Abstract
Background: Cognitive impairment (CI) is a common manifestation of multiple sclerosis (MS), which can severely affect patients’ and their families’ life. Early suspicion and detection of CI can improve general medical management of MS patients. Objectives: To correlate MS related CI to cortical brain lesions using brain magnetic resonance imaging (MRI). Materials and Methods: Cognitive impairment was detected using mini mental state examination (MMSE); Neurological examination and brain MRI were performed for all patients. Correlation was calculated between disease cortical burden detected by MRI and CI. Results: Fifty-three patients with proven MS were scanned by brain MRI; 69.8% of them had cognitive impairment diagnosed with MMSE. The presence and severity of cognitive impairment was correlated to cortical brain lesion. Cognitive impairment was not correlated with non-cortical brain lesions or neurological physical disability measured by Expanded Disability Status Scale (EDSS). Conclusions: Presence of brain frontal cortical lesions detected by MRI in MS patients can predict subsequent development of MS-related CI.
Highlights
Fifty-three patients with proven diagnosis of multiple sclerosis (MS) underwent brain magnetic resonance imaging (MRI) to localize the brain demyelinating lesions, 62.3% of them were females (33 patients) and 37.7% were males (20 patients), their ages ranged from18 to 50 years with mean age of 33.81 ± 7.87 years, the mean duration of the disease was 37.75 ± 23.24 months, twenty-four patients were belonging to the relapsing remitting type of MS, 13 patients were primary progressive, 9 were secondary progressive and only 7 were belonging to the clinically isolated syndrome category of MS (Table 1)
In this study we find a relationship between cortical brain demyelination lesions and cognitive impairment especially in frontal lobe when compared with non-cortical lesions
Analysis of our date revealed that; presence of cortical brain lesions correlated with the occurrence of cognitive impairment and the number of cortical brain lesions directly correlate with the severity of cognitive impairment, these results was in a harmony with the results obtained by Calabrese and his colleague who concluded that the degree of cognitive impairment in patients with MS related to the extent of brain cortical lesions [15] and in agreement with Rinaldi and his colleague who concluded that cortical lesions burden correlates with the severity of MS-related Cognitive impairment (CI) [16], same results was obtained by Nelson and his colleague as they concluded that the size of brain cortical lesions affect the degree of CI [17]
Summary
About 50% of MS patients will experience CI in the course of their disease, which commonly includes long-term memory defect rather than difficulty in making new memories, attention deficits, executive functioning impairment as well as delayed and inefficient information processing [2] These MS-related CIs are less severe than CI observed in Alzheimer’s disease; it can severely affect the patients and their family’s lives [2]. Cognitive impairment was not correlated with non-cortical brain lesions or neurological physical disability measured by Expanded Disability Status Scale (EDSS).
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