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Their role in cognitive progression remains unexplored. Eighty\u2010seven early relapsing\u2013remitting MS patients were enrolled at diagnosis and followed longitudinally. PRLs and CP volume were evaluated at diagnosis using 3\u2009T\u2010MRI. Cognitive decline over time was classified as cognitive progression independent of relapse\/MRI activity (PIRMA). Fifty\u2010five patients (63.2%) showed meaningful cognitive decline: 44 (80.0%) were cognitive PIRMA. PRLs and CP volume at diagnosis were associated with cognitive PIRMA. PRLs and larger CP reflect cognitive progression independent of clinical\/MRI activity, supporting their role as smoldering disease activity markers.<\/jats:p>","DOI":"10.1002\/acn3.70448","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T03:46:11Z","timestamp":1783568771000},"page":"2154-2160","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Paramagnetic Rim Lesions and Choroid Plexus Volume at Diagnosis Are Associated With Cognitive Progression Independent of Relapse and\n                    <scp>MRI<\/scp>\n                    Activity in Early Relapsing\u2013Remitting Multiple Sclerosis"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0426-7223","authenticated-orcid":false,"given":"Stefano","family":"Ziccardi","sequence":"first","affiliation":[{"name":"Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences 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