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All participants underwent clinical evaluation, magnetic resonance imaging (MRI), and comprehensive cognitive assessments. Cognitive function was assessed using the Brief International Cognitive Assessment for MS (BICAMS), which includes the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test\u2013II (CVLT-II), and Brief Visuospatial Memory Test\u2013Revised (BVMT-R). Additional tests evaluated attention, executive function, verbal fluency, and global cognition. Cognitive impairment was defined as a Z\u2011score\u2009\u2264\u2009-1.5 in at least two of the three BICAMS domains. Spearman correlation and multiple linear regression analyses were used to examine associations between neuroimaging metrics and cognitive scores in RRMS patients. Backward stepwise logistic regression was performed to identify variables independently associated with cognitive impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>RRMS patients had a significantly lower ALPS index compared to HC (t\u2009=\u2009-2.225, q\u2009=\u20090.029). Within the RRMS group, patients with cognitive impairment showed further reductions in the ALPS index. Multiple linear regression confirmed that the ALPS index was significantly associated with Z\u2011scores of the Symbol Digit Modalities Test (SDMT; \u03b2\u2009=\u20090.415, q\u2009=\u20090.003), PASAT-3\u00a0s (Paced Auditory Serial Addition Test-3\u00a0s; \u03b2\u2009=\u20090.305, q\u2009=\u20090.037), PASAT-2\u00a0s (\u03b2\u2009=\u20090.429, q\u2009=\u20090.002) and Controlled Oral Word Association Test (COWA; \u03b2\u2009=\u20090.305, q\u2009=\u20090.044). In addition, a negative correlation was observed between white matter lesion number (WMLN) and the Z\u2011scores of COWA (\u03b2\u2009=\u2009-0.340, q\u2009=\u20090.013). In the backward stepwise logistic regression model, the ALPS index (OR\u2009=\u20090.044, 95% CI: 0.003\u20130.776, q\u2009=\u20090.033) and normalized white matter volume (nWMV; OR\u2009=\u20090.764, 95% CI: 0.599\u20130.975, q\u2009=\u20090.030) were retained as variables independently associated with cognitive impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study suggests that both a reduced ALPS index and lower nWMV are independently associated with cognitive impairment in RRMS. These findings implicate the combined roles of impaired interstitial fluid clearance and structural integrity in RRMS-related cognitive dysfunction. As a non-invasive MR metric, the ALPS index may serve as a potential complementary biomarker for assessing cognitive risk in RRMS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12883-026-04826-4","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T09:47:03Z","timestamp":1774604823000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of the along\u2011perivascular space (ALPS) index and white matter volume with cognitive dysfunction in relapsing\u2011remitting multiple sclerosis patients"],"prefix":"10.1186","volume":"26","author":[{"given":"Yuanjun","family":"Song","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shenghui","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinlong","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoyu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"issue":"10130","key":"4826_CR1","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/S0140-6736(18)30481-1","volume":"391","author":"AJ Thompson","year":"2018","unstructured":"Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O. 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J Cereb Blood Flow Metab. 2023;43(8):1328\u201339. https:\/\/doi.org\/10.1177\/0271678X231164337.","journal-title":"J Cereb Blood Flow Metab"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-026-04826-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-026-04826-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-026-04826-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T20:59:34Z","timestamp":1781643574000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12883-026-04826-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4826"],"URL":"https:\/\/doi.org\/10.1186\/s12883-026-04826-4","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"assertion":[{"value":"5 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Committee of the Affiliated Hospital of Inner Mongolia Medical University (KY2025027), and written informed consent was obtained from all participants prior to their involvement. For participants with cognitive decline who were unable to provide informed consent, written informed consent was obtained from their legal guardians or appropriate authorized representatives. All procedures complied with the ethical standards outlined in the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"320"}}