Patients with neuromyelitis optica spectrum disorder (NMOSD) showed cognitive impairment compared to healthy controls, according to a retrospective study published in Applied Neuropsychology: Adult.

In the study, 58% of patients with NMOSD had some level of cognitive impairment and overall, the NMOSD group had significantly lower cognitive performance than the healthy control (HC) group. The main areas of lower cognitive performance were in information processing speed, concentration, and language processing. Executive functions, including cognitive flexibility, sustained attention, and divided attention, were also lower in the NMOSD group.

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Patients with multiple sclerosis (MS) were also tested, but no significant differences were observed between the NMOSD and MS groups in any of the cognitive measures. The HC group was significantly higher than the MS group in terms of phonemic verbal fluency.

Using multiple linear regression, the clinical variables that were the strongest predictors of cognitive impairment in patients with NMOSD, based on the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) criteria, were the presence of depression and the level of disability. In comparison, the strongest predictors for patients with MS were depression and disease duration.

“The prevalence of the cognitive impairment in the majority of our NMOSD patients, associated with psychological comorbidities, also emphasize the need for appropriate mental and neuropsychological services, specifically, regarding interventions to help improving their managing skills for depressive symptoms and cognitive stimulation for the neuropsychological impairments,” the authors wrote.

During the study, 19 patients with NMOSD, 27 patients with MS, and 17 HCs were recruited from a clinical site in Portugal. There were no significant differences in age, the ratio of male to female patients (all 3 groups were predominantly female), or education level.

Each participant was assessed using a variety of neuropsychological tests including the Montreal Cognitive Assessment (MoCA), BICAMS, Verbal Fluency Test (phonemic and semantic), and Hospital Anxiety and Depression Scale (HADS). The BICAMS test consists of 3 separate tests including the California Verbal Learning Test-II (CVLT-II), Brief Visuospatial Memory Test-Revised (BVMT-R), and Symbol Digit Modalities Test (SDMT).


Lopes C, Sousa C, Fraga A, Guimarães J, Vicente S, Sá MJ. Cognitive impairment in neuromyelitis optica spectrum disorder: a retrospective study using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Appl Neuropsychol Adult. Published online May 17, 2023. doi:10.1080/23279095.2023.2210242