Objective:

To identify the determinants of cognitive impairment in an Algerian Multiple Sclerosis (MS)  cohort, including educational attainment, psychosocial factors, and disease burden, and to  assess the moderating role of education on the other determinants.

Background:

Cognitive Impairment is a prevalent and debilitating symptom of MS, significantly impacting patients' quality of life. While extensively studied in  Western populations, data from North Africa, and Algeria specifically, are scarce.

Design/Methods:

In this cross-sectional study, 246 Algerian MS patients underwent comprehensive assessment  including the Symbol Digit Modalities Test (SDMT), Nine-Hole Peg Test (9-HPT), EDSS, and measures of depression/anxiety (HADS) and fatigue  (FSMCF). We employed bivariate analyses (Spearman's correlations, ANOVA, t-tests)  followed by multivariate linear regression to identify independent predictors of cognitive  performance, controlling for collinearity. The final model included all variables significant at  p<0.10 in bivariate analysis.

Results:

We analyzed 246 well-characterized Algerian MS patients (74.8% female, mean age 38.2  ±10.6 years) representing a real-world population with diverse socioeconomic profiles (30.5%  university-educated, 54.5% unemployed). Clinical assessment revealed a mean EDSS of  3.25±1.96 and a mean SDMT score of 37.46±14.54. Our highly significant multivariate  regression model (p < 0.001) explained 58.8% of the variance in cognitive performance. It  identified higher educational attainment as the strongest independent predictor (β = 0.45, p  < 0.001), followed by better fine motor function (9-HPT; β = -0.29, p < 0.001), active  employment status (β = 0.23, p < 0.001), and younger age (β = -0.18, p < 0.001). Notably,  neither neurological disability (EDSS) nor clinical phenotype retained independent  significance in the adjusted model.

Conclusions:

In our Algerian cohort, cognitive performance is independently determined by a triad of  factors: cognitive reserve (education), functional integrity (fine motor skill), and socioprofessional engagement (employment). Our findings mandate  routine cognitive screening for all patients and call for rehabilitation strategies that  specifically target cognitive reserve and real-world functional capacity.