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Al Dahhan NZ, Powanwe AS, Ismail M, Cox E, Tseng J, de Medeiros C, Laughlin S, Bouffet E, Lefebvre J, Mabbott DJ. Network connectivity underlying information processing speed in children: Application of a pediatric brain tumor survivor injury model. Neuroimage Clin 2024; 44:103678. [PMID: 39357471 DOI: 10.1016/j.nicl.2024.103678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 09/25/2024] [Accepted: 09/26/2024] [Indexed: 10/04/2024]
Abstract
Elucidating how adaptive and maladaptive changes to the structural connectivity of brain networks influences neural synchrony, and how this structure-function coupling impacts cognition is an important question in human neuroscience. This study assesses these links in the default mode and executive control networks during resting state, a visual-motor task, and through computational modeling in the developing brain and in acquired brain injuries. Pediatric brain tumor survivors were used as an injury model as they are known to exhibit cognitive deficits, structural connectivity compromise, and perturbations in neural communication. Focusing on information processing speed to assess cognitive performance, we demonstrate that during the presence and absence of specific task demands, structural connectivity of these critical brain networks directly influences neural communication and information processing speed, and white matter compromise has an indirect adverse impact on reaction time via perturbed neural synchrony. Further, when our experimentally acquired structural connectomes simulated neural activity, the resulting functional simulations aligned with our empirical results and accurately predicted cognitive group differences. Overall, our synergistic findings further our understanding of the neural underpinnings of cognition and when it is perturbed. Further establishing alterations in structural-functional coupling as biomarkers of cognitive impairments could facilitate early intervention and monitoring of these deficits.
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Affiliation(s)
- Noor Z Al Dahhan
- The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Arthur S Powanwe
- Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Minarose Ismail
- The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada
| | - Elizabeth Cox
- The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada
| | - Julie Tseng
- The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | | | - Suzanne Laughlin
- The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada
| | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada
| | - Jérémie Lefebvre
- Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; Krembil Research Institute, University Health Network, Toronto, ON M5T 0S8, Canada; Department of Mathematics, University of Toronto, Toronto, ON M5S 2E4, Canada
| | - Donald J Mabbott
- The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada.
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Ding S, Shi Z, Huang K, Fan X, Li X, Zheng H, Wang L, Yan Z, Cai J. Aberrant white matter microstructure detected by automatic fiber quantification in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler Relat Disord 2024; 84:105483. [PMID: 38354445 DOI: 10.1016/j.msard.2024.105483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND OBJECTIVES Myelin oligodendrocyte glycoprotein antibody-associated diseases (MOGAD) is an idiopathic inflammatory demyelinating disorder in children, for which the precise damage patterns of the white matter (WM) fibers remain unclear. Herein, we utilized diffusion tensor imaging (DTI)-based automated fiber quantification (AFQ) to identify patterns of fiber damage and to investigate the clinical significance of MOGAD-affected fiber tracts. METHODS A total of 28 children with MOGAD and 31 healthy controls were included in this study. The AFQ approach was employed to track WM fiber with 100 equidistant nodes defined along each tract for statistical analysis of DTI metrics in both the entire and nodal manner. The feature selection method was used to further screen significantly aberrant DTI metrics of the affected fiber tracts or segments for eight common machine learning (ML) to evaluate their potential in identifying MOGAD. These metrics were then correlated with clinical scales to assess their potential as imaging biomarkers. RESULTS In the entire manner, significantly reduced fractional anisotropy (FA) was shown in the left anterior thalamic radiation, arcuate fasciculus, and the posterior and anterior forceps of corpus callosum in MOGAD (all p < 0.05). In the nodal manner, significant DTI metrics alterations were widely observed across 37 segments in 10 fiber tracts (all p < 0.05), mainly characterized by decreased FA and increased radial diffusivity (RD). Among them, 14 DTI metrics in seven fiber tracts were selected as important features to establish ML models, and satisfactory discrimination of MOGAD was obtained in all models (all AUC > 0.85), with the best performance in the logistic regression model (AUC = 0.952). For those features, the FA of left cingulum cingulate and the RD of right inferior frontal-occipital fasciculus were negatively and positively correlated with the expanded disability status scale (r = -0.54, p = 0.014; r = 0.43, p = 0.03), respectively. CONCLUSION Pediatric MOGAD exhibits extensive WM fiber tract aberration detected by AFQ. Certain fiber tracts exhibit specific patterns of DTI metrics that hold promising potential as biomarkers.
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Affiliation(s)
- Shuang Ding
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400014, China
| | - Zhuowei Shi
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Kaiping Huang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400014, China
| | - Xiao Fan
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400014, China
| | - Xiujuan Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400014, China
| | - Helin Zheng
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400014, China
| | - Longlun Wang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400014, China
| | - Zichun Yan
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Jinhua Cai
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400014, China.
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3
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Suárez Bagnasco M, Paz EFV, Jerez J, Gonzalez A. Association between intelligence quotient scores and body mass index in pediatric multiple sclerosis. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:227-234. [PMID: 35705260 DOI: 10.1080/21622965.2022.2082874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this study is to examine the relationship between body mass index (BMI) and intelligence quotient scores (IQ). The sample included 11 patients with pediatric multiple sclerosis between 8 and 17 years, mean age 14.45 years (SD = 2.69). The BMI was calculated as weight in kilograms divided by the square of height in meters. The Wechsler Intelligence Scale for Children V and the Abbreviated Weschler Intelligence Scale were used to measure total IQ. Average sample BMI and IQ were 24.61 (SD = 5.53) (range: 19-39.4) and 86.63 (SD = 14.79) (range: 66-111), respectively. Results of the Pearson correlation indicated that there was a significant negative association between BMI and IQ, (r = -0.608, p = 0.042). R-squared was 0.370. We discuss if lower IQ lead to BMI gains or whether overweight/obesity lead to intellectual functioning changes. Implication for practice and future research are presented.
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Affiliation(s)
- Mariana Suárez Bagnasco
- Department of Child Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Catholic University of Uruguay, Montevideo, Uruguay
| | | | - Javier Jerez
- Department of Child Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alejandra Gonzalez
- Department of Child Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Lysenko ES, Bogdanova MD, Arsalidou M. Quantitative Meta-analyses of Cognitive Abilities in Children With Pediatric-onset Multiple Sclerosis. Neuropsychol Rev 2022; 33:459-473. [PMID: 35802297 DOI: 10.1007/s11065-022-09546-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS), is the manifestation of multiple sclerosis in individuals before 18 years of age. About a third of children with POMS show some form of lower cognitive performance. The purpose of this study is to examine using quantitative meta-analyses the effect size of altered performance between children with and without POMS on overall intelligence quotient (IQ), information processing speed, and language functions. We searched the literature for studies that reported scores on cognitive tests administered to children with and without POMS. Studies were systematically reviewed using PRISMA guidelines. We analyzed data from 14 studies that examined 1283 children with and without POMS when cognitive categories consisted of five or more studies. Effect sizes, publication bias and potential confounds were considered. Significant cognitive differences are revealed for all categories with the strongest effect observed for overall IQ. A moderate effect is observed for information processing speed, and small effects for verbal fluency and verbal memory. Cognitive abilities present differently in children with POMS and a better understanding of this manifestation will inform intervention and remediation tools that can improve clinical and educational practice for the benefit of children with POMS.
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Affiliation(s)
- Elena S Lysenko
- Neurobiological Foundations of Cognitive Development - Neuropsy Lab, HSE University, 101000, Myasnitskaya st.-20, Moscow, Russian Federation
| | - Mariia D Bogdanova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991, Trubetskaya st.-8/2, Moscow, Russian Federation.
