Memory Deficits Precede Processing Speed Decline in Modern Multiple Sclerosis Care

Cognitive impairment remains a debilitating manifestation of multiple sclerosis, frequently serving as a primary driver of vocational disability and reduced quality of life. For decades, clinical practice has been guided by the understanding that slowed information processing speed is the hallmark cognitive deficit, often assessed through standardized tools like the Symbol Digit Modalities Test [1, 2]. While molecular biomarkers such as neurofilament light chain have been linked to these processing speed outcomes, the underlying drivers of cognitive decline continue to be a focus of intensive research [3, 4]. Current management increasingly relies on a combination of high-efficacy disease-modifying therapies and non-pharmacological interventions, such as exercise and cognitive rehabilitation, to preserve functional capacity [5, 6]. However, as the diagnostic and therapeutic landscape has transformed over the last twenty years, the relevance of historical cognitive models in today's clinical environment requires urgent re-evaluation. Recent findings offer fresh insights into how these cognitive profiles have changed for patients in the modern era, suggesting that clinicians may need to rethink how they screen for cognitive decline.