Depression · Journal article

Oxidative stress, depressive symptoms, disability, cognitive outcomes and hand dexterity in relapsing-remitting multiple sclerosis patients with mild/moderate disability.

Ibro Neuroscience Reports · July 31, 2026

Preliminary Why this matters to you Expert discussion

Early or partial results. Treat as a signal, not a conclusion.

AI Summary

This cross-sectional study of 83 RRMS patients with mild/moderate disability found that neurological disability (EDSS) and education level were the strongest predictors of cognitive outcomes, while most peripheral oxidative stress markers showed no significant correlation with clinical measures. The design cannot establish causality and the null findings for oxidative stress limit the utility of these biomarkers in this population.

What was studied

Cross-sectional observational study. RRMS patients with EDSS ≤ 3 (mild/moderate disability); mean age 32.65 ± 8.05 years; 77.1% female.. n = 83.

Key findings

EDSS negatively associated with SDMT cognitive score (OR=0.95; p=0.02) and PASAT score (OR=0.92; p=0.01) in binary logistic regression In multivariable linear regression, EDSS correlated with SDMT (β=-0.23, p=0.047) and PASAT (β=-0.36, p=0.002) Education level correlated with SDMT (β=0.29, p<0.001) and PASAT (β=0.27, p=0.01)

Safety

Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.

Who this may help

In RRMS patients with mild/moderate disability, clinicians should recognise that neurological disability level and education are established predictors of cognitive outcomes. Peripheral oxidative stress markers showed limited clinical utility in predicting cognitive or motor outcomes in this population, though the single-centre cross-sectional design limits generalisability.

Plain-language summary

Cross-sectional study in a single cohort with modest sample size examining associations between oxidative stress markers and clinical outcomes in RRMS; descriptive findings lack a comparator group and most oxidative stress correlations were not significant.

Study design

As stated by the source record.

MethodsRRMS patients with EDSS ≤ 3 underwent single-occasion assessment of cognitive function (SDMT, PASAT-3), depressive symptoms (BDI-II), hand dexterity (9HPT), neurological disability (EDSS), and peripheral oxidative stress markers (MDA, TAC, SOD, CAT, GPx, GSH). Associations were examined using binary logistic regression and multivariable linear regression.

DesignCross-sectional observational study

PopulationRRMS patients with EDSS ≤ 3 (mild/moderate disability); mean age 32.65 ± 8.05 years; 77.1% female.

Sample size83

Reported figures

Quoted from the source exactly as published.

Sample size83

Female proportion77.1%

Mean age (years)32.65 ± 8.05

EDSS–SDMT association (binary logistic)OR=0.95; p=0.02

EDSS–PASAT association (binary logistic)OR=0.92; p=0.01

EDSS–SDMT association (multivariable linear)β=-0.23; p=0.047

EDSS–PASAT association (multivariable linear)β=-0.36; p=0.002

Education–SDMT associationβ=0.29; p<0.001

Clinical bottom line

Caveats

Cross-sectional design precludes causal inference; no control or comparator group provided.
Majority of oxidative stress marker correlations were not statistically significant; MDA association with cognition lost significance in multivariable analysis.
Single centre study; generalisability to other RRMS populations unknown.
No information on sample size justification, power calculation, or precision of effect estimates beyond p-values and confidence intervals for MDA.

Evidence assessment

Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.

Study design

limited

Cross-sectional design without control group; causality cannot be inferred.

Directness

moderate

Directly measures clinical and laboratory outcomes in RRMS patients; oxidative stress markers are indirect biomarkers.

Consistency

insufficient

Single study; no comparative data provided on consistency with prior work.

Risk of bias

limited

No blinding or randomisation reported; potential selection and measurement bias in cross-sectional design.

Sample adequacy

limited

83 patients; modest sample for multivariable analysis with multiple outcomes examined.

Source abstract

Background. This study aimed to comprehensively examine the interplay between demographic factors, peripheral oxidative stress markers, disability, depressive symptoms, cognitive outcomes, and hand dexterity in Relapsing-remitting Multiple sclerosis (RRMS) patients with mild/moderate disability.Methods. In this cross-sectional study, RRMS patients with Expanded Disability Status Scale (EDSS)≤ 3 underwent assessments of cognitive function (Symbol Digit Modalities Test [SDMT], Paced Auditory Serial Addition Test [PASAT-3]), depressive symptoms (Beck Depression Inventory-II [BDI-II]), hand dexterity (Nine-Hole Peg Test [9HPT]), and neurological disability (EDSS). Oxidative stress markers (malondialdehyde [MDA], total antioxidant capacity [TAC], superoxide dismutase [SOD], catalase activity [CAT], glutathione peroxidase [GPx], and reduced glutathione [GSH]) were also measured.Results. The studied cohort comprised 83 patients (77.1% females; mean age: 32.65 ± 8.05 years). In addition to negative association between the EDSS and cognitive outcomes in binary logistic regression analysis (SDMT: OR=0.95; p = 0.02; PASAT: OR=0.92; p = 0.01); neurological disability also correlated with cognitive scores in multivariable linear regression (SDMT: β=-0.23, p = 0.047; PASAT: β=-0.36, p = 0.002). Education also correlated with the cognitive outcomes (SDMT: β=0.29, p < 0.001; PASAT: β=0.27, p = 0.01). MDA was associated with abnormal cognitive function (SDMT≤44; OR: 2.98 (95%CI: 1.33, 6.66) but correlation between these outcomes was no longer significant in multivariable linear regression (β=-0.21; p = 0.051). Except for a marginal correlation between EDSS and MDA (β=0.21, p = 0.04) and between 9HPT-M and TAC (β=0.26, p = 0.01), there was no significant finding regarding the correlations between the clinical and laboratory outcomes.Conclusion. Even in patients with mild/moderate disability, EDSS and education level were emerged as the strongest predictors of cognitive outcomes in RRMS.

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Mahnaz TalebiAmirreza NaseriNiloofar TaheriDepressionReza Mosaddeghi-Heris