Contribution of cortical lesions to cognitive impairment in Japanese patients with multiple sclerosis

Koji Shinoda,Takuya Matsushita,Masaaki Niino,Noriko Isobe,Osamu Togao,Shiori Sakai,Yuri Nakamura,Jun-Ichi Kira,Katsuhisa Masaki,Haruka Nomiyama,Akio Hiwatashi

doi:10.1038/s41598-020-61012-3

Koji Shinoda, Takuya Matsushita + Show 9 more

Open Access

https://doi.org/10.1038/s41598-020-61012-3

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Abstract

Cortical lesions (CLs) have a low prevalence and are associated with physical disabilities in Japanese patients with multiple sclerosis (MS). However, the contribution of CLs to cognitive impairment remains unclear in Asian MS. Sixty-one prospectively enrolled MS patients underwent three-dimensional double inversion recovery MR imaging, the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), the Apathy Scale (AS), the Fatigue Questionnaire (FQ), and the Hospital Anxiety and Depression Scale (HADS) within a 1-week period. The cognitive impairment index (CII) score was calculated to measure patients’ overall cognitive impairment. MS patients with CLs had poorer scores than those without CLs in most BRB-N tests, but scored comparably in the FQ, AS, and HADS. The number of CLs correlated negatively with all BRB-N test scores and positively with total CII scores. Leukocortical lesions were more extensively associated with cognitive dysfunction in various domains than intracortical lesions. Stepwise multiple regression analysis revealed that potential confounding factors for the highest quartile of CII score were the number of CLs (odds ratio 2.38, p = 0.0070) and the Expanded Disability Severity Scale score (odds ratio 2.13, p = 0.0003). Our results demonstrate that the presence and number of CLs are robustly associated with cognitive dysfunction in Asian MS patients.

Highlights

Cortical lesions (CLs) have a low prevalence and are associated with physical disabilities in Japanese patients with multiple sclerosis (MS)
Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT)-2, and PASAT-3 scores were significantly lower in our MS patients compared with controls, indicating impairments of attention, information processing, and working memory
We believe this lack of correlation in part resulted from the age distribution of this cohort, which included patients from 16 to 72 years of age and lacked very elderly participants

Summary

Introduction

Cortical lesions (CLs) have a low prevalence and are associated with physical disabilities in Japanese patients with multiple sclerosis (MS). This finding is consistent with the result from a previous pathological study, which found that HLA–DRB1*15:01 was associated with greater cortical inflammation in autopsied MS materials[25], suggesting an involvement of HLA class II molecules in CL development[26,27] Another small-scale study of Japanese MS patients that assessed cognitive function reported that the attention of 13 CL-positive patients was significantly worse than that of six CL-negative patients; the study did not classify CLs into ICLs and LCLs and did not evaluate the relationship between CL quantity and cognitive function[17]

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