Neurocognitive Performance in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Systematic Review and Meta-Analysis

Abstract Introduction Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a demyelinating disorder of the central nervous system. Although motor and visual outcomes are established, cognitive effects remain unclear. This systematic review and meta-analysis assessed standardized neuropsychological tests to define the cognitive profile of MOGAD. Methods A comprehensive search of PubMed, Embase, and Web of Science up to August 15, 2025, identified 11 observational studies including 507 patients (68 pediatric, 439 adults). Extracted data included patient characteristics, treatments, and outcomes from validated cognitive instruments such as the Montreal Cognitive Assessment (MoCA), Paced Auditory Serial Addition Test (PASAT-2 and PASAT-3), Symbol Digit Modalities Test (SDMT), and the Wechsler Intelligence Scale for Children – Fifth Edition (WISC-V). Results Adults with MOGAD showed mild global cognitive impairment, with pooled MoCA scores of 24.69 (95% CI: 23.31–26.07). Processing speed and working memory were consistently affected, with pooled PASAT-3 means of 39.14 (95% CI: 35.68–42.61), PASAT-2 of 30.91 (95% CI: 28.08–33.75), and SDMT of 44.47 (95% CI: 41.73–47.20). In pediatric cohorts, WISC-V scores suggested relative preservation of most domains (VCI: 95.57, VSI: 98.31, FRI: 106.14, WMI: 97.44, PSI: 96.66, FSIQ: 98.93). Conclusion This meta-analysis shows that cognitive impairment is a heterogeneous but relevant feature of MOGAD, most evident in processing speed and working memory. Standardized cognitive testing should be integrated into care, and longitudinal studies are needed to clarify long-term outcomes.