- Scientific Research and Practical Center of Pediatric Psychoneurology, Michurinskiy pr.-74, 119602, Moscow, Russian Federation.
| | - Marie Arsalidou
- Neurobiological Foundations of Cognitive Development - Neuropsy Lab, HSE University, 101000, Myasnitskaya st.-20, Moscow, Russian Federation
- York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
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Chitnis T, Vandercappellen J, King M, Brichetto G. Symptom Interconnectivity in Multiple Sclerosis: A Narrative Review of Potential Underlying Biological Disease Processes. Neurol Ther 2022; 11:1043-1070. [PMID: 35680693 PMCID: PMC9338216 DOI: 10.1007/s40120-022-00368-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Fatigue, cognitive impairment, depression, and pain are highly prevalent symptoms in multiple sclerosis (MS). These often co-occur and may be explained by a common etiology. By reviewing existing literature, we aimed to identify potential underlying biological processes implicated in the interconnectivity between these symptoms. Methods A literature search was conducted to identify articles reporting research into the biological mechanisms responsible for the manifestation of fatigue, cognitive impairment, depression, and pain in MS. PubMed was used to search for articles published from July 2011 to July 2021. We reviewed and assessed findings from the literature to identify biological processes common to the symptoms of interest. Results Of 693 articles identified from the search, 252 were selected following screening of titles and abstracts and assessing reference lists of review articles. Four biological processes linked with two or more of the symptoms of interest were frequently identified from the literature: (1) direct neuroanatomical changes to brain regions linked with symptoms of interest (e.g., thalamic injury associated with cognitive impairment, fatigue, and depression), (2) pro-inflammatory cytokines associated with so-called ‘sickness behavior,’ including manifestation of fatigue, transient cognitive impairment, depression, and pain, (3) dysregulation of monoaminergic pathways leading to depressive symptoms and fatigue, and (4) hyperactivity of the hypothalamic–pituitary-adrenal (HPA) axis as a result of pro-inflammatory cytokines promoting the release of brain noradrenaline, serotonin, and tryptophan, which is associated with symptoms of depression and cognitive impairment. Conclusion The co-occurrence of fatigue, cognitive impairment, depression, and pain in MS appears to be associated with a common set of etiological factors, namely neuroanatomical changes, pro-inflammatory cytokines, dysregulation of monoaminergic pathways, and a hyperactive HPA axis. This association of symptoms and biological processes has important implications for disease management strategies and, eventually, could help find a common therapeutic pathway that will impact both inflammation and neuroprotection. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00368-2.
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Affiliation(s)
- Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | | | - Miriam King
- Novartis Pharma AG, Fabrikstrasse 12-2, 4056, Basel, Switzerland
| | - Giampaolo Brichetto
- Associazione Italiana Sclerosi Multipla Rehabilitation Center, Via Operai, 30, 16149, Genoa, GE, Italy
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Zhu Q, Zheng Q, Luo D, Peng Y, Yan Z, Wang X, Chen X, Li Y. The Application of Diffusion Kurtosis Imaging on the Heterogeneous White Matter in Relapsing-Remitting Multiple Sclerosis. Front Neurosci 2022; 16:849425. [PMID: 35360163 PMCID: PMC8960252 DOI: 10.3389/fnins.2022.849425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/31/2022] [Indexed: 12/21/2022] Open
Abstract
Objectives To evaluate the microstructural damage in the heterogeneity of different white matter areas in relapsing-remitting multiple sclerosis (RRMS) patients by using diffusion kurtosis imaging (DKI) and its correlation with clinical and cognitive status. Materials and Methods Kurtosis fractional anisotropy (KFA), fractional anisotropy (FA), mean kurtosis (MK), and mean diffusivity (MD) in T1-hypointense lesions (T1Ls), pure T2-hyperintense lesions (pure-T2Ls), normal-appearing white matter (NAWM), and white matter in healthy controls (WM in HCs) were measured in 48 RRMS patients and 26 sex- and age-matched HCs. All the participants were assessed with the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Symbol Digit Modalities Test (SDMT) scores as the cognitive status. The Kurtzke Expanded Disability Status Scale (EDSS) scores were used to evaluate the clinical status in RRMS patients. Results The lowest KFA, FA, and MK values and the highest MD values were found in T1Ls, followed by pure-T2Ls, NAWM, and WM in HCs. The T1Ls and pure-T2Ls were significantly different in FA (p = 0.002) and MK (p = 0.013), while the NAWM and WM in HCs were significantly different in KFA, FA, and MK (p < 0.001; p < 0.001; p = 0.001). The KFA, FA, MK, and MD values in NAWM (r = 0.360, p = 0.014; r = 0.415, p = 0.004; r = 0.369, p = 0.012; r = −0.531, p < 0.001) were correlated with the MMSE scores and the FA, MK, and MD values in NAWM (r = 0.423, p = 0.003; r = 0.427, p = 0.003; r = −0.359, p = 0.014) were correlated with the SDMT scores. Conclusion Applying DKI to the imaging-based white matter classification has the potential to reflect the white matter damage and is correlated with cognitive impairment.
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De Somma E, O'Mahony J, Brown RA, Brooks BL, Yeh EA, Cardenas de La Parra A, Arnold D, Collins DL, Maranzano J, Narayanan S, Marrie RA, Bar-Or A, Banwell B, Till C. Disrupted cognitive development following pediatric acquired demyelinating syndromes: a longitudinal study. Child Neuropsychol 2021; 28:649-670. [PMID: 34872458 DOI: 10.1080/09297049.2021.2002289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Long-term cognitive deficits have been observed in some children who experience an acquired demyelinating syndrome (ADS). We examined changes in cognitive functioning over the first two years following incident ADS andtested whether normalized brain and thalamic volume accounted for decline over time. Twenty-five youth (mean age 12.8 years) with ADS, 9 of whom were diagnosed with multiple sclerosis (MS) and 16 of whom experienced monophasic ADS (monoADS), underwent two neuropsychological evaluationsand MRI scans at approximately6- and 24-months post ADS-onset. We examined changes in cognitive outcomes over time and between patient groups. Generalized linear mixed-effect regression models were used to examine the association of normalized brain and thalamic volumesbetween the two timepointswith cognitive z-scores. Cognitive performance was within the age-expected range for both groups and remained stable over time on 15 measures. In the combined sample of monoADS and MS patients, declines (p < .05) were noted on the Symbol Digit Modalities Test (SDMT), the Auditory Working Memory (AWM), and the WJ-III Visual Matching (VisMat)tests, but did not survive FDR correction. Clinically significant declines, as measured by the Reliable Change Index, were observed on the SDMT,AWM, and VisMattests by 19, 42, and 32%, respectively. Lower normalized brain volume at 6-months predicted a negative change in SDMT (B = 0.45, 95%CI: 0.07,0.83) and AWM (B = 0.30, 95%CI: 0.13, 0.47). Chronicity of demyelination is not required for cognitive decline nor for reduced brain volume, suggesting that even a single demyelinating event may negatively impact cognitive potential in children.
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Affiliation(s)
| | - Julia O'Mahony
- Neurosciences and Mental Health, Hospital for Sick Children, Canada Hospital for Sick Children, Toronto, Canada
| | | | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
| | - E Ann Yeh
- Neurosciences and Mental Health, Hospital for Sick Children, Canada Hospital for Sick Children, Toronto, Canada.,Department of Neurology, Hospital for Sick Children, Toronto, Canada
| | | | - Douglas Arnold
- McConnell Brain Imaging Centre, McGill University, Montreal, Canada
| | - D Louis Collins
- McConnell Brain Imaging Centre, McGill University, Montreal, Canada
| | | | - Sridar Narayanan
- McConnell Brain Imaging Centre, McGill University, Montreal, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Amit Bar-Or
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Banwell
- Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christine Till
- Department of Psychology, York University, Toronto, Canada.,Neurosciences and Mental Health, Hospital for Sick Children, Canada Hospital for Sick Children, Toronto, Canada
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Bonacchi R, Meani A, Pagani E, Marchesi O, Falini A, Filippi M, Rocca MA. Association of Age at Onset With Gray Matter Volume and White Matter Microstructural Abnormalities in People With Multiple Sclerosis. Neurology 2021; 97:e2007-e2019. [PMID: 34607928 DOI: 10.1212/wnl.0000000000012869] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate whether age at onset influences brain gray matter volume (GMV) and white matter (WM) microstructural abnormalities in adult patients with multiple sclerosis (MS), given its influence on clinical phenotype and disease course. METHODS In this hypothesis-driven cross-sectional study, we enrolled 67 patients with pediatric-onset MS (POMS) and 143 sex- and disease duration (DD)-matched randomly selected patients with adult-onset MS (AOMS), together with 208 healthy controls. All participants underwent neurologic evaluation and 3T MRI acquisition. MRI variables were standardized based on healthy controls, to remove effects of age and sex. Associations with DD in patients with POMS and patients with AOMS were studied with linear models. Time to reach clinical and MRI milestones was assessed with product-limit approach. RESULTS At DD 1 year, GMV and WM fractional anisotropy (FA) were abnormal in AOMS but not in POMS. Significant interaction of age at onset (POMS vs AOMS) into the association with DD was found for GMV and WM FA. The crossing point of regression lines in POMS and AOMS was at 20 years of DD for GMV and 14 for WM FA. For POMS and AOMS, median DD was 29 and 19 years to reach Expanded Disability Status Scale score 3 (p < 0.001), 31 and 26 years to reach abnormal Paced Auditory Serial Addition Task, 3-second version (p = 0.01), 24 and 18 years to reach abnormal GMV (p = 0.04), and 19 and 17 years to reach abnormal WM FA (p = 0.36). DISCUSSION Younger patients are initially resilient to MS-related damage. Then, compensatory mechanisms start failing with loss of WM integrity, followed by GM atrophy and finally disability.
