Vascular risk factors’ impact on motor performance and sensorimotor network structural integrity in multiple sclerosis

Background: Vascular risk factors (VRFs) are associated with diffuse brain damage in multiple sclerosis (MS). We investigated VRFs’ impact on motor performance and sensorimotor network (SMN) structural integrity in MS patients. Methods: In this retrospective cross-sectional study, 268 MS patients and 180 healthy controls were classified according to VRF presence (VRF[+]) or absence (VRF[−]). Clinical measures included Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk test, and 9-Hole Peg Test. SMN integrity was assessed using white matter lesion volumes, cortical thickness of primary motor and somatosensory cortices, normalized deep gray matter volume (NDGMV), anterior (ACMA) and posterior cerebellar motor area volumes, mean upper cervical cord area, and diffusion metrics of the middle and superior cerebellar peduncles, medial lemniscus (ML), and corticospinal tracts. Group differences and MS–VRF interactions were examined. In MS, associations between clinical and magnetic resonance imaging (MRI) measures were explored, focusing on VRF influence. Results: MS-VRF[+] patients showed higher EDSS scores and worse motor performance than MS-VRF[−] (false discovery rate p value [pFDR] ⩽ 0.004). Significant MS–VRF interactions were observed for motor performance, ML mean diffusivity, NDGMV, and ACMA volumes (pFDR ⩽ 0.039). In MS, EDSS was associated with the VRF × ML fractional anisotropy interaction term (β = 1.931, p = 0.042). Conclusions: VRFs may contribute to increased disability, motor impairment, and region-specific SMN structural damage in MS patients.