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Simani L, Molaeipour L, Kian S, Leavitt VM. Correlation between cognitive changes and neuroradiological changes over time in multiple sclerosis: a systematic review and meta-analysis. J Neurol 2024:10.1007/s00415-024-12517-8. [PMID: 38890188 DOI: 10.1007/s00415-024-12517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND While many studies have examined relationships of neuroimaging variables to cognitive measures in multiple sclerosis (MS), longitudinal studies are lacking. The relationship of cognitive changes to neuroradiological changes in MS is thus incompletely understood. The present study systematically reviews all studies reporting a relationship between MRI changes and cognitive changes after at least one year of follow-up. METHOD An extensive and methodical search of online databases was conducted to identify qualified studies until August 2023. Among various cognitive tests and magnetic resonance imaging (MRI) measures, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), verbal fluency, T2 lesion volume (T2LV), white matter lesion volume (WML), and grey matter volume (GMV) qualified for inclusion in a meta-analysis investigating the association of cognitive changes to neuroradiological changes. RESULTS We identified 35 studies that explored the link between MRI changes and changes in cognitive outcomes. Of these, twenty studies (57.14%) investigated the association between SDMT/PASAT and MRI metrics. Eleven studies (31.42%) focused on the relationship between MRI metrics and verbal learning and memory, while ten studies (28.57%) reported associations with visuospatial learning and memory. Furthermore, eight studies (22.85%) analyzed the correlation between verbal fluency and MRI measures. Only 5 were eligible for inclusion in the meta-analysis. The meta-analysis evaluated correlations between SDMT/PASAT and GMV (rs = 0.67, 95% CI 0.44-0.91), and verbal fluency and T2LV (rs = 0.35, 95% CI 0.09-0.60). CONCLUSION In this rigorously conducted systematic review, we found a significant association of cognitive changes, specifically SDMT/PASAT and verbal fluency, to changes in T2LV and atrophy in individuals with MS. Findings should be interpreted cautiously due to the limited amount of high-quality research, small sample sizes, and variability in study methodologies.
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Affiliation(s)
- Leila Simani
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Leila Molaeipour
- Department of Biostatistics and Epidemiology, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeid Kian
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Victoria M Leavitt
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
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Mirmosayyeb O, Nabizadeh F, Moases Ghaffary E, Yazdan Panah M, Zivadinov R, Weinstock-Guttman B, Benedict RHB, Jakimovski D. Cognitive performance and magnetic resonance imaging in people with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2024; 88:105705. [PMID: 38885600 DOI: 10.1016/j.msard.2024.105705] [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: 12/18/2023] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Several studies have shown the different relationships between cognitive functions and structural magnetic resonance imaging (MRI) measurements in people with multiple sclerosis (pwMS). However, there is an ongoing debate regarding the magnitude of correlation between MRI measurements and specific cognitive function tests. This systematic review and meta-analysis aimed to synthesize the most consistent correlations between MRI measurements and cognitive function in pwMS. METHODS PubMed/MEDLINE, Embase, Scopus, and Web of Science databases were systematically searched up to February 2023, to find relevant data. The search utilized syntax and medical subject headings (MeSH) relevant to cognitive performance tests and MRI measurements in pwMS. The R software version 4.3.3 with random effect models was used to estimate the pooled effect sizes. RESULTS 13,559 studies were reviewed, of which 136 were included. The meta-analyses showed that thalamic volume had the most significant correlations with Symbol Digit Modalities Test (SDMT) r = 0.47 (95 % CI: 0.39 to 0.56, p < 0.001, I2 = 88 %), Brief Visual Memory Test-Revised-Total Recall (BVMT-TR) r = 0.51 (95 % CI: 0.36 to 0.66, p < 0.001, I2 = 81 %), California Verbal Learning Test-II-Total Recall (CVLT-TR) r = 0.47 (95 % CI: 0.34 to 0.59, p < 0.001, I2 = 69 %,), and Delis-Kaplan Executive Function System (DKEFS) r = 0.48 (95 % CI: 0.34 to 0.63, p < 0.001, I2 = 22 %,). CONCLUSION We conclude that thalamic volume exhibits highest relationships with information processing speed (IPS), visuospatial learning-memory, verbal learning-memory, and executive function in pwMS. A comprehensive understanding of the intricacies of the mechanisms underpinning this association requires additional research.
