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. 2025 Jan;32(1):e70007.
doi: 10.1111/ene.70007.

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

E Leveraro  1 , M Cellerino  1 , C Lapucci  2 , M Dighero  1 , L Nasone  2 , T Sirito  1 , D Boccia  1 , N Cavalli  1 , G Bavestrello  1 , A Uccelli  1   2 , G Boffa  1   2 , M Inglese  1   2
Affiliations

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

E Leveraro et al. Eur J Neurol. 2025 Jan.

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.

Keywords: BICAMS; cognitive impairment; high‐efficacy therapy; multiple sclerosis.

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Conflict of interest statement

Dr. M. Inglese received grants NIH, NMSS, FISM; received fees for consultation from BMS; Janssen, Roche, Genzyme, Merck, Biogen, and Novartis. Dr. M. Cellerino received personal compensations from Novartis, Sanofi Genzyme, Teva, and consulting fees from Zambon. Dr. G. Boffa was supported by a research fellowship FISM—Fondazione Italiana Sclerosi Multipla 2019/BR/016 and financed or co‐financed with the “5 per mille” public funding. He received personal fee from Novartis and Roche. Dr. C. Lapucci received personal fee from Novartis, Roche, Sanofi, BMS, and Janssen. Dr. Uccelli received grants from FISM, Biogen, Roche, Alexion, and Merck Serono. All other authors declare no competing interests.

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