Cognition

Detecting progression in Multiple Sclerosis: practical approaches and emerging tools

Explore how clinicians can detect progression earlier and how clinical assessment, imaging, OCT, biomarkers and digital tools may contribute to a more complete evaluation.

Progression in Multiple Sclerosis (MS) can begin early and may continue even in the absence of relapses or new MRI lesions. Detecting these changes sooner is becoming increasingly relevant as new therapeutic options for progression emerge.

In this keynote, Celia Oreja-Guevara explores how progression can be identified in clinical practice through a combination of patient-reported changes, functional assessment, cognition, MRI, optical coherence tomography (OCT), fluid biomarkers and digital tools.

Key Insights from the Lecture:

Progression can occur from the early stages of Multiple Sclerosis, including independently of relapses.
Relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA) both contribute to disability accumulation.
Progression should not be associated only with advanced disability.
Patients with lower Expanded Disability Status Scale (EDSS) scores may already experience meaningful decline.
Asking patients about changes in walking, cognition, work performance, sport and daily activities can reveal progression that standard scales may not capture.
EDSS remains widely used but may be insufficient on its own, particularly for subtle changes in function.
Functional measures such as the Nine-Hole Peg Test, walking tests and cognitive assessment can provide additional information.
Paramagnetic rim lesions (PRLs) and slowly expanding lesions may help identify progression, although broader clinical use depends on practical and automated imaging tools.
OCT may provide a useful and accessible way to monitor progression over time and may help detect PIRA.
GFAP and neurofilaments are potential fluid biomarkers of progression, but further evidence is needed before they can be relied on for individual clinical decisions.
Patient-reported outcomes may support monitoring, but adherence can become challenging when repeated active input is required.
Passive digital monitoring may offer greater practical potential than tools requiring frequent patient interaction.
A combination of clinical, imaging and fluid biomarkers may ultimately provide a more reliable assessment of progression than any single measure.Age-related changes and menopause can mimic worsening and should be considered when assessing possible MS progression.