Patients with neuromyelitis optica spectrum disorder (NMOSD) may experience neuropsychological impairment, according to a study published in the Multiple Sclerosis Journal.

The results of the prospective multicenter study called CogniNMO-Study showed that patients with NMOSD had impaired visual processing speed and semantic fluency. Testing revealed significantly lower scores on the Symbol Digit Modalities Test (SDMT; P =.007) and the semantic fluency (P <.001) and congruent speed (P <.001) portions of Multiple Sclerosis Inventory Cognition (MuSIC) tests compared to normative data. No significant changes across all cognitive tests were observed at 1- and 2-year follow-ups.

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“This study assessed the extent of impairment in neuropsychological tests in the largest NMOSD sample reported to date and analyzed cognition data at follow-up. The data illustrate that NMOSD patients displayed below-average visual processing speed and semantic fluency,” the authors said.

When comparing patients with NMOSD who were seropositive for aquaporin-4 antibodies (AQP4-IgG; n=174) to those who were double seronegative for both AQP4-IgG and myelin oligodendrocyte glycoprotein-antibodies (MOG-IgG; n=43), no significant differences were observed between the 2 subgroups.

Cognitive test scores did show a correlation with some clinical variables. The SDMT scores were correlated with Expanded Disability Status Scale (EDSS) visual function and motor function scores (rs =-.31 and -.42, respectively). Fatigue Scale for Motor and Cognitive Functions scores were also correlated with SDMT scores (rs =-.35).

SDMT scores were significantly different between patients with visual impairment (EDSS visual function system score > 0) and those without visual impairment. No difference was observed between the 2 groups for MuSIC congruent speed. The duration of the disease did not show a relationship with the scores on the cognitive tests.

“We propose to develop a standard change-sensitive test battery adapted to NMOSD patients for use in future longitudinal studies to examine cognitive performance independently of visual and motor disabilities,” the authors said.

A total of 217 patients with NMOSD were enrolled in the study, including 174 who were seropositive for AQP4-IgG and 43 who were double seronegative. The median disease duration for the full cohort was 6 years, and the median age was 52 years. Test scores were compared to z-standardized scores of 241 healthy controls for the SDMT and 158 healthy controls for the MuSIC tests.


Hümmert MW, Stern C, Paul F, et al. Cognition in patients with neuromyelitis optica spectrum disorders: a prospective multicentre study of 217 patients (CogniNMO-Study). Mult Scler. Published online February 14, 2023. doi:10.1177/13524585231151212