Rethinking Cognitive Screening in Multiple Sclerosis: Detection and Attribution for Patient-Centred Care

Cognitive screening in multiple sclerosis (MS) serves two important clinical purposes: identifying individuals who may require more comprehensive evaluation and monitoring cognitive change over time. Cognitive performance is associated with employment, daily functioning, and quality of life, and a definable subgroup of individuals with MS experiences clinically meaningful impairment. However, brief screening scores are increasingly interpreted as indicators of MS disease activity or progression despite limited evidence that routine surveillance improves patient outcomes or reliably distinguishes neurological change from practice effects, motor impairment, fatigue, mood, medication burden, and other influences. Historical prevalence estimates may also overstate individual risk when normal base rates of low scores and variable impairment criteria are not considered. Digital platforms may improve accessibility and measurement frequency but do not resolve these attributional and psychometric limitations. This narrative review examines the validated uses and limitations of cognitive screening in MS and argues for an interpretation that is contextual, psychometrically grounded, and linked to actionable clinical decisions. Cognitive screening should identify concerns requiring further evaluation, not independently determine their cause, permanence, or relationship to disease progression.