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Affiliation(s)
- Omid Mirmosayyeb
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Fardin Nabizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Yazdan Panah
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Ralph H B Benedict
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Dejan Jakimovski
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States; Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States.
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Russo AW, Stockel KE, Tobyne SM, Ngamsombat C, Brewer K, Nummenmaa A, Huang SY, Klawite EC. Associations between corpus callosum damage, clinical disability, and surface-based homologous inter-hemispheric connectivity in multiple sclerosis. Brain Struct Funct 2022; 227:2909-2922. [PMID: 35536387 PMCID: PMC9850837 DOI: 10.1007/s00429-022-02498-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/11/2022] [Indexed: 01/22/2023]
Abstract
Axonal damage in the corpus callosum is prevalent in multiple sclerosis (MS). Although callosal damage is associated with disrupted functional connectivity between hemispheres, it is unclear how this relates to cognitive and physical disability. We investigated this phenomenon using advanced measures of microstructural integrity in the corpus callosum and surface-based homologous inter-hemispheric connectivity (sHIC) in the cortex. We found that sHIC was significantly decreased in primary motor, somatosensory, visual, and temporal cortical areas in a group of 36 participants with MS (29 relapsing-remitting, 4 secondary progressive MS, and 3 primary-progressive MS) compared with 42 healthy controls (cluster level, p < 0.05). In participants with MS, global sHIC correlated with fractional anisotropy and restricted volume fraction in the posterior segment of the corpus callosum (r = 0.426, p = 0.013; r = 0.399, p = 0.020, respectively). Lower sHIC, particularly in somatomotor and posterior cortical areas, was associated with cognitive impairment and higher disability scores on the Expanded Disability Status Scale (EDSS). We demonstrated that higher levels of sHIC attenuated the effects of posterior callosal damage on physical disability and cognitive dysfunction, as measured by the EDSS and Brief Visuospatial Memory Test-Revised (interaction effect, p < 0.05). We also observed a positive association between global sHIC and years of education (r = 0.402, p = 0.018), supporting the phenomenon of "brain reserve" in MS. Our data suggest that preserved sHIC helps prevent cognitive and physical decline in MS.
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Affiliation(s)
- Andrew W. Russo
- Department of Neurology, Massachusetts General Hospital, Boston, MA, US
| | | | - Sean M. Tobyne
- Department of Neurology, Massachusetts General Hospital, Boston, MA, US
| | - Chanon Ngamsombat
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, No. 149, 13th Street, Charlestown, Boston, MA 02129, US
| | - Kristina Brewer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, US
| | - Aapo Nummenmaa
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, No. 149, 13th Street, Charlestown, Boston, MA 02129, US
| | - Susie Y. Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, No. 149, 13th Street, Charlestown, Boston, MA 02129, US
| | - Eric C. Klawite
- Department of Neurology, Massachusetts General Hospital, Boston, MA, US
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Primary CNS lymphoma of the corpus callosum: presentation and neurocognitive outcomes. J Neurooncol 2022; 158:99-109. [PMID: 35445956 DOI: 10.1007/s11060-022-04014-7] [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: 02/19/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The corpus callosum (CC) is frequently involved in primary central nervous system lymphomas (PCNSLs). In this cohort study, we described the neurocognition of patients with PCNSL-CC and its posttherapeutic evolution. METHODS Immunocompetent patients with PCNSL-CC were identified retrospectively at the Pitié-Salpêtrière Hospital. We described their clinical presentation. Neuropsychological test scores (MMSE; digit spans; Free and Cued Selective Reminding Test; Image Oral Naming Test; Frontal Assessment Battery; Trail Making Test; Stroop and verbal fluency tests; Rey's Complex Figure test) and factors impacting them were analyzed. RESULTS Twenty-seven patients were included (median age: 67 years, median Karnofsky Performance Status: 70); cognitive impairment and balance disorders were present in 74% and 59%, respectively. At diagnosis, neuropsychological test results were abnormal for global cognitive efficiency (63% of patients), memory (33-80% depending on the test) and executive functions (44-100%). Results for visuospatial and language tests were normal. All patients received high-dose methotrexate-based polychemotherapy, followed in one patient by whole-brain radiotherapy; 67% of patients achieved complete response (CR). With a median follow-up of 48 months (range 6-156), patients in CR had persistent abnormal test results for global cognitive efficiency in 17%, executive function in 18-60%, depending on the test, and memory in 40-60%. Splenium location and age ≥ 60 years were significantly associated with worse episodic memory scores throughout the follow-up. CONCLUSIONS PCNSL-CC is associated with frequent cognitive dysfunctions, especially memory impairment, which may recover only partially despite CR and warrant specific rehabilitation. Older age (≥ 60) and splenium location are associated with worse neurocognitive outcomes.
