Brief international cognitive assessment for MS (BICAMS) and NEDA maintenance in MS patients: A 2-year follow-up longitudinal study

Abstract

Background: The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been validated in many cross-sectional studies. However, longitudinal data on BICAMS subset trajectories and their correlation with disease activity during follow-up are scarce. Objectives: We aimed to (i) assess BICAMS changes in MS patients initiating high-efficacy disease-modifying-treatments (DMTs), (ii) compare these changes based on maintenance of “no-evidence-of-disease-activity” (NEDA-3) status over 24 months, and (iii) determine baseline clinical parameters predictive of cognitive changes. Methods: We enrolled 101 MS patients (mean age:40,45 ± 11; Relapsing–Remitting-MS:81%) initiating highly-effective-DMTs. Patients underwent Expanded Disability Status Scale (EDSS), BICAMS, and Hospital Anxiety and Depression Scale (HADS), at baseline and after 24 months. Regression-based change index (RB-CI) had been used for cognitive change evaluation over follow-up. Results: During follow-up, 78 (77.3%) patients maintained NEDA-3 status. Considering a 90% of confidence levels for RB-CI, 12 (11.9%) improved at SDMT, 13 (12.9%) at CVLT-II and 13 (12.9%) at BVMT-R; while 7 (6.9%) were classified as worsened at SDMT, 11 (10.9%) at CVLT-II and 8 (7.9%) at BVMT-R. SDMT scores significantly improved at follow-up for the entire group (p = 0.003) and in patients maintaining NEDA-3 (p < 0.001). The multivariable regression model assessing the SDMT improvement (n = 12; z = 1.65), was significant and explained 21% of the variance (p = 0.038; Nagelkerke R2 = 0.212). Lower EDSS proved to be an independent predictor of SDMT reliable improvement (p = 0.027) in our sample. Conclusions: Our findings showed that early disease activity control—especially in patients with low baseline disability—may yield significant benefits even in terms of cognitive performance.