# Executive Dysfunction and Disability in SPMS: Predictive Value of the Frontal Assessment Battery in the UCLH MS‐STAT2 Cohort

## TL;DR

This study shows that lower scores on a quick test of executive function predict disability progression in people with secondary progressive multiple sclerosis.

## Contribution

Demonstrates the FAB test's predictive value for disability progression in SPMS patients using a large clinical cohort.

## Key findings

- 29.9% of SPMS patients scored below the clinical threshold on the FAB test.
- Lower FAB scores correlated with higher disability measures and worse cognitive performance.
- FAB scores predicted future disability progression comparable to other validated cognitive tests.

## Abstract

Cognitive impairment is common in secondary progressive multiple sclerosis (SPMS), with executive dysfunction disproportionately so. The frontal assessment battery (FAB) is a bedside test assessing executive function. This study explores the distribution of FAB scores in a large SPMS cohort and their associations with disability.

Data were analysed from 294 participants in a cognitive substudy of the MS‐STAT2 trial (NCT03387670). Associations between baseline FAB scores, ambulation status (Expanded Disability Status Scale [EDSS] < 6.0 vs. ≥ 6.0) and other disability measures were assessed using generalised linear models, adjusting for age, education, gender and disease duration. FAB performance was also compared against other cognitive tests (SDMT, CVLT‐II, BVMT‐R).

23.8% of participants scored the FAB maximum of 18; 29.9% scored below the clinical threshold of 16. FAB scores showed moderate correlations with SDMT (ρ = 0.46), CVLT‐II (ρ = 0.36) and BVMT‐R (ρ = 0.43), and participants scoring < 16 were significantly more likely to be impaired across these cognitive domains (p < 0.001). Lower baseline FAB scores were significantly associated with higher EDSS, slower T25FW and reduced manual dexterity (9HPT) (all p < 0.005) at baseline and longitudinally, with performance comparable to other validated cognitive tests.

We present a large cohort of FAB scores in the SPMS population. Lower FAB scores are associated with both concurrent and future disability and may offer a scalable tool for identifying individuals at greater risk of progression and a robust trial outcome measure.