{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T18:17:21Z","timestamp":1774030641635,"version":"3.50.1"},"reference-count":76,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Predicting conversion from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) is critical for managing people with multiple sclerosis (PwMS). Cognitive function has been linked to disease progression in RRMS, yet its association with conversion to SPMS remains underexplored. This study aimed to assess this relationship using the newly developed DAAE score to calculate the risk of conversion to SPMS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The risk of conversion over five years was assessed using the DAAE score (0\u201312), and the PwMS were categorized into very-low-to-low and medium-to-high risk groups. Cognitive function was assessed using the Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Paced Auditory Serial Addition Test (PASAT), and California Verbal Learning Test-Second Edition (CVLT-II). Pairwise correlations and hierarchical linear and logistic regression analyses were performed to examine the relationship between cognition and conversion risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 217 PwMS were included (very low to low\u2009=\u2009185, medium to high\u2009=\u200932). The DAAE score was moderately correlated with SDMT and BVMT-R and weakly correlated with PASAT and CVLT-II. Multivariable linear regressions found SDMT (beta\u2009=\u2009\u22120.125, 95%CI: \u22120.155, \u22120.096, p-value\u2009&lt;\u20090.001), BVMT-R (beta\u2009=\u2009\u22120.157, 95%CI: \u22120.200, \u22120.114, p-value\u2009&lt;\u20090.001), PASAT (beta\u2009=\u2009\u22120.084, 95%CI: \u22120.111, \u22120.057, p-value\u2009&lt;\u20090.001), and CVLT-II (beta\u2009=\u2009\u22120.088, 95%CI: \u22120.125, \u22120.050, p-value\u2009&lt;\u20090.001) were independently associated with the risk of conversion. Among these, SDMT (beta\u2009=\u2009\u22120.093, 95% CI: \u22120.133 to \u22120.054, p-value\u2009&lt;\u20090.001) was the most robust predictor of conversion risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In conclusion, low cognitive performance across the BICAMS battery and the PASAT, with the SDMT as the most robust predictor, is associated with an increased risk of conversion from RRMS to SPMS. By demonstrating this association through a machine-learning framework, the present study supports the integration of standardized neuropsychological assessments into routine clinical practice as tools for monitoring conversion risk in PwMS, beyond conventional clinical measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344558","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:27:05Z","timestamp":1774027625000},"page":"e0344558","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cognitive function is associated with risk of conversion to secondary progressive multiple sclerosis: A cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"given":"Omid","family":"Mirmosayyeb","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ida","family":"Mohammadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6511-4103","authenticated-orcid":true,"given":"Shahryar","family":"Rajai Firouzabadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saeed","family":"Vaheb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Yazdan Panah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0219-3518","authenticated-orcid":true,"given":"Tom A.","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca","family":"Weinstock-Guttman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6960-1265","authenticated-orcid":true,"given":"Vahid","family":"Shaygannejad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"pone.0344558.ref001","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jaut.2014.01.022","article-title":"The diagnosis of multiple sclerosis and the various related demyelinating syndromes: A critical review","author":"D Karussis","year":"2014","journal-title":"J Autoimmun"},{"issue":"4","key":"pone.0344558.ref002","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1212\/WNL.46.4.907","article-title":"Defining the 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P\u00e9rez-Cerd\u00e1","year":"2016","journal-title":"Mult Scler Demyelinating Disord"},{"key":"pone.0344558.ref027","first-page":"263","article-title":"Inflammatory demyelinating diseases of the central nervous system","volume":"145","author":"R H\u00f6ftberger","year":"2017","journal-title":"Handb Clin Neurol"},{"key":"pone.0344558.ref028","doi-asserted-by":"crossref","first-page":"1210091","DOI":"10.3389\/fnmol.2023.1210091","article-title":"Neurodegeneration and its potential markers in the diagnosing of secondary progressive multiple sclerosis. 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Eijlers","year":"2019","journal-title":"Neurology"},{"key":"pone.0344558.ref032","doi-asserted-by":"crossref","first-page":"105755","DOI":"10.1016\/j.msard.2024.105755","article-title":"Clinical risk stratification: Development and validation of the DAAE score, a tool for estimating patient risk of transition to secondary progressive multiple sclerosis","volume":"89","author":"TA Fuchs","year":"2024","journal-title":"Mult Scler Relat Disord"},{"issue":"2","key":"pone.0344558.ref033","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"AJ Thompson","year":"2018","journal-title":"Lancet Neurol"},{"issue":"11","key":"pone.0344558.ref034","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1212\/WNL.33.11.1444","article-title":"Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS)","volume":"33","author":"JF Kurtzke","year":"1983","journal-title":"Neurology"},{"key":"pone.0344558.ref035","article-title":"Symbol digit modalities test","author":"A Smith","year":"1973","journal-title":"The clinical neuropsychologist"},{"issue":"4","key":"pone.0344558.ref036","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1177\/1352458513501570","article-title":"Comparing long-term results of PASAT and SDMT scores in relation to neuropsychological testing in multiple sclerosis","volume":"20","author":"JM Sonder","year":"2014","journal-title":"Mult Scler"},{"issue":"6","key":"pone.0344558.ref037","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1080\/13854046.2012.694912","article-title":"Validity