Abstract
BackgroundMagnetic Resonance Imaging (MRI) techniques provided evidences into the understanding of cognitive impairment (CIm) in Multiple Sclerosis (MS).ObjectivesTo investigate the role of white matter (WM) and gray matter (GM) in predicting long-term CIm in a cohort of MS patients.Methods303 out of 597 patients participating in a previous multicenter clinical-MRI study were enrolled (49.4% were lost at follow-up). The following MRI parameters, expressed as fraction (f) of intracranial volume, were evaluated: cerebrospinal fluid (CSF-f), WM-f, GM-f and abnormal WM (AWM-f), a measure of lesion load. Nine years later, cognitive status was assessed in 241 patients using the Symbol Digit Modalities Test (SDMT), the Semantically Related Word List Test (SRWL), the Modified Card Sorting Test (MCST), and the Paced Auditory Serial Addition Test (PASAT). In particular, being SRWL a memory test, both immediate recall and delayed recall were evaluated. MCST scoring was calculated based on the number of categories, number of perseverative and non-perseverative errors.ResultsAWM-f was predictive of an impaired performance 9 years ahead in SDMT (OR 1.49, CI 1.12–1.97 p = 0.006), PASAT (OR 1.43, CI 1.14–1.80 p = 0.002), SRWL-immediate recall (OR 1.72 CI 1.35–2.20 p<0.001), SRWL-delayed recall (OR 1.61 CI 1.28–2.03 p<0.001), MCST-category (OR 1.52, CI 1.2–1.9 p<0.001), MCST-perseverative error(OR 1.51 CI 1.2–1.9 p = 0.001), MCST-non perseverative error (OR 1.26 CI 1.02–1.55 p = 0.032).ConclusionIn our large MS cohort, focal WM damage appeared to be the most relevant predictor of the long-term cognitive outcome.
Highlights
Cognitive Impairment (CIm) has been recognized as an important feature of Multiple Sclerosis (MS), affecting up to 65% patients
AWM-f was predictive of an impaired performance 9 years ahead in Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), Semantically Related Word List Test (SRWL)-immediate recall, SRWL-delayed recall, Modified Card Sorting Test (MCST)-category, MCST-perseverative error(OR 1.51 Cognitive Index (CI) 1.2–1.9 p = 0.001), MCST-non perseverative error
We recently showed that baseline (BL) gray matter (GM) atrophy and EDSS were the best long-term (9 years follow-up) predictors of clinical disease progression in relapsing remitting (RR) MS patients[11].Considering these findings, the aim of the present study was to investigate the role of white matter (WM) and GM damage in predicting long term (9 years follow-up) CIm in a large multicenter cohort of MS patients
Summary
Cognitive Impairment (CIm) has been recognized as an important feature of Multiple Sclerosis (MS), affecting up to 65% patients. Other studies showed a clear discrepancy between LL and severity of CIm in MS [6].WM abnormalities were weakly correlated with CIm, suggesting that WM abnormalities alone cannot fully explain the extent of clinical symptoms and CIm in MS [7, 8].In the present study, WM, and GM atrophy and WM LL were obtained through a fully automated, operator-independent, multiparametric segmentation method from a large MS population [9, 10] By using this approach, we recently showed that baseline (BL) GM atrophy and EDSS were the best long-term (9 years follow-up) predictors of clinical disease progression in relapsing remitting (RR) MS patients[11].Considering these findings, the aim of the present study was to investigate the role of WM and GM damage in predicting long term (9 years follow-up) CIm in a large multicenter cohort of MS patients. Magnetic Resonance Imaging (MRI) techniques provided evidences into the understanding of cognitive impairment (CIm) in Multiple Sclerosis (MS)
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