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Affiliation(s)
- Raffaello Bonacchi
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Alessandro Meani
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Olga Marchesi
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Andrea Falini
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy
| | - Maria A Rocca
- From the Neuroimaging Research Unit, Division of Neuroscience (R.B., A.M., E.P., O.M., M.F., M.A.R.), Neurology Unit (R.B., M.F., M.A.R.), Neuroradiology Unit (A.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (A.F., M.F., M.A.R.), Milan, Italy.
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Govindarajan ST, Liu Y, Parra Corral MA, Bangiyev L, Krupp L, Charvet L, Duong TQ. White matter correlates of slowed information processing speed in unimpaired multiple sclerosis patients with young age onset. Brain Imaging Behav 2021; 15:1460-1468. [PMID: 32748319 DOI: 10.1007/s11682-020-00345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Slowed information processing speed is among the earliest markers of cognitive impairment in multiple sclerosis (MS) and has been associated with white matter (WM) structural integrity. Localization of WM tracts associated with slowing, but not significant impairment, on specific cognitive tasks in pediatric and young age onset MS can facilitate early and effective therapeutic intervention. Diffusion tensor imaging data were collected on 25 MS patients and 24 controls who also underwent the Symbol Digit Modalities Test (SDMT) and the computer-based Cogstate simple and choice reaction time tests. Fractional anisotropy (FA), mean (MD), radial (RD) and axial (AD) diffusivities were correlated voxel-wise with processing speed measures. All DTI metrics of several white matter tracts were significantly different between groups (p < 0.05). Notably, higher MD, RD, and AD, but not FA, in the corpus callosum correlated with lower scores on both SDMT and simple reaction time. Additionally, all diffusivity metrics in the left corticospinal tract correlated negatively with SDMT scores, whereas only MD in the right superior fronto-occipital fasciculus correlated with simple reaction time. In conclusion, subtle slowing of processing speed is correlated with WM damage in the visual-motor processing pathways in patients with young age of MS onset.
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Affiliation(s)
| | - Yilin Liu
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Lev Bangiyev
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lauren Krupp
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Leigh Charvet
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Tim Q Duong
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY, USA.
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10
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Contribution of Gray Matter Atrophy and White Matter Damage to Cognitive Impairment in Mildly Disabled Relapsing-Remitting Multiple Sclerosis Patients. Diagnostics (Basel) 2021; 11:diagnostics11030578. [PMID: 33807060 PMCID: PMC8005138 DOI: 10.3390/diagnostics11030578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022] Open
Abstract
Cognitive impairment (CI) is frequently present in multiple sclerosis patients. Despite ongoing research, the neurological substrates have not been fully elucidated. In this study we investigated the contribution of gray and white matter in the CI observed in mildly disabled relapsing-remitting multiple sclerosis (RRMS) patients. For that purpose, 30 patients with RRMS (median EDSS = 2), and 30 age- and sex-matched healthy controls were studied. CI was assessed using the symbol digit modalities test (SDMT) and the memory alteration test. Brain magnetic resonance imaging, diffusion tensor imaging (DTI), voxel-based morphometry (VBM), brain segmentation, thalamic vertex analysis, and connectivity-based thalamic parcellation analyses were performed. RRMS patients scored significantly lower in both cognitive tests. In the patient group, significant atrophy in the thalami was observed. Multiple regression analyses revealed associations between SDMT scores and GM volume in both hemispheres in the temporal, parietal, frontal, and occipital lobes. The DTI results pointed to white matter damage in all thalamocortical connections, the corpus callosum, and several fasciculi. Multiple regression and correlation analyses suggested that in RRMS patients with mild disease, thalamic atrophy and thalamocortical connection damage may lead to slower cognitive processing. Furthermore, white matter damage at specific fasciculi may be related to episodic memory impairment.
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Yahya N, Manan HA. Diffusion tensor imaging indices to predict cognitive changes following adult radiotherapy. Eur J Cancer Care (Engl) 2020; 30:e13329. [PMID: 32909654 DOI: 10.1111/ecc.13329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 05/01/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) can detect changes to white matter tracts following assaults including high dose radiation. This study aimed to systematically evaluate DTI indices to predict cognitive changes following adult radiotherapy. MATERIALS AND METHODS We searched PubMed and Scopus electronic databases to identify eligible studies according to PRISMA guidelines. Studies were extracted for information on demographics, DTI changes and associations to cognitive outcomes. RESULTS Six studies were selected for inclusion with 110 patients (median study size: 20). 5/6 studies found significant cognitive decline and analysed relationships to DTI changes. Decreased fractional anisotropy (FA) was consistently associated with cognitive decline. Associations clustered at specific regions of cingulum and corpus callosum. Only one study conducted multivariable analysis. CONCLUSION Fractional anisotropy is a clinically meaningful biomarker for radiotherapy-related cognitive decline. Studies accruing larger patient cohorts are needed to guide therapeutic changes that can abate the decline.
