Does cognitive performance explain the gap between physiological and perceived fall-risk in people with multiple sclerosis?

Background: Cognitive impairment is linked with increased risk of falls in people with multiple sclerosis (pwMS), but it is not clear whether cognitive performance may help to account for the discordance between fall-risk due to actual physiological functioning and the individual's perception of their fall-risk. This study examined the relationship between cognitive performance and the concordance/discordance of physiological and perceived fall-risk in pwMS. Methods: : In this single-center cross-sectional analysis of 201 pwMS, proxies for physiological (gait speed) and perceived (Modified Falls Efficacy Scale) fall-risk were collected. Participants were categorized into 4 groups using established cut-off values: high physiological – high perceived (H_phy-H_per), high physiological – low perceived (H_phy-L_per), low physiological – low perceived (L_phy-L_per), and low physiological – high perceived (L_phy-H_per) fall-risk. Cognitive performance was evaluated using the NeuroTrax computerized cognitive battery, which generates a global cognitive score (GCS) as well as scores for individual cognitive domains. Results: Overall, 27.4 % of participants exhibited a discordance between physiological and perceived fall-risk. Individuals with discordant fall-risk did not have worse cognitive scores than individuals with concordant fall-risk, whether GCS or individual cognitive domains. However, among concordant groups, participants in the H_phy-H_per group had worse cognitive scores (GCS) as well as information processing, attention, motor skills, executive function and visual spatial domain scores than participants in the L_phy-L_per group. Conclusion: In this study, one in 4 pwMS had a discordance between their physiological and perceived fall-risk. This discordance was not explained by cognitive performance.