Abstract
Background: Brain atrophy, which is associated with cognitive impairment and retinal nerve fiber layer (RNFL) atrophy, is the main biomarker of neurodegeneration in multiple sclerosis (MS). However, data on the relationship between inflammatory markers, such as oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF), and cognition, RNFL atrophy, and brain atrophy are scarce. The aim of this study was to assess the influence of RNFL thickness, brain atrophy markers, intrathecal OCBs, and the immunoglobulin G (IgG) index on cognitive decline over a 5-year period in patients with MS.Methods: This prospective, single-center, observational cohort study included 49 patients with relapsing MS followed up over 5 years. At baseline, the patients underwent brain magnetic resonance imaging (MRI). Cognitive evaluation was performed using the Brief International Cognitive Assessment for MS (BICAMS), and RNFL thickness was assessed using optical coherence tomography (OCT). OCBs and IgG levels in the CSF were evaluated at baseline. The BICAMS, OCT, and MRI findings were re-evaluated after 5 years.Results: A significant reduction in information processing speed, visual learning, temporal RNFL thickness, the Huckman index, and third ventricle mean diameter was found in all 49 patients with relapsing MS over the observation period (p < 0.05). Of the patients, 63.3% had positive OCBs and 59.2% had elevated IgG indices. The atrophy of the temporal segment and papillomacular bundle and the presence of OCBs were significantly related to a decline in information processing speed in these patients (p < 0.05). However, brain atrophy markers were not found to be significant on the general linear models.Conclusions: RNFL atrophy and the presence of OCBs were related to cognitive decline in patients with MS over a 5-year follow-up period, thereby suggesting their utility as potential biomarkers of cognitive decline in MS.
Highlights
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system (CNS) [1] that leads to demyelination and diffuse neurodegeneration in both the brain and spinal cord gray matter and white matter [1, 2]
Positive oligoclonal band (OCB) and elevated immunoglobulin G (IgG) indices did not differ according to sex (χ 2 = 0.079, p > 0.05 and χ 2 = 0.843, p > 0.05, respectively), age (p > 0.05), and disease duration (p > 0.05)
The severity of disability was assessed using the Expanded Disability Status Scale (EDSS) at baseline, and the changes in EDSS scores between the baseline and follow-up assessments did not differ between patients with positive and negative OCBs (p > 0.05), as well as between patients with elevated and lower than normal IgG indices (p > 0.05)
Summary
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system (CNS) [1] that leads to demyelination and diffuse neurodegeneration in both the brain and spinal cord gray matter and white matter [1, 2]. Studies have shown the involvement of both inflammatory and neurodegenerative processes from the early stages of the disease [2, 4, 5]. It remains unknown whether early degeneration is an independent process in MS or whether it is secondary to inflammation [2, 5]. The aim of this study was to assess the influence of RNFL thickness, brain atrophy markers, intrathecal OCBs, and the immunoglobulin G (IgG) index on cognitive decline over a 5-year period in patients with MS
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