TY - JOUR
T1 - Cognitive function is associated with risk of conversion to secondary progressive multiple sclerosis
T2 - A cross-sectional study
AU - Mirmosayyeb, Omid
AU - Mohammadi, Ida
AU - Firouzabadi, Shahryar Rajai
AU - Vaheb, Saeed
AU - Panah, Mohammad Yazdan
AU - Fuchs, Tom A.
AU - Weinstock-Guttman, Bianca
AU - Shaygannejad, Vahid
N1 - Publisher Copyright:
© 2026 Mirmosayyeb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2026/3
Y1 - 2026/3
N2 - Background Predicting conversion from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) is critical for managing people with multiple sclerosis (PwMS). Cognitive function has been linked to disease progression in RRMS, yet its association with conversion to SPMS remains underexplored. This study aimed to assess this relationship using the newly developed DAAE score to calculate the risk of conversion to SPMS. Methods The risk of conversion over five years was assessed using the DAAE score (0–12), and the PwMS were categorized into very-low-to-low and medium-to-high risk groups. Cognitive function was assessed using the Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Paced Auditory Serial Addition Test (PASAT), and California Verbal Learning Test-Second Edition (CVLT-II). Pairwise correlations and hierarchical linear and logistic regression analyses were performed to examine the relationship between cognition and conversion risk. Results A total of 217 PwMS were included (very low to low = 185, medium to high = 32). The DAAE score was moderately correlated with SDMT and BVMT-R and weakly correlated with PASAT and CVLT-II. Multivariable linear regressions found SDMT (beta = −0.125, 95%CI: −0.155, −0.096, p-value < 0.001), BVMT-R (beta = −0.157, 95%CI: −0.200, −0.114, p-value < 0.001), PASAT (beta = −0.084, 95%CI: −0.111, −0.057, p-value < 0.001), and CVLT-II (beta = −0.088, 95%CI: −0.125, −0.050, p-value < 0.001) were independently associated with the risk of conversion. Among these, SDMT (beta = −0.093, 95% CI: −0.133 to −0.054, p-value < 0.001) was the most robust predictor of conversion risk.
AB - Background Predicting conversion from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) is critical for managing people with multiple sclerosis (PwMS). Cognitive function has been linked to disease progression in RRMS, yet its association with conversion to SPMS remains underexplored. This study aimed to assess this relationship using the newly developed DAAE score to calculate the risk of conversion to SPMS. Methods The risk of conversion over five years was assessed using the DAAE score (0–12), and the PwMS were categorized into very-low-to-low and medium-to-high risk groups. Cognitive function was assessed using the Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Paced Auditory Serial Addition Test (PASAT), and California Verbal Learning Test-Second Edition (CVLT-II). Pairwise correlations and hierarchical linear and logistic regression analyses were performed to examine the relationship between cognition and conversion risk. Results A total of 217 PwMS were included (very low to low = 185, medium to high = 32). The DAAE score was moderately correlated with SDMT and BVMT-R and weakly correlated with PASAT and CVLT-II. Multivariable linear regressions found SDMT (beta = −0.125, 95%CI: −0.155, −0.096, p-value < 0.001), BVMT-R (beta = −0.157, 95%CI: −0.200, −0.114, p-value < 0.001), PASAT (beta = −0.084, 95%CI: −0.111, −0.057, p-value < 0.001), and CVLT-II (beta = −0.088, 95%CI: −0.125, −0.050, p-value < 0.001) were independently associated with the risk of conversion. Among these, SDMT (beta = −0.093, 95% CI: −0.133 to −0.054, p-value < 0.001) was the most robust predictor of conversion risk.
UR - https://www.scopus.com/pages/publications/105033918792
U2 - 10.1371/journal.pone.0344558
DO - 10.1371/journal.pone.0344558
M3 - Article
C2 - 41860849
AN - SCOPUS:105033918792
SN - 1932-6203
VL - 21
JO - PLOS ONE
JF - PLOS ONE
IS - 3 March
M1 - e0344558
ER -