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Affiliation(s)
- Noorazrul Yahya
- Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Hanani A Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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12
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Abel S, Vavasour I, Lee LE, Johnson P, Ristow S, Ackermans N, Chan J, Cross H, Laule C, Dvorak A, Schabas A, Hernández-Torres E, Tam R, Kuan AJ, Morrow SA, Wilken J, Rauscher A, Bhan V, Sayao AL, Devonshire V, Li DKB, Carruthers R, Traboulsee A, Kolind SH. Associations Between Findings From Myelin Water Imaging and Cognitive Performance Among Individuals With Multiple Sclerosis. JAMA Netw Open 2020; 3:e2014220. [PMID: 32990740 PMCID: PMC7525360 DOI: 10.1001/jamanetworkopen.2020.14220] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Cognitive impairment is a debilitating symptom of multiple sclerosis (MS) that affects up to 70% of patients. An improved understanding of the underlying pathology of MS-related cognitive impairment would provide considerable benefit to patients and clinicians. OBJECTIVE To determine whether there is an association between myelin damage in tissue that appears completely normal on standard clinical imaging, but can be detected by myelin water imaging (MWI), with cognitive performance in MS. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, participants with MS and controls underwent cognitive testing and magnetic resonance imaging (MRI) from August 23, 2017, to February 20, 2019. Participants were recruited through the University of British Columbia Hospital MS clinic and via online recruitment advertisements on local health authority websites. Cognitive testing was performed in the MS clinic, and MRI was performed at the adjacent academic research neuroimaging center. Seventy-three participants with clinically definite MS fulfilling the 2017 revised McDonald criteria for diagnosis and 22 age-, sex-, and education-matched healthy volunteers without neurological disease were included in the study. Data analysis was performed from March to November 2019. EXPOSURES MWI was performed at 3 T with a 48-echo, 3-dimensional, gradient and spin-echo (GRASE) sequence. Cognitive testing was performed with assessments drawn from cognitive batteries validated for use in MS. MAIN OUTCOMES AND MEASURES The association between myelin water measures, a measurement of the T2 relaxation signal from water in the myelin bilayers providing a specific marker for myelin, and cognitive test scores was assessed using Pearson correlation. Three white matter regions of interest-the cingulum, superior longitudinal fasciculus (SLF), and corpus callosum-were selected a priori according to their known involvement in MS-related cognitive impairment. RESULTS For the 95 total participants, the mean (SD) age was 49.33 (11.44) years. The mean (SD) age was 50.2 (10.7) years for the 73 participants with MS and 46.4 (13.5) for the 22 controls. Forty-eight participants with MS (66%) and 14 controls (64%) were women. The mean (SD) years of education were 14.7 (2.2) for patients and 15.8 (2.5) years for controls. In MS, significant associations were observed between myelin water measures and scores on the Symbol Digit Modalities Test (SLF, r = -0.490; 95% CI, -0.697 to -0.284; P < .001; corpus callosum, r = -0.471; 95% CI, -0.680 to -0.262; P < .001; and cingulum, r = -0.419; 95% CI, -0.634 to -0.205; P < .001), Selective Reminding Test (SLF, r = -0.444; 95% CI, -0.660 to -0.217; P < .001; corpus callosum, r = -0.411; 95% CI, -0.630 to -0.181; P = .001; and cingulum, r = -0.361; 95% CI, -0.602 to -0.130; P = .003), and Controlled Oral Word Association Test (SLF, r = -0.317; 95% CI, -0.549 to -0.078; P = .01; and cingulum, r = -0.335; 95% CI, -0.658 to -0.113; P = .006). No significant associations were found in controls. CONCLUSIONS AND RELEVANCE This study used MWI to demonstrate that otherwise normal-appearing brain tissue is diffusely damaged in MS, and the findings suggest that myelin water measures are associated with cognitive performance. MWI offers an in vivo biomarker feasible for use in clinical trials investigating cognition, providing a means for monitoring changes in myelination and its association with symptom worsening or improvement.
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Affiliation(s)
- Shawna Abel
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Irene Vavasour
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Eunyoung Lee
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Poljanka Johnson
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Ristow
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathalie Ackermans
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jillian Chan
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Cross
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology & Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Dvorak
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Schabas
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Enedino Hernández-Torres
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Tam
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie J. Kuan
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah A. Morrow
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Jeffrey Wilken
- Department of Neurology, Georgetown University Hospital, Washington, DC
- Washington Neuropsychology Research Group LLC, Fairfax, Virginia
| | - Alexander Rauscher
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Virender Bhan
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana-Luiza Sayao
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Virginia Devonshire
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - David K. B. Li
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Carruthers
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon H. Kolind
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, British Columbia, Canada
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Thrue C, Riemenschneider M, Hvid LG, Stenager E, Dalgas U. Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains. Mult Scler 2020; 27:1477-1485. [DOI: 10.1177/1352458520936231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the “time matters”-perspective has become a focal point when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible.
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Affiliation(s)
- C Thrue
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - M Riemenschneider
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - LG Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - E Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/Department of Neurology, MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Sønderborg, Denmark
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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14
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Wallach AI, Waltz M, Casper TC, Aaen G, Belman A, Benson L, Chitnis T, Gorman M, Graves J, Harris Y, Lotze TE, Mar S, Moodley M, Ness JM, Rensel M, Rodriguez M, Rose JW, Schreiner T, Tillema JM, Waubant E, Weinstock-Guttman B, Charvet LE, Krupp LB. Cognitive processing speed in pediatric-onset multiple sclerosis: Baseline characteristics of impairment and prediction of decline. Mult Scler 2019; 26:1938-1947. [PMID: 31775571 DOI: 10.1177/1352458519891984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cognitive impairment occurs in approximately one-third of pediatric-onset multiple sclerosis (POMS) patients. The Symbol Digit Modalities Test (SDMT), a widely used cognitive screen in adults, has yet to be incorporated early into the standard care of POMS. OBJECTIVE To screen for cognitive impairment early in the course of POMS and analyze predictive factors. METHODS Of the 955 POMS or clinically isolated syndrome (CIS) patients prospectively assessed from March 2014 to July 2018, 500 POMS and 116 CIS patients met inclusion criteria (disease onset before the age of 18, one or more SDMTs, and 8 years or older at the time of testing). Those with relapse were analyzed separately from those who were relapse-free. RESULTS At initial assessment, the mean (interquartile range (IQR)) age at symptom onset was 13.5 years (12.0, 15.9) and the mean (±SD) disease duration was 3.0 ± 2.9 years. Impaired processing speed occurred in 23.4% of POMS and in 16.4% of CIS. On serial testing (n = 383, mean follow-up: 1.8 years), 14.1% had clinically meaningful decline predicted by older age of multiple sclerosis (MS) onset and male gender. Disease relapse or steroid use led to transient worsening on the SDMT. CONCLUSION Early in the disease, some POMS and CIS patients are at risk for cognitive impairment and subsequent decline.
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Affiliation(s)
- Asya I Wallach
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Michael Waltz
- Pediatrics, The University of Utah, Salt Lake City, UT, USA
| | | | - Gregory Aaen
- Pediatric Multiple Sclerosis Center, Loma Linda University, Loma Linda, CA, USA
| | - Anita Belman
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Leslie Benson
- Partners Multiple Sclerosis Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jennifer Graves
- Pediatric MS Center, Neurology, University of California, San Diego, San Diego, CA, USA
| | - Yolanda Harris
- Center for Pediatric-Onset Demyelinating Disease, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy E Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Soe Mar
- Pediatric MS and other Demyelinating Disease Center, Washington University in St Louis, St. Louis, MO, USA
| | - Manikum Moodley
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Jayne M Ness
- Center for Pediatric-Onset Demyelinating Disease, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Moses Rodriguez
- Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
| | - John W Rose
- Pediatrics, The University of Utah, Salt Lake City, UT, USA
| | - Teri Schreiner
- Department of Neurology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | | | - Emmanuelle Waubant
- Regional Pediatric MS Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bianca Weinstock-Guttman
- The Pediatric MS Center, Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - Leigh E Charvet
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Lauren B Krupp
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
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15
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Abel S, Vavasour I, Lee LE, Johnson P, Ackermans N, Chan J, Dvorak A, Schabas A, Wiggermann V, Tam R, Kuan AJ, Morrow SA, Wilken J, Laule C, Rauscher A, Bhan V, Sayao AL, Devonshire V, Li DK, Carruthers R, Traboulsee A, Kolind SH. Myelin Damage in Normal Appearing White Matter Contributes to Impaired Cognitive Processing Speed in Multiple Sclerosis. J Neuroimaging 2019; 30:205-211. [PMID: 31762132 DOI: 10.1111/jon.12679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Cognitive impairment is a core symptom in multiple sclerosis (MS). Damage to normal appearing white matter (NAWM) is likely involved. We sought to determine if greater myelin heterogeneity in NAWM is associated with decreased cognitive performance in MS. METHODS A total of 27 participants with MS and 13 controls matched for age, sex, and education underwent myelin water imaging (MWI) from which the myelin water fraction (MWF) was calculated. Corpus callosum, superior longitudinal fasciculus, and cingulum were chosen as regions of interest (ROIs) a priori based on their involvement in MS-related cognitive impairment. Cognitive performance was assessed using the Symbol Digit Modalities Test (SDMT). Pearson ́s product moment correlations were performed to assess relationships between cognitive performance and myelin heterogeneity (variance of MWF within an ROI). RESULTS In MS, myelin heterogeneity in all three ROIs was significantly associated with performance on the SDMT. These correlations ranged from moderate (r = -.561) to moderately strong (r = -.654) and were highly significant (P values ranged from .001 to .0002). Conversely, myelin heterogeneity was not associated with SDMT performance in controls in any ROI (P > .108). CONCLUSION Increased myelin heterogeneity in NAWM is associated with decreased cognitive processing speed performance in MS.
