Abstract
PurposeAs conventional quantitative magnetic resonance imaging (MRI) parameters are weakly associated with cognitive impairment (CI) in early multiple sclerosis (MS), we explored microstructural white matter alterations in early MS or clinically isolated syndrome (CIS) comparing patients with or without CI.MethodsBased on a preceding tract-based spatial statistics analysis (3 Tesla MRI) which contrasted 106 patients with early MS or CIS and 49 healthy controls, diffusion metrics (fractional anisotropy, FA, mean diffusivity, MD) were extracted from significant clusters using an atlas-based approach. The FA and MD were compared between patients with (Ci_P n = 14) and without (Cp_P n = 81) cognitive impairment in a subset of patients who underwent CI screening.ResultsThe FA was reduced in Ci_P compared to Cp_P in the splenium of corpus callosum (p = 0.001), right parahippocampal cingulum (p = 0.002) and fornix cres./stria terminalis (0.042), left posterior corona radiata (p = 0.012), bilateral cerebral peduncles, medial lemniscus and in cerebellar tracts. Increased MD was detected in the splenium of corpus callosum (p = 0.01). The CI-related localizations overlapped only partially with MS lesions.ConclusionMicrostructural white matter alterations at disease onset were detectable in Ci_P compared to Cp_P in known cognitively relevant fiber tracts, indicating the relevance of early treatment initiation in MS and CIS.
Highlights
Cognitive impairment (CI) is a frequent symptom with prevalence of 40–65% in multiple sclerosis (MS)
It has been attributed to damage of brain white matter (WM) as well as to brain grey matter (GM), both of which can be caused by demyelination, inflammation and axonal loss [1]
We studied differences between patients who were assigned to cognitively impaired (Ci_P) or cognitively preserved patients (Cp_P) after first diagnosis of MS or clinically isolated syndrome (CIS) to identify relevant clusters in WM which might be related to CI
Summary
Cognitive impairment (CI) is a frequent symptom with prevalence of 40–65% in multiple sclerosis (MS). CI has already been reported in early disease stages of MS and clinically isolated syndrome (CIS) with a prevalence ranging from 13% to 20% [2,3,4]. Due to the fact that CI is highly relevant for occupational disability and restrictions in daily life, the early onset of CI is indicative of future quality of life for MS patients [5]. Efforts have been made to identify risk factors to determine and predict CI based on clinical markers (Expanded disability status sclae (EDSS), disease duration) and conventional magnetic resonance imaging (MRI) parameters (brain lesion load and location in T1 and T2-weighted MRI, brain atrophy) [6, 7]; associations between conventional MRI parameters, such as brain atrophy or lesion load, and CI were weak, especially in young MS patients with short disease dura-. The lack of association between conventional MRI characteristics and baseline CI was recently confirmed in a large multicenter cohort study on patients first diagnosed with MS or CIS [9]
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