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El Ayoubi NK, Bou Reslan SW, Baalbaki MM, Darwish H, Khoury SJ. Effect of fingolimod vs interferon treatment on OCT measurements and cognitive function in RRMS. Mult Scler Relat Disord 2021; 53:103041. [PMID: 34051694 DOI: 10.1016/j.msard.2021.103041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To explore prospectively through OCT the rate of retinal layer changes in relapsing-remitting multiple sclerosis patients followed up on fingolimod or interferon, as well as the treatments' differential effects on cognitive tests scores. METHODS This prospective observational study enrolled 128 stable RRMS patients treated either with fingolimod (n = 71) or interferon (n = 56). Symbol-Digit Modality Test and retinal OCT scans were obtained at baseline and every 6 to 12 months. A subgroup of patients underwent expanded cognitive tests annually (Brief visual-spatial memory-total recall, BVMT-delayed recall, and Montreal Cognitive Assessment). Retinal-OCT scans were also obtained from 22 age- and sex-matched healthy controls. Mixed effects regression was used to study annualized changes in retinal layers and cognitive function, including differences between treatment groups. Correlations between annualized changes in retinal measurements and cognitive scores were also explored. RESULTS Fingolimod treated patients showed no significant difference in the rate of thinning of all retinal layers when compared to healthy controls and had significantly less GCIPL thinning when compared to interferons. SDMT scores improved similarly among both RRMS treatment groups. However, interferon but not fingolimod treated patients had significant decline in MOCA and total recall scores. We also found correlations between the annualized change in GCIPL thickness and annualized change in MOCA scores, and similar correlations with annualized change in total recall scores. CONCLUSION Fingolimod has a potential role in reducing retinal neurodegeneration in RRMS. Longitudinal OCT measures appear to be sensitive to changes in cognitive function and may be useful for monitoring neuroprotective therapies.
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Affiliation(s)
- Nabil K El Ayoubi
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; Department of Neurology, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah W Bou Reslan
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwa M Baalbaki
- Department of Neurology, George Washington University, Washington DC, United States
| | - Hala Darwish
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; Hariri School of Nursing, American University of Beirut, Lebanon
| | - Samia J Khoury
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; Department of Neurology, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Lin SJ, Kolind S, Liu A, McMullen K, Vavasour I, Wang ZJ, Traboulsee A, McKeown MJ. Both Stationary and Dynamic Functional Interhemispheric Connectivity Are Strongly Associated With Performance on Cognitive Tests in Multiple Sclerosis. Front Neurol 2020; 11:407. [PMID: 32581993 PMCID: PMC7287147 DOI: 10.3389/fneur.2020.00407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/20/2020] [Indexed: 01/04/2023] Open
Abstract
Although functional connectivity has been extensively studied in MS, robust estimates of both stationary (static connectivity at the time) and dynamic (connectivity variation across time) functional connectivity has not been commonly evaluated and neither has its association to cognition. In this study, we focused on interhemispheric connections as previous research has shown links between anatomical homologous connections and cognition. We examined functional interhemispheric connectivity (IC) in MS during resting-state functional MRI using both stationary and dynamic strategies and related connectivity measures to processing speed performance. Twenty-five patients with relapsing-remitting MS and 41 controls were recruited. Stationary functional IC was assessed between homologous Regions of Interest (ROIs) using correlation. For dynamic IC, a sliding window approach was used to quantify changes between homologous ROIs across time. We related IC measures to cognitive performance with correlation and regression. Compared to control subjects, MS demonstrated increased IC across homologous regions, which accurately predicted performance on the symbol digit modalities test (SDMT) (R 2 = 0.96) and paced auditory serial addition test (PASAT) (R 2 = 0.59). Dynamic measures were not different between the 2 groups, but dynamic IC was related to PASAT scores. The associations between stationary/dynamic connectivity and cognitive tests demonstrated that different aspects of functional IC were associated with cognitive processes. Processing speed measured in SDMT was associated with static interhemispheric connections and better PASAT performance, which requires working memory, sustain attention, and processing speed, was more related to rigid IC, underlining the neurophysiological mechanism of cognition in MS.
