AQP4 and Cognitive impairment: None of the MSQOL-54 subscale scores were significantly affected by AQP4-IgG seropositivity, and there was no significant relationship between the physical or mental health composite score of the MSQOL-54 and CI.<h4>Conclusion</h4>Our findings suggest that cognitive impairment is a relevant yet underrecognized feature of NMOSD, particularly among AQP4-IgG seropositive patients.