The relationship between objective and subjective cognitive performance and clinical and MRI disease burden in early multiple sclerosis

Subjective cognitive performance in multiple sclerosis (MS) correlates weakly with objective performance, but is more strongly associated with depression. We aimed to identify symptoms and brain MRI volumes related to subjective and objective cognitive performance. 205 MS subjects, diagnosed within the last 15 years, completed the SymptoMScreen, patient-reported Expanded Disability Status Scale, Neuro-QoL subjective cognitive and fatigue sub-scores, and Beck Depression Inventory. For the objective cognitive assessment the smartphone-based icompanion Symbol test was used. Volumetric variables were calculated from the 52 available brain MRIs using icobrain. A weak correlation was observed between subjective and objective performance (rho = 0.21, p = 0.002). Subjective performance was negatively associated with pain, dizziness, fatigue and depression, while objective performance was negatively related to walking impairment. Objective performance significantly correlated with thalamic volume, while subjective performance did not correlate with any brain volumes. In other words, subjective and objective cognitive performance are related to different clinical markers: subjective performance is linked to invisible symptoms, while objective performance is linked to more visible measurable clinical markers. Integrating both perspectives in clinical practice may provide a more holistic understanding of cognition in MS, allowing for tailored interventions that enhance patient care and quality of life.