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Affiliation(s)
- Shawna Abel
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Irene Vavasour
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Eunyoung Lee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Poljanka Johnson
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathalie Ackermans
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jillian Chan
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Dvorak
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Schabas
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Wiggermann
- Department of Physics and Astronomy and Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie J Kuan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Jeffrey Wilken
- Department of Neurology and Washington Neuropsychology Research Group, Georgetown University Hospital, LLC, Fairfax, VA
| | - Cornelia Laule
- Department of Radiology Pathology & Laboratory Medicine, Physics & Astronomy and International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Virender Bhan
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana-Luiza Sayao
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Virginia Devonshire
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kb Li
- Department of Radiology and Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Carruthers
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon H Kolind
- Department of Medicine (Neurology), Radiology, Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Bells S, Lefebvre J, Longoni G, Narayanan S, Arnold DL, Yeh EA, Mabbott DJ. White matter plasticity and maturation in human cognition. Glia 2019; 67:2020-2037. [PMID: 31233643 DOI: 10.1002/glia.23661] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/21/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022]
Abstract
White matter plasticity likely plays a critical role in supporting cognitive development. However, few studies have used the imaging methods specific to white matter tissue structure or experimental designs sensitive to change in white matter necessary to elucidate these relations. Here we briefly review novel imaging approaches that provide more specific information regarding white matter microstructure. Furthermore, we highlight recent studies that provide greater clarity regarding the relations between changes in white matter and cognition maturation in both healthy children and adolescents and those with white matter insult. Finally, we examine the hypothesis that white matter is linked to cognitive function via its impact on neural synchronization. We test this hypothesis in a population of children and adolescents with recurrent demyelinating syndromes. Specifically, we evaluate group differences in white matter microstructure within the optic radiation; and neural phase synchrony in visual cortex during a visual task between 25 patients and 28 typically developing age-matched controls. Children and adolescents with demyelinating syndromes show evidence of myelin and axonal compromise and this compromise predicts reduced phase synchrony during a visual task compared to typically developing controls. We investigate one plausible mechanism at play in this relationship using a computational model of gamma generation in early visual cortical areas. Overall, our findings show a fundamental connection between white matter microstructure and neural synchronization that may be critical for cognitive processing. In the future, longitudinal or interventional studies can build upon our knowledge of these exciting relations between white matter, neural communication, and cognition.
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Affiliation(s)
- Sonya Bells
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jérémie Lefebvre
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Mathematics, University of Toronto, Toronto, Ontario, Canada
| | - Giulia Longoni
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sridar Narayanan
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Douglas L Arnold
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Eleun Ann Yeh
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Donald J Mabbott
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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Bartlett E, Shaw M, Schwarz C, Feinberg C, DeLorenzo C, Krupp LB, Charvet LE. Brief Computer-Based Information Processing Measures are Linked to White Matter Integrity in Pediatric-Onset Multiple Sclerosis. J Neuroimaging 2018; 29:140-150. [DOI: 10.1111/jon.12566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Elizabeth Bartlett
- Department of Biomedical Engineering; Stony Brook University; Stony Brook NY
| | - Michael Shaw
- Department of Neurology, New York University Langone Medical Center; NYU Langone Health; New York NY
| | - Colleen Schwarz
- Department of Nursing; Stony Brook University; Stony Brook NY
| | - Charles Feinberg
- Department of Neurology, New York University Langone Medical Center; NYU Langone Health; New York NY
| | - Christine DeLorenzo
- Department of Biomedical Engineering; Stony Brook University; Stony Brook NY
- Department of Psychiatry; Stony Brook University; Stony Brook NY
| | - Lauren B. Krupp
- Department of Neurology, New York University Langone Medical Center; NYU Langone Health; New York NY
| | - Leigh E. Charvet
- Department of Neurology, New York University Langone Medical Center; NYU Langone Health; New York NY
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18
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Tenembaum SN. Pediatric Multiple Sclerosis: Distinguishing Clinical and MR Imaging Features. Neuroimaging Clin N Am 2018; 27:229-250. [PMID: 28391783 DOI: 10.1016/j.nic.2016.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article presents an overview of evolving diagnostic criteria of pediatric multiple sclerosis and related disorders, emphasizing distinguishing clinical and neuroimaging features that should be considered for differential diagnosis in childhood and adolescence. New data on the integrity of brain tissue in children with MS provided by advanced MR imaging techniques are addressed as well.
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Affiliation(s)
- Silvia N Tenembaum
- Department of Neurology, National Pediatric Hospital Dr. Juan P. Garrahan, Combate de los Pozos 1881, Ciudad Autónoma de Buenos Aires C1436AAM, Argentina; International Pediatric MS Study Group, Foundation for Neurologic Disease, 10 State Street, Newburyport, MA 01950, USA.
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19
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Pediatric Multiple Sclerosis and Cognition: A Review of Clinical, Neuropsychologic, and Neuroradiologic Features. Behav Neurol 2017; 2017:1463570. [PMID: 29434433 PMCID: PMC5757108 DOI: 10.1155/2017/1463570] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/10/2017] [Accepted: 12/04/2017] [Indexed: 11/17/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disease. Although cognitive impairment has been well established in adult patients with MS, its occurrence in patients with pediatric-onset MS has recently been reported. In this review, I discuss the main features of cognitive impairment in pediatric MS as determined by long-term follow-up studies, neuropsychiatric test batteries, and the results of neuroradiological imaging studies that investigated the pathogenesis of pediatric MS. The most commonly affected cognitive domains in adults are attention, processing speed, and visuomotor skills; language and intelligence are also affected in pediatric MS. A young age at disease onset is the strongest risk factor for these impairments, which may be due to the effect of inflammatory demyelination and neurodegeneration on the developing central nervous system and neural networks in children. Cognitive impairment has long-term effects on patients' academic life and the quality of their social life. Therefore, all patients with pediatric MS should be screened and monitored for cognitive impairment. This review also highlights the need for neuropsychological test batteries that assess different cognitive domains in children and adolescents with multiple sclerosis and for cognitive rehabilitation programs to improve the quality of their academic and social life.
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Longoni G, Brown RA, MomayyezSiahkal P, Elliott C, Narayanan S, Bar-Or A, Marrie RA, Yeh EA, Filippi M, Banwell B, Arnold DL. White matter changes in paediatric multiple sclerosis and monophasic demyelinating disorders. Brain 2017; 140:1300-1315. [PMID: 28334875 DOI: 10.1093/brain/awx041] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 01/16/2017] [Indexed: 12/30/2022] Open
Abstract
See Hacohen et al. (doi:10.1093/awx075) for a scientific commentary on this article. Most children who experience an acquired demyelinating syndrome of the central nervous system will have a monophasic disease course, with no further clinical or radiological symptoms. A subset will be diagnosed with multiple sclerosis, a life-long disorder. Using linear mixed effects models we examined longitudinal diffusion properties of normal-appearing white matter in 505 serial scans of 132 paediatric participants with acquired demyelinating syndromes followed for a median of 4.4 years, many from first clinical presentation, and 106 scans of 80 healthy paediatric participants. Fifty-three participants with demyelinating syndromes eventually received a diagnosis of paediatric-onset multiple sclerosis. Diffusion tensor imaging measures properties of water diffusion through tissue, which normally becomes increasingly restricted and anisotropic in the brain during childhood and adolescence, as fibre bundles develop and myelinate. In the healthy paediatric participants, our data demonstrate the expected trajectory of more restricted and anisotropic white matter diffusivity with increasing age. However, in participants with multiple sclerosis, fractional anisotropy decreased and mean diffusivity of non-lesional, normal-appearing white matter progressively increased after clinical presentation, suggesting not only a failure of age-expected white matter development but also a progressive loss of tissue integrity. Surprisingly, patients with monophasic disease failed to show age-expected changes in diffusion parameters in normal-appearing white matter, although they did not show progressive loss of integrity over time. Further analysis demonstrated that participants with monophasic disease experienced different post-onset trajectories in normal-appearing white matter depending on their presenting phenotype: those with acute disseminated encephalomyelitis demonstrated abnormal trajectories of diffusion parameters compared to healthy paediatric participants, as did patients with non-acute disseminated encephalomyelitis presentations associated with lesions in the brain at onset. Patients with monofocal syndromes such as optic neuritis, transverse myelitis, or isolated brainstem syndromes in whom multifocal brain lesions were absent, showed trajectories more closely approximating normal-appearing white matter development. Our findings also suggest the existence of sexual dimorphism in the effects of demyelinating syndromes on normal-appearing white matter development. Overall, we demonstrate failure of white matter maturational changes and progressive loss of white matter integrity in paediatric-onset multiple sclerosis, but also show that even a single demyelinating attack-when associated with white matter lesions in the brain-negatively impacts subsequent normal-appearing white matter development.
