Neurocognitive outcomes in older adults with multiple sclerosis: Evidence from a cross-sectional cohort

INTRODUCTION: Aging in people with multiple sclerosis (MS) presents a complex clinical scenario, where the cumulative effects of neurodegeneration and the physiological changes of aging increase the risk of cognitive impairment (CI). However, the cognitive profile of older people with MS (OPMS) has been scarcely characterized, particularly in Latin American contexts. OBJECTIVE: To explore the prevalence and profile of cognitive impairment in OPMS, compare them with younger people with MS (YPMS), and identify clinical predictors of CI, assessing whether age acts as an independent factor. METHODS: This was an observational, analytical, cross-sectional study including 339 people with MS (PwMS) evaluated at Dr. J.M. Ramos Mejía Hospital between 2022 and 2024. Standardized neuropsychological batteries (BICAMS, BRNB) were administered, and CI was defined as performance ≤ -1.5 SD in at least two domains. PwMS were divided into two age-based groups: Older PwMS (OPMS: n = 83, >50 years) and Younger PwMS (YPMS: n = 256, 18-50 years) and compared using Student's t or Mann-Whitney U tests for continuous variables, and chi-square or Fisher's exact tests for categorical variables, depending on distribution and sample size. Binary logistic regression was conducted to identify clinical and sociodemographic variables associated with CI. RESULTS: CI prevalence was significantly higher in OPMS (59 %) compared to YPMS (42.6 %; p<.01). Information processing speed was the most affected domain (56.6 %). OPMS performed significantly worse than YPMS across all cognitive domains (p<.05), with no significant differences in mood variables or fatigue levels (p>.05). However, OPMS exhibited greater disability (p<.01) as measured by the EDSS. Logistic regression indicated that age was not a significant predictor of CI once other variables were controlled for (p = .933), whereas greater neurological disability (EDSS) was associated with higher risk (OR = 1.92, p < .001), and higher education functioned as a protective factor (OR = 0.82, p = .009). CONCLUSION: Older adults with MS show a higher prevalence and severity of cognitive impairment compared with younger people. Neurological disability, rather than chronological age, is significantly associated with CI. These findings underscore the need to adapt assessment and intervention strategies to the aging context of MS and promote the development of differentiated clinical approaches for this population.