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Affiliation(s)
- Sue-Jin Lin
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, BC, Canada
| | - Shannon Kolind
- Division of Neurology, Department of Medicine, UBC Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Aiping Liu
- Department of Electrical and Computer Engineering Program, University of British Columbia, Vancouver, BC, Canada
| | - Katrina McMullen
- Division of Neurology, Department of Medicine, UBC Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Irene Vavasour
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Z Jane Wang
- Department of Electrical and Computer Engineering Program, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, UBC Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Martin J McKeown
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, BC, Canada.,Division of Neurology, Department of Medicine, UBC Hospital, University of British Columbia, Vancouver, BC, Canada
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Feng Y, Yan W, Wang J, Song J, Zeng Q, Zhao C. Local White Matter Fiber Clustering Differentiates Parkinson's Disease Diagnoses. Neuroscience 2020; 435:146-160. [PMID: 32272152 DOI: 10.1016/j.neuroscience.2020.03.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
Scans without evidence of dopaminergic deficit (SWEDD) patients are often misdiagnosed with Parkinson's disease (PD) but have normal dopamine transporter scans. We hypothesised that white matter tracts associated with motor and cognition functions may be affected differently by SWEDD and PD. Automatically annotated fibre clustering (AAFC) is a novel clustering method based on diffusion magnetic resonance imaging (dMRI) tractography that enables highly robust reconstruction of white matter tracts that are composed of corresponding clusters. This study aimed to investigate the white matter properties in the subdivisions of white matter tracts among SWEDD and PD groups. We applied AAFC to identify white matter tracts related to motion and cognition functions in the dataset consisting of SWEDD (n = 22), PD (n = 30) and normal control (NC) (n = 30). Then, we resampled 200 nodes along fibres of cluster, and the diffusion metric values corresponding to each node were calculated and used for comparison. Compared with NC, PD showed significant difference (p < 0.05) in two clusters in thalamo-frontal (TF), one cluster in thalamo-parietal (TP) and one cluster in thalamo-occipital (TO), whereas SWEDD presented no significant difference. Three clusters in cingulum bundle (CB) commonly exhibited significant differences in PD versus SWEDD and NC versus SWEDD. The support vector machine classifier achieved high accuracies in PD-NC, PD-SWEDD and NC-SWEDD classifications. This outcome validated these local white matter differences were useful to separate the three groups. These results suggest that PD exerts more significant effects on thalamo tracts than SWEDD, and unique microstructural changes occur in CB tract in SWEDD.
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Affiliation(s)
- Yuanjing Feng
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Zhejiang Provincial United Key Laboratory of Embedded Systems, Hangzhou 310023, China.