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Affiliation(s)
- Giulia Longoni
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Robert A Brown
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Parya MomayyezSiahkal
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Colm Elliott
- Centre for Intelligent Machines, Department of Electrical and Computer Engineering, Faculty of Engineering, McGill University, Montreal, QC, Canada
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Amit Bar-Or
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - E Ann Yeh
- Department of Pediatrics, University of Toronto; Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Brenda Banwell
- Division of Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas L Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
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Akbar N, Signori A, Amato MP, Sormani MP, Portaccio E, Niccolai C, Goretti B, Till C, Banwell B. Maturational Trajectory of Processing Speed Performance in Pediatric Multiple Sclerosis. Dev Neuropsychol 2017; 42:299-308. [DOI: 10.1080/87565641.2017.1351974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nadine Akbar
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Maria Pia Amato
- Neurologic Unit, Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Claudia Niccolai
- Neurologic Unit, Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Benedetta Goretti
- Neurologic Unit, Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Christine Till
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Brenda Banwell
- Department of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Changes in White Matter Microstructure Impact Cognition by Disrupting the Ability of Neural Assemblies to Synchronize. J Neurosci 2017; 37:8227-8238. [PMID: 28743724 DOI: 10.1523/jneurosci.0560-17.2017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/11/2017] [Accepted: 07/14/2017] [Indexed: 12/27/2022] Open
Abstract
Cognition is compromised by white matter (WM) injury but the neurophysiological alterations linking them remain unclear. We hypothesized that reduced neural synchronization caused by disruption of neural signal propagation is involved. To test this, we evaluated group differences in: diffusion tensor WM microstructure measures within the optic radiations, primary visual area (V1), and cuneus; neural phase synchrony to a visual attention cue during visual-motor task; and reaction time to a response cue during the same task between 26 pediatric patients (17/9: male/female) treated with cranial radiation treatment for a brain tumor (12.67 ± 2.76 years), and 26 healthy children (16/10: male/female; 12.01 ± 3.9 years). We corroborated our findings using a corticocortical computational model representing perturbed signal conduction from myelin. Patients show delayed reaction time, WM compromise, and reduced phase synchrony during visual attention compared with healthy children. Notably, using partial least-squares-path modeling we found that WM insult within the optic radiations, V1, and cuneus is a strong predictor of the slower reaction times via disruption of neural synchrony in visual cortex. Observed changes in synchronization were reproduced in a computational model of WM injury. These findings provide new evidence linking cognition with WM via the reliance of neural synchronization on propagation of neural signals.SIGNIFICANCE STATEMENT By comparing brain tumor patients to healthy children, we establish that changes in the microstructure of the optic radiations and neural synchrony during visual attention predict reaction time. Furthermore, by testing the directionality of these links through statistical modeling and verifying our findings with computational modeling, we infer a causal relationship, namely that changes in white matter microstructure impact cognition in part by disturbing the ability of neural assemblies to synchronize. Together, our human imaging data and computer simulations show a fundamental connection between WM microstructure and neural synchronization that is critical for cognitive processing.
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The computer-based Symbol Digit Modalities Test: establishing age-expected performance in healthy controls and evaluation of pediatric MS patients. Neurol Sci 2017; 38:635-642. [DOI: 10.1007/s10072-017-2813-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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Alterations in Functional and Structural Connectivity in Pediatric-Onset Multiple Sclerosis. PLoS One 2016; 11:e0145906. [PMID: 26731278 PMCID: PMC4701472 DOI: 10.1371/journal.pone.0145906] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/10/2015] [Indexed: 11/19/2022] Open
Abstract
Background Reduced white matter (WM) integrity is a fundamental aspect of pediatric multiple sclerosis (MS), though relations to resting-state functional MRI (fMRI) connectivity remain unknown. The objective of this study was to relate diffusion-tensor imaging (DTI) measures of WM microstructural integrity to resting-state network (RSN) functional connectivity in pediatric-onset MS to test the hypothesis that abnormalities in RSN reflects changes in structural integrity. Methods This study enrolled 19 patients with pediatric-onset MS (mean age = 19, range 13–24 years, 14 female, mean disease duration = 65 months, mean age of disease onset = 13 years) and 16 age- and sex-matched healthy controls (HC). All subjects underwent 3.0T anatomical and functional MRI which included DTI and resting-state acquisitions. DTI processing was performed using Tract-Based Spatial Statistics (TBSS). RSNs were identified using Independent Components Analysis, and a dual regression technique was used to detect between-group differences in the functional connectivity of RSNs. Correlations were investigated between DTI measures and RSN connectivity. Results Lower fractional anisotropy (FA) was observed in the pediatric-onset MS group compared to HC group within the entire WM skeleton, and particularly the corpus callosum, posterior thalamic radiation, corona radiata and sagittal stratum (all p < .01, corrected). Relative to HCs, MS patients showed higher functional connectivity involving the anterior cingulate cortex and right precuneus of the default-mode network, as well as involving the anterior cingulate cortex and left middle frontal gyrus of the frontoparietal network (all p < .005 uncorrected, k≥30 voxels). Higher functional connectivity of the right precuneus within the default-mode network was associated with lower FA of the entire WM skeleton (r = -.525, p = .02), genu of the corpus callosum (r = -.553, p = .014), and left (r = -.467, p = .044) and right (r = -.615, p = .005) sagittal stratum. Conclusions Loss of WM microstructural integrity is associated with increased resting-state functional connectivity in pediatric MS, which may reflect a diffuse and potentially compensatory activation early in MS.
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Akbar N, Banwell B, Sled JG, Binns MA, Doesburg SM, Rypma B, Lysenko M, Till C. Brain activation patterns and cognitive processing speed in patients with pediatric-onset multiple sclerosis. J Clin Exp Neuropsychol 2015; 38:393-403. [DOI: 10.1080/13803395.2015.1119255] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cardoso M, Olmo NR, Fragoso YD. Systematic Review of Cognitive Dysfunction in Pediatric and Juvenile Multiple Sclerosis. Pediatr Neurol 2015; 53:287-92. [PMID: 26233264 DOI: 10.1016/j.pediatrneurol.2015.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/21/2015] [Accepted: 06/09/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cognitive dysfunction is a common finding in individuals with multiple sclerosis at all ages. Cognitive impairment may drastically affect the life of younger patients with multiple sclerosis who are still undergoing education and schooling. METHODS We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations to assess the published data on multiple sclerosis and cognition in pediatric or juvenile patients. Only articles presenting original data on patients with multiple sclerosis diagnosed before age 18 years of age were included. RESULTS Thirty-two articles fulfilled the inclusion criteria for this systematic review. The conclusion from all articles was that cognitive dysfunction in multiple sclerosis starting before the age of 18 years is both significant and disruptive and must be routinely assessed. However, assessment methods were heterogeneous and often very expensive to perform, whereas proposals for treatment were virtually absent in the literature. CONCLUSION Cognitive dysfunction can be a significant symptom of multiple sclerosis of early onset, but its impact and management needs to be better assessed. A task force should be created to study and manage cognitive dysfunction in pediatric and juvenile multiple sclerosis.
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Affiliation(s)
- Mariana Cardoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil; Post-graduation in Neurology, Ipemed, Belo Horizonte, Minas Gerais, Brazil; Neuroimmunology Angiocorpore, Santos, São Paulo, Brazil
| | - Neide Regina Olmo
- Department of Neurology, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil
| | - Yara Dadalti Fragoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil; Neuroimmunology Angiocorpore, Santos, São Paulo, Brazil.
