Cognitive Assessment of Individuals with Multiple Sclerosis in the Arab World: a Systematic Review

The prevalence of multiple sclerosis (MS) is on the rise globally, and recent epidemiological studies have observed increased rates in the Arab world (i.e., countries of North Africa and the Middle East where Arabic is the primary language). However, assessment of cognitive impairment and its relevant covariates (e.g., fatigue and depressive symptomatology) in the Arab world has not been rigorously reviewed. Thus, the objective of the present study was to systematically review the current use of cognitive assessment measures in observational and interventional studies of individuals with MS in the Arab world. A systematic review of studies that assessed cognitive function in adults with MS in the Arab world was conducted using PubMed, PsycINFO, CINAHL, The Cochrane Library, Embase, WHO Global Index Medicus, and Ovid Global Health. Studies that featured at least one objective cognitive measure were included. Eligible studies were reviewed for bias and study quality using the QUADAS-2 and NIH QAT. Study characteristics and finding were extracted by two independent reviewers, with results confirmed by a third reviewer. A total of 13 (N = 846) studies met inclusion criteria. Risk of bias and included measures varied across studies. Results demonstrated inconsistent availability and use of MS cognitive assessment tools across the Arab world. An Arabic version of the BICAMS was the only cognitive battery that was evaluated with regard to psychometric properties. The most common individual test include in reviewed studies was the SDMT. However, validation studies are still needed for this and a number of other measures. Other measures are still in the early stages of translation and cultural-linguistic norming. This review of cognitive assessment of individuals with MS in the Arab world was limited by variable study quality and measure selection. The present review provides a summary of the tests most commonly used in this region and recommendations for future investigation.