Cognitive impairment in multiple sclerosis: An exploratory analysis of environmental and lifestyle risk factors

Autoři: Maria Pia Amato aff001;  Elio Prestipino aff001;  Angelo Bellinvia aff001;  Claudia Niccolai aff001;  Lorenzo Razzolini aff001;  Luisa Pastò aff003;  Roberto Fratangelo aff001;  Laura Tudisco aff001;  Mattia Fonderico aff001;  Paolo Luca Mattiolo aff001;  Benedetta Goretti aff001;  Giovanni Bosco Zimatore aff004;  Nunzia Alessandra Losignore aff004;  Emilio Portaccio aff005;  Francesco Lolli aff001
Působiště autorů: Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy aff001;  IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy aff002;  SOD Neurological Rehabilitation, Careggi University Hospital, Florence, Italy aff003;  Operative Unit of Neurology, Dimiccoli General Hospital, Barletta, Italy aff004;  SOC Neurology, San Giovanni di Dio Hospital, Florence, Italy aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222929



Many potentially modifiable risk factors for MS are investigated. It is not known, however, if these factors also apply to MS-related cognitive impairment (CI), a frequent consequence of MS.


The aim of our study was to assess risk factors for CI in MS patients, focusing on environmental exposures, lifestyle and comorbidities.


We included MS patients referring to MS Centers in Florence and Barletta between 2014 and 2017. Neuropsychological performance was assessed through the Rao’s battery and Stroop test, cognitive reserve (premorbid intelligence quotient–IQ) was evaluated using the National Adult Reading Test (NART). Potential risk factors were investigated through a semi-structured questionnaire.


150 patients were included. CI was detected in 45 (30%) subjects and was associated with older age (p<0.005), older age at MS onset (p = 0.016), higher EDSS score (p<0.005), progressive disease course (p = 0.048) and lower premorbid IQ score (p<0.005). As for risk factors, CI was related with lower physical activity in childhood-adolescence (p<0.005). In women, hormonal therapy resulted to be protective against CI (p = 0.041). However, in the multivariable analysis, the only significant predictors of CI were older age (p<0.05; OR 1.06, 95% CI 1.02–1.10) and lower premorbid IQ (p<0.05; OR 0.93, 95% CI: 0.88–0.98). Removing IQ from the model, CI was associated with higher EDSS (p = 0.030; OR 1.25, 95% CI 1.02–1.53) and, marginally, previous physical activity (p = 0.066; OR 0.49, 95% CI: 0.23–1.05)


Our findings suggest that physical activity in childhood-adolescence could be a contributor to cognitive reserve building, thus representing a potential protective factors for MS-related CI susceptible to preventive strategies.

Klíčová slova:

Cannabis – Cognitive impairment – Hormonal therapy – Medical risk factors – Multiple sclerosis – Neuropsychological testing – Neuropsychology – Physical activity


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