| | - Wenxuan Yan
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, China
| | - Jingqiang Wang
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, China
| | - Jiahao Song
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, China
| | - Qingrun Zeng
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, China
| | - Changchen Zhao
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, China
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Engl C, Tiemann L, Grahl S, Bussas M, Schmidt P, Pongratz V, Berthele A, Beer A, Gaser C, Kirschke JS, Zimmer C, Hemmer B, Mühlau M. Cognitive impairment in early MS: contribution of white matter lesions, deep grey matter atrophy, and cortical atrophy. J Neurol 2020; 267:2307-2318. [PMID: 32328718 PMCID: PMC7359155 DOI: 10.1007/s00415-020-09841-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/27/2020] [Accepted: 04/14/2020] [Indexed: 12/02/2022]
Abstract
Background Cognitive impairment (CI) is a frequent and debilitating symptom in MS. To better understand the neural bases of CI in MS, this magnetic resonance imaging (MRI) study aimed to identify and quantify related structural brain changes and to investigate their relation to each other. Methods We studied 51 patients with CI and 391 patients with cognitive preservation (CP). We analyzed three-dimensional T1-weighted and FLAIR scans at 3 Tesla. We determined mean cortical thickness as well as volumes of cortical grey matter (GM), deep GM including thalamus, cerebellar cortex, white matter, corpus callosum, and white matter lesions (WML). We also analyzed GM across the whole brain by voxel-wise and surface-based techniques. Results Mean disease duration was 5 years. Comparing MS patients with CI and CP, we found higher volumes of WML, lower volumes of deep and cortical GM structures, and lower volumes of the corpus callosum (all corrected p values < 0.05). Effect sizes were largest for WML and thalamic volume (standardized ß values 0.25 and − 0.25). By logistic regression analysis including both WML and thalamic volume, we found a significant effect only for WML volume. Inclusion of the interaction term of WML and thalamic volume increased the model fit and revealed a highly significant interaction of WML and thalamic volume. Moreover, voxel-wise and surface-based comparisons of MS patients with CI and CP showed regional atrophy of both deep and cortical GM independent of WML volume and overall disability, but effect sizes were lower. Conclusion Although several mechanisms contribute to CI already in the early stage of MS, WML seem to be the main driver with thalamic atrophy primarily intensifying this effect.
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Affiliation(s)
- Christina Engl
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Laura Tiemann
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Sophia Grahl
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Matthias Bussas
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Paul Schmidt
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Viola Pongratz
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Annkathrin Beer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Christian Gaser
- Department of Psychiatry and Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany. .,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.
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Platten M, Martola J, Fink K, Ouellette R, Piehl F, Granberg T. MRI-Based Manual versus Automated Corpus Callosum Volumetric Measurements in Multiple Sclerosis. J Neuroimaging 2019; 30:198-204. [PMID: 31750599 DOI: 10.1111/jon.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/13/2019] [Accepted: 10/26/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND PURPOSE Corpus callosum atrophy is a neurodegenerative biomarker in multiple sclerosis (MS). Manual delineations are gold standard but subjective and labor intensive. Novel automated methods are promising but require validation. We aimed to compare the robustness of manual versus automatic corpus callosum segmentations based on FreeSurfer. METHODS Nine MS patients (6 females, age 38 ± 13 years, disease duration 7.3 ± 5.2 years) were scanned twice with repositioning using 3-dimensional T1 -weighted magnetic resonance imaging on three scanners (two 1.5 T and one 3.0 T), that is, six scans/patient, on the same day. Normalized corpus callosum areas were measured independently by a junior doctor and neuroradiologist. The cross-sectional and longitudinal streams of FreeSurfer were used to segment the corpus callosum volume. RESULTS Manual measurements had high intrarater (junior doctor .96 and neuroradiologist .96) and interrater agreement (.94), by intraclass correlation coefficient (P < .001). The coefficient of variation was lowest for longitudinal FreeSurfer (.96% within scanners; 2.0% between scanners) compared to cross-sectional FreeSurfer (3.7%, P = .001; 3.8%, P = .058) and the neuroradiologist (2.3%, P = .005; 2.4%, P = .33). Longitudinal FreeSurfer was also more accurate than cross-sectional (Dice scores 83.9 ± 7.5% vs. 78.9 ± 8.4%, P < .01 relative to manual segmentations). The corpus callosum measures correlated with physical disability (longitudinal FreeSurfer r = -.36, P < .01; neuroradiologist r = -.32, P < .01) and cognitive disability (longitudinal FreeSurfer r = .68, P < .001; neuroradiologist r = .64, P < .001). CONCLUSIONS FreeSurfer's longitudinal stream provides corpus callosum measures with better repeatability than current manual methods and with similar clinical correlations. However, due to some limitations in accuracy, caution is warranted when using FreeSurfer with clinical data.