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Rocca MA, Sonkin M, Copetti M, Pagani E, Arnold DL, Narayanan S, Sled JG, Banwell B, Filippi M. Diffusion tensor magnetic resonance imaging in very early onset pediatric multiple sclerosis. Mult Scler 2015. [DOI: 10.1177/1352458515596600] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Active myelination during childhood may influence the impact of multiple sclerosis (MS) on brain structural integrity. We studied normal-appearing white matter (NAWM) in children with MS onset before age 12 years using diffusion tensor (DT) magnetic resonance imaging (MRI). Methods: DT MRI scans were obtained from 22 MS children with their first attack before age 12 years, and 31 healthy controls from two referral centers. Using probabilistic tractography, brain tissue integrity within interhemispheric, intrahemispheric, and projection tracts was compared between patients and site-matched controls. The impact of disease and age at MRI on tract NAWM fractional anisotropy (FA) and mean diffusivity (MD) values was evaluated using linear models. Results: Compared to controls, pediatric MS patients had reduced FA and increased MD of the bilateral superior longitudinal fasciculus and corpus callosum (CC), without center-by-group interaction. CC NAWM average FA was correlated with brain T2 lesion volume. In controls, the majority of the tracts analyzed showed a significant increase of FA and decrease of MD with age. Such a linear correlation was lost in patients. Conclusions: In very young pediatric MS patients, DT MRI abnormalities affect brain WM tracts differentially, and are only partially correlated with focal WM lesions. Impaired maturation of WM tracts with age may be an additional factor contributing to these findings.
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Affiliation(s)
- MA Rocca
- Neuroimaging Research Unit, San Raffaele Scientific Institute, ‘Vita-Salute’ San Raffaele University, Italy
| | - M Sonkin
- Research Institute, The Hospital for Sick Children, Canada
| | - M Copetti
- IRCCS-Ospedale Casa Sollievo della Sofferenza, Italy
| | - E Pagani
- Neuroimaging Research Unit, San Raffaele Scientific Institute, ‘Vita-Salute’ San Raffaele University, Italy
| | - DL Arnold
- McConnell Brain Imaging Center, Montreal Neurological Institute, Canada
| | - S Narayanan
- McConnell Brain Imaging Center, Montreal Neurological Institute, Canada
| | - JG Sled
- Research Institute, The Hospital for Sick Children, Canada
| | - B Banwell
- Research Institute, The Hospital for Sick Children, Canada/The Children’s Hospital of Philadelphia, USA
| | - M Filippi
- Neuroimaging Research Unit, San Raffaele Scientific Institute, ‘Vita-Salute’ San Raffaele University, Italy
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Waldman A, Ghezzi A, Bar-Or A, Mikaeloff Y, Tardieu M, Banwell B. Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research. Lancet Neurol 2014; 13:936-48. [PMID: 25142460 DOI: 10.1016/s1474-4422(14)70093-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The clinical features, diagnostic challenges, neuroimaging appearance, therapeutic options, and pathobiological research progress in childhood-and adolescent-onset multiple sclerosis have been informed by many new insights in the past 7 years. National programmes in several countries, collaborative research efforts, and an established international paediatric multiple sclerosis study group have contributed to revised clinical diagnostic definitions, identified clinical features of multiple sclerosis that differ by age of onset, and made recommendations regarding the treatment of paediatric multiple sclerosis. The relative risks conveyed by genetic and environmental factors to paediatric multiple sclerosis have been the subject of several large cohort studies. MRI features have been characterised in terms of qualitative descriptions of lesion distribution and applicability of MRI aspects to multiple sclerosis diagnostic criteria, and quantitative studies have assessed total lesion burden and the effect of the disease on global and regional brain volume. Humoral-based and cell-based assays have identified antibodies against myelin, potassium-channel proteins, and T-cell profiles that support an adult-like T-cell repertoire and cellular reactivity against myelin in paediatric patients with multiple sclerosis. Finally, the safety and efficacy of standard first-line therapies in paediatric multiple sclerosis populations are now appreciated in more detail, and consensus views on the future conduct and feasibility of phase 3 trials for new drugs have been proposed.
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Affiliation(s)
- Amy Waldman
- Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Angelo Ghezzi
- Ospedale di Gallarate, Centro Studi Sclerosi Multipla, Gallarate, Italy
| | - Amit Bar-Or
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Yann Mikaeloff
- Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Tardieu
- Service de Neurologie Pédiatrique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brenda Banwell
- Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
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Todorow M, DeSouza JF, Banwell BL, Till C. Interhemispheric cooperation in global-local visual processing in pediatric multiple sclerosis. J Clin Exp Neuropsychol 2014; 36:111-26. [PMID: 24433093 DOI: 10.1080/13803395.2013.867013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Impairments in visuospatial abilities are commonly reported in children and adolescents with multiple sclerosis (MS). Corpus callosum (CC) pathology occurs in patients with MS and may contribute to impairment in visuospatial perception, particularly when interhemispheric information transfer is required. This study used a global-local hierarchical letter paradigm to examine the relationship between interhemispheric information transfer and white matter integrity in the CC assessed using diffusion tensor imaging. Thirteen cognitively preserved pediatric-onset MS patients and 15 age-matched healthy controls were asked to determine whether a target letter E appeared at the attended level of the stimulus. As expected, both groups processed global and local information more slowly under divided than selective attention conditions. The MS group performed similarly to the control group with respect to reaction time and accuracy on selective and divided attention conditions, with one exception. Specifically, the presence of a global target when attending to a local target caused greater response conflict in the MS group than in controls (p = .01). Pooling both the patient and control data, greater response conflict was associated with reduced white matter integrity as indicated by lower fractional anisotropy in the anterior body of the CC (r = -.33, p < .05). Results suggest that reduced white matter integrity in anterior regions of the CC may lead to less efficient inhibition of task-irrelevant global information in the hierarchal processing of visual information.
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Affiliation(s)
- Michelle Todorow
- a Department of Psychology , York University , Toronto , ON , Canada
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30
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Travers BG, Bigler ED, Tromp DPM, Adluru N, Froehlich AL, Ennis C, Lange N, Nielsen JA, Prigge MBD, Alexander AL, Lainhart JE. Longitudinal processing speed impairments in males with autism and the effects of white matter microstructure. Neuropsychologia 2014; 53:137-45. [PMID: 24269298 PMCID: PMC3946881 DOI: 10.1016/j.neuropsychologia.2013.11.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 11/12/2013] [Accepted: 11/14/2013] [Indexed: 11/24/2022]
Abstract
The present study used an accelerated longitudinal design to examine group differences and age-related changes in processing speed in 81 individuals with autism spectrum disorder (ASD) compared to 56 age-matched individuals with typical development (ages 6-39 years). Processing speed was assessed using the Wechsler Intelligence Scale for Children-3rd edition (WISC-III) and the Wechsler Adult Intelligence Scale-3rd edition (WAIS-III). Follow-up analyses examined processing speed subtest performance and relations between processing speed and white matter microstructure (as measured with diffusion tensor imaging [DTI] in a subset of these participants). After controlling for full scale IQ, the present results show that processing speed index standard scores were on average 12 points lower in the group with ASD compared to the group with typical development. There were, however, no significant group differences in standard score age-related changes within this age range. For subtest raw scores, the group with ASD demonstrated robustly slower processing speeds in the adult versions of the IQ test (i.e., WAIS-III) but not in the child versions (WISC-III), even though age-related changes were similar in both the ASD and typically developing groups. This pattern of results may reflect difficulties that become increasingly evident in ASD on more complex measures of processing speed. Finally, DTI measures of whole-brain white matter microstructure suggested that fractional anisotropy (but not mean diffusivity, radial diffusivity, or axial diffusivity) made significant but small-sized contributions to processing speed standard scores across our entire sample. Taken together, the present findings suggest that robust decreases in processing speed may be present in ASD, more pronounced in adulthood, and partially attributable to white matter microstructural integrity.