and reliability of a Persian translation of the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS)","volume":"26","author":"A Eshaghi","year":"2012","journal-title":"Clin Neuropsychol"},{"key":"pone.0344558.ref038","volume-title":"California Verbal Learning Test","author":"D Delis","year":"2000"},{"issue":"2","key":"pone.0344558.ref039","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2466\/pms.1977.44.2.367","article-title":"Paced auditory serial-addition task: A measure of recovery from concussion","volume":"44","author":"DM Gronwall","year":"1977","journal-title":"Percept Mot Skills"},{"key":"pone.0344558.ref040","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1212\/WNL.39.2.161","article-title":"Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis","volume":"39","author":"SM Rao","year":"1989","journal-title":"Neurology"},{"issue":"4","key":"pone.0344558.ref041","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1177\/135245859900500409","article-title":"The Multiple Sclerosis Functional Composite Measure (MSFC): An Integrated Approach to MS Clinical Outcome Assessment","volume":"5","author":"JS Fischer","year":"1999","journal-title":"Mult 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Stata Statistical Software: Release 18","year":"2023"},{"issue":"2","key":"pone.0344558.ref047","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1093\/ajhp\/zxz280","article-title":"Significant correlation versus strength of correlation","volume":"77","author":"QL Her","year":"2020","journal-title":"Am J Health Syst Pharm"},{"issue":"1","key":"pone.0344558.ref048","doi-asserted-by":"crossref","first-page":"13953","DOI":"10.1038\/s41598-024-64278-z","article-title":"Prediction of post-delivery hemoglobin levels with machine learning algorithms","volume":"14","author":"S Aghajanian","year":"2024","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0344558.ref049","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1186\/s13195-025-01827-2","article-title":"Longitudinal structural MRI-based deep learning and radiomics features for predicting Alzheimer\u2019s disease progression","volume":"17","author":"S Aghajanian","year":"2025","journal-title":"Alzheimers Res Ther"},{"issue":"1","key":"pone.0344558.ref050","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1002\/ijgo.14305","article-title":"Diagnostic value of ophthalmic artery Doppler indices for prediction of preeclampsia at 28-32\u2009weeks of gestation","volume":"160","author":"M Saleh","year":"2023","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0344558.ref051","first-page":"2825","article-title":"Scikit-learn: Machine learning in Python","volume":"12","author":"F Pedregosa","year":"2011","journal-title":"The Journal of Machine Learning Research"},{"issue":"5","key":"pone.0344558.ref052","article-title":"Persistent progression independent of relapse activity in multiple sclerosis","volume":"7","author":"C Zhu","year":"2025","journal-title":"Brain Commun"},{"issue":"4","key":"pone.0344558.ref053","doi-asserted-by":"crossref","first-page":"184","DOI":"10.7224\/1537-2073.2020-114","article-title":"Predicting long-term disability in multiple sclerosis: A narrative review of current evidence and future directions","volume":"24","author":"B Weinstock-Guttman","year":"2022","journal-title":"Int J MS Care"},{"issue":"4","key":"pone.0344558.ref054","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1007\/s00415-023-12021-5","article-title":"Identification and management of subclinical disease activity in early multiple sclerosis: A review","volume":"271","author":"D Ontaneda","year":"2024","journal-title":"J Neurol"},{"issue":"7","key":"pone.0344558.ref055","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1177\/1352458520973618","article-title":"Quantifying cognition and fatigue to enhance the sensitivity of the EDSS during relapses","volume":"27","author":"SA Morrow","year":"2021","journal-title":"Mult Scler"},{"key":"pone.0344558.ref056","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2021.666868","article-title":"Berger, clinical and paraclinical biomarkers and the hitches to assess conversion to secondary progressive multiple sclerosis: A systematic review","volume":"12","author":"N G. Krajnc","year":"2021","journal-title":"Frontiers Neurology"},{"key":"pone.0344558.ref057","doi-asserted-by":"crossref","first-page":"102950","DOI":"10.1016\/j.msard.2021.102950","article-title":"The Symbol Digit Modalities Test (SDMT) is sensitive but non-specific in MS: Lexical access speed, memory, and information processing speed independently contribute to SDMT performance","volume":"51","author":"J Sandry","year":"2021","journal-title":"Mult Scler Relat Disord"},{"key":"pone.0344558.ref058","doi-asserted-by":"crossref","first-page":"1188124","DOI":"10.3389\/fneur.2023.1188124","article-title":"Processing speed and memory test performance are associated with different brain region volumes in Veterans and others with progressive multiple sclerosis","volume":"14","author":"RI Spain","year":"2023","journal-title":"Front Neurol"},{"issue":"4","key":"pone.0344558.ref059","doi-asserted-by":"crossref","DOI":"10.1002\/brb3.2050","article-title":"Patterns of cortical grey matter thickness reduction in multiple sclerosis","volume":"11","author":"J Fujimori","year":"2021","journal-title":"Brain Behav"},{"issue":"2","key":"pone.0344558.ref060","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1002\/ana.25145","article-title":"Deep gray matter volume loss drives disability worsening in multiple sclerosis","volume":"83","author":"A Eshaghi","year":"2018","journal-title":"Ann Neurol"},{"key":"pone.0344558.ref061","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.90.15_supplement.P2.393","article-title":"Predictors of conversion to secondary progressive multiple sclerosis in patients with relapsing\u2013remitting multiple sclerosis (P2.393)","volume":"90","author":"D Tomic","year":"2018","journal-title":"Neurology"},{"issue":"1","key":"pone.0344558.ref062","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1186\/s40001-025-02533-3","article-title":"Timed 25-foot walk test is independently associated with cognitive function in multiple sclerosis: a cross-sectional 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