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Affiliation(s)
- Michael Platten
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Division of Neuroradiology, Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.,School of Engineering Sciences in Chemistry, Biotechnology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Juha Martola
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Center for Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Russell Ouellette
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Division of Neuroradiology, Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Center for Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Division of Neuroradiology, Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
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10
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Tolf A, Fagius J, Carlson K, Åkerfeldt T, Granberg T, Larsson E, Burman J. Sustained remission in multiple sclerosis after hematopoietic stem cell transplantation. Acta Neurol Scand 2019; 140:320-327. [PMID: 31297793 DOI: 10.1111/ane.13147] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine whether treatment with autologous hematopoietic stem cell transplantation (HSCT) can induce sustained complete remission in patients with multiple sclerosis (MS). MATERIAL AND METHODS Case series of patients with relapsing-remitting MS (n = 10) treated at a single center between 2004 and 2007 and followed up for 10 years. The patients were treated with a BEAM/ATG conditioning regimen (n = 9) or a cyclophosphamide/ATG conditioning regimen (n = 1) followed by infusion of unmanipulated autologous hematopoietic stem cells. The primary endpoint was sustained complete remission. Sustained complete remission was defined as "no evidence of disease activity-4," sustained for a period of at least 5 years without any ongoing disease-modifying treatment. Furthermore, MS was considered as "resolved" if intrathecal IgG production and cerebrospinal fluid neurofilament light levels were normalized as well. RESULTS Five out of 10 patients were in sustained complete remission at the end of the study. In three of them, MS was resolved. CONCLUSIONS Our data demonstrate that sustained complete remission after autologous HSCT for MS is possible.
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Affiliation(s)
- Andreas Tolf
- Department of Neuroscience Uppsala University Uppsala Sweden
| | - Jan Fagius
- Department of Neuroscience Uppsala University Uppsala Sweden
| | - Kristina Carlson
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Torbjörn Åkerfeldt
- Section of Clinical Chemistry and Pharmacology Uppsala University Hospital Uppsala Sweden
| | - Tobias Granberg
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Division of Neuroradiology, Department of Radiology Karolinska University Hospital Stockholm Sweden
| | - Elna‐Marie Larsson
- Department of Surgical Sciences/Radiology Uppsala University Uppsala Sweden
| | - Joachim Burman
- Department of Neuroscience Uppsala University Uppsala Sweden
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11
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Artemiadis A, Anagnostouli M, Zalonis I, Chairopoulos K, Triantafyllou N. Structural MRI correlates of cognitive function in multiple sclerosis. Mult Scler Relat Disord 2018; 21:1-8. [PMID: 29438835 DOI: 10.1016/j.msard.2018.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/03/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cognitive impairment (CI) has been associated with numerous magnetic resonance imaging (MRI) indices in multiple sclerosis (MS) patients. In this study we investigated the association of a large set of 2D and 3D MRI markers with cognitive function in MS. METHODS A sample of 61 RRMS patients (mean age 41.8 ± 10.6 years old, 44 women, mean disease duration 137.9 ± 83.9 months) along with 51 age and gender matched healthy controls was used in this cross-sectional study. Neuropsychological and other tests, along with a large set of 2D/3D MRI evaluations were made. RESULTS 44.3% of patients had CI. CI patients had more disability, physical fatigue than non-CI patients and more psychological distress than non-CI patients and HCs. Also, CI patients had significantly larger third ventricle width and volume, smaller coprus callosum index and larger lesion volume than non-CI patients. These MRI markers also significantly predicted cognitive scores after adjusting for age and education, explaining about 30.6% of the variance of the total cognitive score. CONCLUSIONS Selected linear and volumetric MRI indices predict cognitive function in MS. Future studies should expand these results by exploring longitudinal changes and producing normative data.
