wondered whether this inconsistency in the literature may be due to not evaluating for a nonlinear link between these variables, or in other words, whether there is a threshold above which self-reported cognitive concerns are associated with performance-based cognitive dysfunction. So again, in a sample of about 900 individuals with multiple sclerosis aged 18 to 65, we examined this question, finding that above a threshold of approximately 50 on a scale called the Perceived Deficits Questionnaire, which measures these self-reported cognitive concerns, we saw an association between increased self-reported cognitive concerns and performance-based cognitive impairment measured using the MACFIMS, or the Minimal Assessment of Cognitive Function in MS cognitive battery. But below 50 on this PDQ score, there was no association. So this relationship persisted even after controlling for demographic or disease-related covariates, suggesting that there appears to be a nonlinear link between these variables. This helps to resolve equivocal literature to date and also supports further study to evaluate whether the relationships between self-reported cognitive concerns and other variables also vary based on this threshold. Nonetheless, it helps to resolve equivocal data to date and also really validates, I think, the importance of both self-reported cognitive concerns and performance-based cognitive dysfunction in understanding cognition in people with MS. I think the overarching thing that I really want to emphasize is that I think a lot of people with multiple sclerosis experience symptoms of depression, anxiety, and cognitive dysfunction, which at times may be under-recognized in this population. I think it is really important that these issues are appropriately assessed and addressed as these are areas that can be addressed with the work of clinicians and ongoing research is needed to explore other approaches to managing these conditions which can be really impactful on the lives of people with MS.
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