Background: Patient-reported outcome measures (PROMs) improve multiple sclerosis (MS) management by reflecting patients' perspectives of their disease. Mayo Clinic Electronic Emoji Based Neurological Impairment Status (MEBNIS) is a short PROM consisting of four equally-weighted domains (MemoryMEBNIS, MoodMEBNIS, Fatigue-SleepinessMEBNIS, and AmbulationMEBNIS) and CompositeMEBNIS, which are based on emojis.

Objective: To investigate the correlations of MEBNIS with patient-reported, examination-based, performance-based, and radiological metrics of disease severity in persons with MS (pwMS).

Methods: PwMS (n = 195) prospectively completed MEBNIS, Expanded Disability Status Scale (EDSS), MS Functional Composite (MSFC) and its subtests [25-Foot Walk Test (25FWT), 9-Hole Peg Test (9HPT), Paced Auditory Serial Addition Test (PASAT)], Beck Depression Inventory (BDI), Fatigue Questionnaire (FQ), and Epworth Sleepiness Scale (ESS) between May 2021 and May 2024. Participants also underwent brain MRIs. Correlations were summarized using Spearman's rank correlation coefficients.

Results: MemoryMEBNIS correlated (p≤0.001) with PASAT (rho = -0.25), ESS (rho = 0.24), FQ (rho = 0.36), and BDI (rho = 0.36). MoodMEBNIS correlated (p<0.001) with FQ (rho = 0.40) and BDI (rho = 0.46). Fatigue-SleepinessMEBNIS correlated (p<0.001) with ESS (rho = 0.49), FQ (rho = 0.59), and BDI (rho = 0.44). AmbulationMEBNIS correlated (p<0.001) with EDSS (rho = 0.69), MSFC z-score (rho = -0.59), 25FWT (rho = 0.66), 9HPT (rho = 0.54), PASAT (rho = -0.32), FQ (rho = 0.41), and BDI (rho = 0.37). CompositeMEBNIS correlated (p<0.001) with EDSS (rho = 0.47), MSFC z-score (rho = -0.42), 25FWT (rho = 0.49), 9HPT (rho = 0.36), PASAT (rho = -0.26), ESS (rho = 0.38), FQ (rho = 0.64), and BDI (rho = 0.58). MemoryMEBNIS, AmbulationMEBNIS and CompositeMEBNIS correlated with cortical gray matter (MemoryMEBNIS rho = -0.17; AmbulationMEBNIS rho = -0.30; CompositeMEBNIS rho = -0.20) and thalamus (MemoryMEBNIS rho = -0.17; AmbulationMEBNIS rho = -0.20; CompositeMEBNIS rho = -0.17) volumes (p<0.05).

Conclusions: As a novel visual PROM, MEBNIS correlates with established patient-reported, examination-based, performance-based, and radiological metrics of MS severity. It offers a fast, intuitive, and accessible multi-domain evaluation of impairment and disease severity in MS, applicable to both clinical practice and clinical trials as a potential digital tool.