Sex Differences in the Neuropsychiatric Symptoms of Multiple Sclerosis: Symptômes neuropsychiatriques de la sclérose en plaques: différences selon le sexe

Objective There are clinical and radiological sex differences in people with multiple sclerosis (pwMS); however, the influence of sex on the neuropsychiatric symptoms of MS remains unclear. This study aimed to clarify whether there are sex differences in the neuropsychiatric symptoms of MS. Method A consecutive clinical cohort of 1530 pwMS completed the Hospital Anxiety and Depression Scale for symptoms of anxiety (HADS-A) and depression (HADS-D), the Modified Fatigue Impact Scale (MFIS), the Perceived Deficits Questionnaire (PDQ) for subjective cognitive concerns, and the Minimal Assessment of Cognitive Function in MS neurocognitive battery. Linear regression analyses were undertaken to predict neuropsychiatric raw scores from sex, adjusting for age, educational years, Expanded Disability Status Scale (EDSS) scores, disease duration, and disease subtype. The significance threshold was set at p < .01. Results Mean age was 43.2 years (SD = 10.6), mean disease duration was 9.7 years (SD = 8.4), and median EDSS was 2.0 (IQR = 1.5–3.5). Seventy-three percent of participants were female. Controlling for covariates, females had higher MFIS, PDQ, California Verbal Learning Test, and Brief Visuospatial Memory Test total learning scores, and lower Judgment of Line Orientation and Paced Auditory Serial Addition Test scores than males, all p < .01. Sex was not independently predictive of scores on the HADS-A, HADS-D, Controlled Oral Word Association Test, Brief Visuospatial Memory Test delayed recall, Symbol Digit Modalities Test, or Delis-Kaplan Executive Function System. Conclusions Among pwMS, females experience greater fatigue, cognitive complaints, and dysfunction in spatial rotation and working memory than males, while males have elevated learning/memory difficulties. The absence of differences in symptoms of depression and anxiety between males and females contrasts with well-described sex differences in the general population. These data support future research that can explain sex-specific mechanisms of neuropsychiatric symptoms in pwMS.