Background: Cognitive impairment (CI) is prevalent among people with multiple sclerosis (PwMS), significantly affecting their quality of life and functional capacity. While the relationship between CI and motor function has been explored in healthy aging and other neurological conditions, its association with upper and lower motor function in PwMS remains underexplored.

Methods: This cross-sectional study analyzed data from 125 PwMS (Mage: 37.6 years; median disease duration: 8 years) to examine cognitive outcomes. Cognitive status was evaluated using the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-Second Edition (CVLT-II), and Brief Visuospatial Memory Test-Revised (BVMT-R). Motor function was assessed with the 9-Hole Peg Test (9-HPT) and the Timed 25-Foot Walk Test (T25FW). Hierarchical regression models identified significant predictors of cognitive performance.

Results: Multivariate analyses revealed that T25FW was the strongest predictor of SDMT (β = - 3.10, p < 0.001), CVLT-II (β = - 2.91, p < 0.001), and BVMT-R (β = - 1.98, p < 0.001). Additional predictors included disease duration (SDMT: β = - 0.26, p = 0.033; CVLT-II: β = - 0.28, p = 0.048; BVMT-R: β = - 0.23, p = 0.037) and education (BVMT-R: β = 0.60, p = 0.004). EDSS was a significant predictor for SDMT (β = - 1.42, p = 0.029). The 9-HPT was not independently associated with cognitive status.

Conclusions: T25FW emerged as a robust predictor of processing speed, verbal memory, and visuospatial memory, underscoring its value as a practical assessment tool correlating with cognitive status in PwMS.