The pooled prevalence of cognitive impairment in adults with myelin oligodendrocyte glycoprotein antibody-associated disease: A Systematic Review & Meta-Analysis.

OBJECTIVE: To determine the pooled prevalence of cognitive impairment (CI) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) relative to relapsing-remitting multiple sclerosis (RRMS) and identify the primary cognitive domains impaired. METHODS: Electronic databases were searched from inception to January 2026 for studies featuring adults with MOGAD evaluated with formal neuropsychological testing. Impairment was organized into six cognitive domains. Prevalence was estimated using logit transformation and compared with RRMS via a two-proportion Z-test. Risk of bias was assessed and certainty of evidence was summarized using GRADE. RESULTS: Among 958 unique records, 6 met inclusion criteria. The pooled prevalence of MOGAD CI was 22% (95% CI 13-35%), with 51% (95% CI 35% - 67%) demonstrating impairment in at least 1 cognitive domain. Verbal memory (19% [CI 10%-34%]) and working memory/processing speed (19% [CI 10%-31%]) were most frequently affected. The prevalence of CI was 10.5% lower than RRMS (32.5% [CI 29-36%], p = 0.11). CONCLUSION: Approximately 22% of adults with MOGAD experience CI, with verbal memory and processing speed among the key cognitive domains involved. Future large-scale prospective studies should determine the prevalence of MOGAD-related CI across the age span and clinical spectrum and compared with other acquired demyelinating syndromes.