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Meta-Analysis
. 2024 Nov 19;24(1):454.
doi: 10.1186/s12883-024-03943-2.

Comparing cognitive impairment using MACFIMS in patients with multiple sclerosis and healthy controls: a systematic review and meta-analysis

Amirreza Nasirzadeh  1 , Mohammad Mohammadi  2 , Melika Arab Bafrani  3 , Aynaz Mohammadi  4 , Hossein Bakhtiari-Dovvombaygi  5   6
Affiliations
Meta-Analysis

Comparing cognitive impairment using MACFIMS in patients with multiple sclerosis and healthy controls: a systematic review and meta-analysis

Amirreza Nasirzadeh et al. BMC Neurol. .

Abstract

Background: Multiple sclerosis (MS) is a chronic autoimmune disorder affecting the central nervous system, leading to a range of symptoms that impact physical, psychiatric, and cognitive functions. Cognitive dysfunction is prevalent among patients with MS (pwMS), affecting at least 65% of patients, and includes deficits in processing speed, attention, learning, memory, and executive function. Despite the significant impact on daily life, cognitive impairment in MS patients is often underrecognized in clinical settings.

Methods: This systematic review and meta-analysis aimed to evaluate cognitive function using the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery among pwMS patients and healthy controls (HCs). A comprehensive search of the Web of Science, PubMed, Scopus, and Cochrane Library databases was conducted on January 2024 following the PRISMA guidelines. Eligible studies included peer-reviewed research assessing the validity of the MACFIMS in adult MS patients. Data extraction and quality assessment were performed using standardized tools, and statistical analyses were conducted using R4.2.3.

Results: Eight studies met the inclusion criteria, including a total of 1,481 pwMS and 1,072 HCs. The meta-analysis revealed significant cognitive deficits in pwMS patients compared to HCs across all the MACFIMS subtests, including language, spatial processing, new learning and memory, processing speed, and executive function. Processing speed and working memory were the most affected domains, with 36% of pwMS showing impairment on the Symbol Digit Modalities Test (SDMT). Subgroup analyses indicated that the Expanded Disability Status Scale (EDSS) score significantly influenced cognitive impairment, while disease duration had a limited impact.

Conclusions: The MACFIMS effectively discriminates between pwMS patients and HCs, demonstrating its validity as a comprehensive cognitive assessment tool for MS. Routine cognitive screening, particularly for processing speed and working memory, is crucial for early detection and intervention. Future research should focus on the sensitivity and specificity of the MACFIMS across diverse MS subtypes and cultural contexts to enhance its global applicability in clinical practice.

Keywords: Cognitive impairment; MACFIMS; Multiple sclerosis.

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Conflict of interest statement

Declarations Ethics approval and consent to participate This study is a secondary analysis of previously published research and does not report on any original studies involving human participants or animals conducted by the authors. Consent for publication Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Mean differences, prevalence and odds ratio of cognitive impairment based on COWAT. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on COWAT; E odds ratio of cognitive impairment based on COWAT
Fig. 2
Fig. 2
Mean differences, prevalence and odds ratio of cognitive impairment based on JLO. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on JLO; E odds ratio of cognitive impairment based on JLO
Fig. 3
Fig. 3
Mean differences, prevalence and odds ratio of cognitive impairment based on IMMEDIATE CVLT. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on IMMEDIATE CVLT; E odds ratio of cognitive impairment based on IMMEDIATE CVLT
Fig. 4
Fig. 4
Mean differences, prevalence and odds ratio of cognitive impairment based on DELAYED CVLT. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on DELAYED CVLT; E odds ratio of cognitive impairment based on DELAYED CVLT
Fig. 5
Fig. 5
Mean differences, prevalence and odds ratio of cognitive impairment based on IMMEDIATE BVMT. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on IMMEDIATE BVMT; E odds ratio of cognitive impairment based on IMMEDIATE BVMT
Fig. 6
Fig. 6
Mean differences, prevalence and odds ratio of cognitive impairment based on DELAYED BVMT. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on DELAYED BVMT; E odds ratio of cognitive impairment based on DELAYED BVMT
Fig. 7
Fig. 7
Mean differences, prevalence and odds ratio of cognitive impairment based on SDMT. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on SDMT; E odds ratio of cognitive impairment based on SDMT
Fig. 8
Fig. 8
Mean differences, prevalence and odds ratio of cognitive impairment based on PASAT2. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on PASAT2; E odds ratio of cognitive impairment based on PASAT2
Fig. 9
Fig. 9
Mean differences, prevalence and odds ratio of cognitive impairment based on PASAT3. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on PASAT3; E odds ratio of cognitive impairment based on PASAT3
Fig. 10
Fig. 10
Mean differences, prevalence and odds ratio of cognitive impairment based on DKEFS-CCS. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on DKEFS-CCS; E odds ratio of cognitive impairment based on DKEFS-CCS
Fig. 11
Fig. 11
Mean differences, prevalence and odds ratio of cognitive impairment based on DKEFS-FSDS. A overall mean difference; B mean differences based on EDSS subgroup; C mean differences based on disease duration subgroup; D prevalence of cognitive impairment based on DKEFS-FSDS; E odds ratio of cognitive impairment based on DKEFS-FSDS
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