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Affiliation(s)
- Artemios Artemiadis
- 1st Department of Neurology, Aeginition Hospital, Faculty of Medicine, National Kapodistrian University of Athens, Vas. Sofias Ave. 72-74, GR-11528 Athens, Greece; Department of Neurology, Army Share Fund Hospital (NIMTS), Monis Petraki 10-12, GR-11521 Athens, Greece.
| | - Maria Anagnostouli
- 1st Department of Neurology, Aeginition Hospital, Faculty of Medicine, National Kapodistrian University of Athens, Vas. Sofias Ave. 72-74, GR-11528 Athens, Greece
| | - Ioannis Zalonis
- 1st Department of Neurology, Aeginition Hospital, Faculty of Medicine, National Kapodistrian University of Athens, Vas. Sofias Ave. 72-74, GR-11528 Athens, Greece
| | - Konstantinos Chairopoulos
- Department of Neurology, Army Share Fund Hospital (NIMTS), Monis Petraki 10-12, GR-11521 Athens, Greece
| | - Nikos Triantafyllou
- 1st Department of Neurology, Aeginition Hospital, Faculty of Medicine, National Kapodistrian University of Athens, Vas. Sofias Ave. 72-74, GR-11528 Athens, Greece
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12
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Hughes AJ, Dunn KM, Chaffee T. Sleep Disturbance and Cognitive Dysfunction in Multiple Sclerosis: a Systematic Review. Curr Neurol Neurosci Rep 2018; 18:2. [PMID: 29380072 DOI: 10.1007/s11910-018-0809-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW The present review summarizes recent research on the association between sleep disturbance and cognitive dysfunction in MS. Assessment methodology, domain-specific associations between sleep disturbance and cognitive dysfunction, and implications for future research and treatment are discussed. RECENT FINDINGS All 12 studies included in this review found significant associations between sleep disturbance and cognitive dysfunction; however, results varied considerably depending on the assessment method used and the cognitive domain assessed. Self-reported sleep disturbance generally predicted self-report but not objective measures of cognitive dysfunction. Objective sleep measures (e.g., polysomnography, actigraphy) generally predicted objective impairments in processing speed and attention; however, objective sleep disturbance was more variable in predicting performance in other cognitive domains (e.g., memory, executive function). Sleep disturbance may help predict future cognitive decline in MS. Results highlight the need to integrate sleep assessment into routine MS care. Interventions aimed treating sleep disturbance may offer promise for improving cognitive dysfunction in MS.
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Affiliation(s)
- Abbey J Hughes
- Department of Physical Medicine and Rehabilitation, Division for Rehabilitation Psychology and Neuropsychology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Katherine M Dunn
- Department of Physical Medicine and Rehabilitation, Division for Rehabilitation Psychology and Neuropsychology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Psychology, Loyola University Maryland, Baltimore, MD, USA
| | - Trisha Chaffee
- Department of Physical Medicine and Rehabilitation, Division for Rehabilitation Psychology and Neuropsychology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Delorme S, De Guio F, Reyes S, Jabouley A, Chabriat H, Jouvent E. Reaction Time Is Negatively Associated with Corpus Callosum Area in the Early Stages of CADASIL. AJNR Am J Neuroradiol 2017; 38:2094-2099. [PMID: 28912283 DOI: 10.3174/ajnr.a5378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/23/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Reaction time was recently recognized as a marker of subtle cognitive and behavioral alterations in the early clinical stages of CADASIL, a monogenic cerebral small-vessel disease. In unselected patients with CADASIL, brain atrophy and lacunes are the main imaging correlates of disease severity, but MR imaging correlates of reaction time in mildly affected patients are unknown. We hypothesized that reaction time is independently associated with the corpus callosum area in the early clinical stages of CADASIL. MATERIALS AND METHODS Twenty-six patients with CADASIL without dementia (Mini-Mental State Examination score > 24 and no cognitive symptoms) and without disability (modified Rankin Scale score ≤ 1) were compared with 29 age- and sex-matched controls. Corpus callosum area was determined on 3D-T1 MR imaging sequences with validated methodology. Between-group comparisons were performed with t tests or χ2 tests when appropriate. Relationships between reaction time and corpus callosum area were tested using linear regression modeling. RESULTS Reaction time was significantly related to corpus callosum area in patients (estimate = -7.4 × 103, standard error = 3.3 × 103, P = .03) even after adjustment for age, sex, level of education, and scores of depression and apathy (estimate = -12.2 × 103, standard error = 3.8 × 103, P = .005). No significant relationship was observed in controls. CONCLUSIONS Corpus callosum area, a simple and robust imaging parameter, appears to be an independent correlate of reaction time at the early clinical stages of CADASIL. Further studies will determine whether corpus callosum area can be used as an outcome in future clinical trials in CADASIL or in more prevalent small-vessel diseases.