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Affiliation(s)
- Brittany G Travers
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA.
| | - Erin D Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT 84602, USA; The Brain Institute of Utah, University of Utah, 36 South Wasatch Drive, Salt Lake City, UT 84112, USA; Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Do P M Tromp
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Nagesh Adluru
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Alyson L Froehlich
- Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT, USA
| | - Chad Ennis
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Nicholas Lange
- Departments of Psychiatry and Biostatistics, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA; Neurostatistics Laboratory, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Jared A Nielsen
- Interdepartmental Program in Neuroscience, University of Utah, 401 MREB, 20 North 1900 East, Salt Lake City, UT 84132, USA
| | - Molly B D Prigge
- Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT, USA
| | - Andrew L Alexander
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA; Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd., Madison, WI 53719, USA; Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Room 1005 Madison, WI 53705, USA
| | - Janet E Lainhart
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA
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DTI Measurements in Multiple Sclerosis: Evaluation of Brain Damage and Clinical Implications. Mult Scler Int 2013; 2013:671730. [PMID: 23606965 PMCID: PMC3628664 DOI: 10.1155/2013/671730] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 02/20/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022] Open
Abstract
Diffusion tensor imaging (DTI) is an effective means of quantifying parameters of demyelination and axonal loss. The application of DTI in Multiple Sclerosis (MS) has yielded noteworthy results. DTI abnormalities, which are already detectable in patients with clinically isolated syndrome (CIS), become more pronounced as disease duration and neurological impairment increase. The assessment of the microstructural alterations of white and grey matter in MS may shed light on mechanisms responsible for irreversible disability accumulation. In this paper, we examine the DTI analysis methods, the results obtained in the various tissues of the central nervous system, and correlations with clinical features and other MRI parameters. The adoption of DTI metrics to assess the outcome of prognostic measures may represent an extremely important step forward in the MS research field.
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Verhey LH, Sled JG. Advanced magnetic resonance imaging in pediatric multiple sclerosis. Neuroimaging Clin N Am 2013; 23:337-54. [PMID: 23608694 DOI: 10.1016/j.nic.2012.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This review summarizes results from studies that have applied advanced magnetic resonance (MR) imaging techniques to patients with pediatric-onset multiple sclerosis (MS), and includes a discussion of cortical imaging techniques, volumetry, magnetization transfer and diffusion tensor imaging, proton magnetic resonance spectroscopy, and functional MR imaging. Multicenter studies on the sensitivity of these techniques to natural history of disease and treatment response are required before their implementation into clinical practice.
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MacAllister WS, Christodoulou C, Milazzo M, Preston TE, Serafin D, Krupp LB, Harder L. Pediatric Multiple Sclerosis: What we know and where are we headed? Child Neuropsychol 2013; 19:1-22. [DOI: 10.1080/09297049.2011.639758] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dockstader C, Gaetz W, Bouffet E, Tabori U, Wang F, Bostan SR, Laughlin S, Mabbott DJ. Neural correlates of delayed visual-motor performance in children treated for brain tumours. Cortex 2012; 49:2140-50. [PMID: 23102743 DOI: 10.1016/j.cortex.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 07/04/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
Abstract
Both structural and functional neural integrity is critical for healthy cognitive function and performance. Across studies, it is evident that children who are affected by neurological insult commonly demonstrate impaired cognitive abilities. Children treated with cranial radiation for brain tumours suffer substantial structural damage and exhibit a particularly high correlation between the degree of neural injury and cognitive deficits. However the pathophysiology underlying impaired cognitive performance in this population, and many other paediatric populations affected by neurological injury or disease, is unknown. We wished to investigate the characteristics of neuronal function during visual-motor task performance in a group of children who were treated with cranial radiation for brain tumours. We used Magnetoencephalography to investigate neural function during visual-motor reaction time (RT) task performance in 15 children treated with cranial radiation for Posterior Fossa malignant brain tumours and 17 healthy controls. We found that, relative to controls, the patient group showed: 1) delayed latencies for neural activation in both visual and motor cortices; 2) muted motor responses in the alpha (8-12Hz) and beta (13-29Hz) bandwidths, and 3) potentiated visual and motor responses in the gamma (30-100Hz) bandwidth. Collectively these observations indicate impaired neural processing during visual-motor RT performance in this population and that delays in the speed of visual and motor neuronal processing both contribute to the delays in the behavioural response. As increases in gamma activity are often observed with increases in attention and effort, increased gamma activities in the patient group may reflect compensatory neural activity during task performance. This is the first study to investigate neural function in real-time during cognitive performance in paediatric brain tumour patients.
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Affiliation(s)
- Colleen Dockstader
- The Hospital for Sick Children, Department of Psychology, Toronto, ON, Canada
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Aliotta R, Cox JL, Donohue K, Weinstock-Guttman B, Yeh EA, Polak P, Dwyer MG, Zivadinov R. Tract-based spatial statistics analysis of diffusion-tensor imaging data in pediatric- and adult-onset multiple sclerosis. Hum Brain Mapp 2012; 35:53-60. [PMID: 22936429 DOI: 10.1002/hbm.22148] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 05/29/2012] [Accepted: 06/05/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND White matter (WM) microstructure may vary significantly in pediatric-onset (PO) and adult-onset (AO) patients with multiple sclerosis (MS), a difference that could be explained by the effects of an inherent plasticity in the affected pediatric brains early in the disease, and a phenomenon that does not occur later in life. This hypothesis would support the observation that disease progression is much slower in POMS compared to AOMS patients. OBJECTIVES To examine WM microstructure in the brain of adults with POMS and AOMS, using tract based spatial statistics (TBSS) analysis of diffusion-tensor imaging (DTI). METHODS Adults with relapsing-remitting (RR) POMS, who were diagnosed before age of 18 years (n = 16), were compared with age-matched (AOA, n = 23) and disease duration-matched (AOD, n = 22) RR patients who developed MS after the age of 18 years. Scans were analyzed using the FSL software package (Oxford, UK) and statistics were performed using TBSS to evaluate WM microstructure between groups based on the mean fractional anisotropy (FA) values obtained from the DTI. RESULTS Widespread cortical and deep WM area differences characterized by increased FA values were seen in the AOAMS compared with POMS group (P < 0.05, TFCE corrected). Significantly increased FA values of posterior WM areas were detected in the AODMS compared with POMS group (P < 0.05, TFCE corrected). CONCLUSION Increased FA values in WM areas of the AOMS compared with the POMS patients suggest that diffuse WM microstructure changes are more attributable to age of onset than a simple function of disease duration and age.
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Affiliation(s)
- Rachel Aliotta
- State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York; Buffalo Neuroimaging Analysis Center, Buffalo, New York
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Palmer SL, Glass JO, Li Y, Ogg R, Qaddoumi I, Armstrong GT, Wright K, Wetmore C, Broniscer A, Gajjar A, Reddick WE. White matter integrity is associated with cognitive processing in patients treated for a posterior fossa brain tumor. Neuro Oncol 2012; 14:1185-93. [PMID: 22898373 DOI: 10.1093/neuonc/nos154] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Children treated for posterior fossa tumors experience reduced cognitive processing speed and, after imaging, show damage to white matter (WM) tracts in the brain. This study explores relationships between white matter microstructure, assessed by fractional anisotropy (FA), and speed of cognitive processing using tract-based spatial statistics (TBSS). At 36 months after treatment with radiotherapy and chemotherapy, 40 patients completed an MRI examination and neuropsychological evaluation. Patients were matched with healthy control subjects based on age, sex, and race. Individual FA values were extracted from examinations for all voxels identified as having significant association between processing speed and FA using TBSS. The regions were labeled anatomically, and fiber tracts were grouped into larger fiber bundle categories based on their anatomical and functional associations. Analyses were performed between mean skeletal FA values in each of the fiber bundles and each of the cognitive processing scores controlling for age. Children 3 years after treatment for posterior fossa brain tumors demonstrate significantly lower processing speed associated with decreased FA, compared with their healthy peers. Commissural fibers in the corpus callosum were negatively affected by disease and therapy with detrimental consequence on patients' cognitive processing. Diffusion tensor imaging of the white matter tracts in the brain is relevant to determining potential mechanisms underlying clinically meaningful change in cognitive performance. Neuroprotective strategies are needed to preserve critical functions.
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Affiliation(s)
- Shawna L Palmer
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA.
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