Abstract
ABSTRACTCognitive decline is a frequent but undervalued aspect of multiple sclerosis (MS). Currently, it remains unclear what the strongest determinants of cognitive dysfunction are, with grey matter damage most directly related to cognitive impairment. Multi-parametric studies seem to indicate that individual factors of MS-pathology are highly interdependent causes of grey matter atrophy and permanent brain damage. They are associated with intermediate functional effects (e.g. in functional MRI) representing a balance between disconnection and (mal) adaptive connectivity changes. Therefore, a more comprehensive MRI approach is warranted, aiming to link structural changes with functional brain organization. To better understand the disconnection syndromes and cognitive decline in MS, this paper reviews the associations between MRI metrics and cognitive performance, by discussing the interactions between multiple facets of MS pathology as determinants of brain damage and how they affect network efficiency.
Highlights
Multiple sclerosis (MS) is a common inflammatory and demyelinating disease of the central nervous system (CNS)
MS has been traditionally classified as a white matter (WM) disease, involvement of grey matter (GM) by demyelination and neurodegeneration has become evident in all stages of the disease.[4,5,6]
Cognitive decline is an important source of disability in MS patients and an undervalued aspect of disease progression
Summary
Multiple sclerosis (MS) is a common inflammatory and demyelinating disease of the central nervous system (CNS). Recent advances in diffusion tensor imaging (DTI) and tractography are providing insights about WM microstructure, allowing noninvasive mapping of inter-cortical and deep GM anatomic connections.[37,38] Recent assessments of brain networks in MS patients show that changes in cognitive performance are accompanied by variable modifications in functional[39,40] and structural[38,41] connectivity. These emerging imaging processing techniques are promising tools to surmount the limitations of conventional MRI in providing information about the integration of brain regions and systems. We present an overview of new imaging analysis techniques studying structural and functional brain networks towards accessing the interplay between structural damage, functional changes and cognitive outcome
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