{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:13:21Z","timestamp":1791562401892,"version":"4.3.4"},"reference-count":60,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Cognitive impairment (CI) affects the quality of life in multiple sclerosis (MS). Identifying influencing factors is key to improving CI monitoring. This systematic review and meta\u2010analysis examines clinical and sociodemographic variables impacting the cognitive screening Symbol Digit Modalities Test (SDMT) performance across MS subtypes, identifying subgroups at greater risk of cognitive impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Registered on PROSPERO (CRD42023451696), a literature search was conducted on August 6, 2023, using PubMed, Embase, and CENTRAL. Following the PRISMA 2020 guideline, a random\u2010effects meta\u2010analysis addressed heterogeneity in correlation and meta\u2010regression analyses. Multivariable regression model results were qualitatively synthesized (systematic review). The JBI Critical Appraisal Tool assessed bias risk. Primary outcome was SDMT raw scores, with EDSS and disease duration as primary exposures, extended with age, sex, education, depression, fatigue, mobility scores, and treatment as secondary exposures, according to our protocol. Associations were evaluated via univariate study\u2010level correlations, univariate meta\u2010regressions, study\u2010level multivariable regression models, and multivariate meta\u2010regressions, assessing covariate interdependence. Heterogeneity was quantified with\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      . Only observational cross\u2010sectional data (or baseline data from longitudinal studies) were included.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 155 studies with 22,828 patients were analyzed. In mixed and relapsing\u2013remitting MS (RRMS), EDSS was the strongest negative correlate of SDMT (mixed MS: \u22120.44 CI:[\u22120.50; \u22120.36]; RRMS: \u22120.47 [\u22120.66; \u22120.23]). Education showed a moderate positive correlation (mixed MS: 0.31 [0.20; 0.42]; RRMS: 0.32 [\u22120.02; 0.59]). Due to cross\u2010sectional design, heterogeneity, and potential aggregation\/ecological bias, findings are exploratory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Poor SDMT performance is mainly driven by physical disability and cognitive reserve (education), modulated by sex, depression, and age, highlighting the need to integrate clinical and sociodemographic data in MS cognitive monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acn3.70172","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T12:31:05Z","timestamp":1758717065000},"page":"58-70","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Cognitive Impairment in Multiple Sclerosis: The Role of Clinical and Sociodemographic Factors \u2010 A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0734-906X","authenticated-orcid":false,"given":"Katalin","family":"Lugosi","sequence":"first","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Multiple Sclerosis Centre Bajcsy\u2010Zsilinszky Hospital  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie A.","family":"Engh","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tam\u00e1s","family":"K\u00f3i","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Department of Stochastics Budapest University of Technology and Economics  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt","family":"Moln\u00e1r","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Department of Anaesthesiology and Intensive Therapy Semmelweis University  Budapest Hungary"},{"name":"Department of Anaesthesiology and Intensive Therapy Poznan University of Medical Sciences  Poznan Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e1bor","family":"Csukly","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Department of Psychiatry and Psychotherapy Semmelweis University  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaudia","family":"Horv\u00e1th","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Centre Bajcsy\u2010Zsilinszky Hospital  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Hargitai","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Centre Bajcsy\u2010Zsilinszky Hospital  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Hegyi","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Institute for Translational Medicine, Medical School, University of P\u00e9cs  P\u00e9cs Hungary"},{"name":"Institute of Pancreatic Diseases, Semmelweis University  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt","family":"Mezei","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Department of Neurology Semmelweis University  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"231","volume-title":"Handbook of Clinical Neurology","author":"Goodin D. 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