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Affiliation(s)
- S Delorme
- From the University Paris Diderot (S.D., F.D.G., H.C., E.J.), Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France
| | - F De Guio
- From the University Paris Diderot (S.D., F.D.G., H.C., E.J.), Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité (F.D.G., H.C., E.J.), Paris, France
| | - S Reyes
- Department of Neurology (S.R., A.J., H.C., E.J.), AP-HP, Lariboisière Hospital, Paris, France
| | - A Jabouley
- Department of Neurology (S.R., A.J., H.C., E.J.), AP-HP, Lariboisière Hospital, Paris, France
| | - H Chabriat
- From the University Paris Diderot (S.D., F.D.G., H.C., E.J.), Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité (F.D.G., H.C., E.J.), Paris, France.,Department of Neurology (S.R., A.J., H.C., E.J.), AP-HP, Lariboisière Hospital, Paris, France
| | - E Jouvent
- From the University Paris Diderot (S.D., F.D.G., H.C., E.J.), Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France .,DHU NeuroVasc Sorbonne Paris Cité (F.D.G., H.C., E.J.), Paris, France.,Department of Neurology (S.R., A.J., H.C., E.J.), AP-HP, Lariboisière Hospital, Paris, France
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14
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Papathanasiou A, Messinis L, Zampakis P, Papathanasopoulos P. Corpus callosum atrophy as a marker of clinically meaningful cognitive decline in secondary progressive multiple sclerosis. Impact on employment status. J Clin Neurosci 2017; 43:170-175. [PMID: 28601572 DOI: 10.1016/j.jocn.2017.05.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/22/2017] [Indexed: 11/16/2022]
Abstract
Cognitive impairment in Multiple Sclerosis (MS) is more frequent and pronounced in secondary progressive MS (SPMS). Cognitive decline is an important predictor of employment status in patients with MS. Magnetic Resonance Imaging (MRI) markers have been used to associate tissue damage with cognitive dysfunction. The aim of the study was to designate the MRI marker that predicts cognitive decline in SPMS and explore its effect on employment status. 30 SPMS patients and 30 healthy participants underwent neuropsychological assessment using the Trail Making Test (TMT) parts A and B, semantic and phonological verbal fluency task and a computerized cognitive screening battery (Central Nervous System Vital Signs). Employment status was obtained as a quality of life measure. Brain MRI was performed in all participants. We measured total lesion volume, third ventricle width, thalamic and corpus callosum atrophy. The frequency of cognitive decline for our SPMS patients was 80%. SPMS patients differed significantly from controls in all neuropsychological measures. Corpus callosum area was correlated with cognitive flexibility, processing speed, composite memory, executive functions, psychomotor speed, reaction time and phonological verbal fluency task. Processing speed and composite memory were the most sensitive markers for predicting employment status. Corpus callosum area was the most sensitive MRI marker for memory and processing speed. Corpus callosum atrophy predicts a clinically meaningful cognitive decline, affecting employment status in our SPMS patients.
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Affiliation(s)
- Athanasios Papathanasiou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; Neuropsychology Section, Department of Neurology, University of Patras Medical School, Patras 265 04, Greece.
| | - Lambros Messinis
- Neuropsychology Section, Department of Neurology, University of Patras Medical School, Patras 265 04, Greece
| | - Petros Zampakis
- Department of Radiology, University of Patras Medical School, Patras 265 04, Greece
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15
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Morrow SA, Menon S, Rosehart H, Sharma M. Developing easy to perform routine MRI measurements as potential surrogates for cognitive impairment in MS. Clin Neurol Neurosurg 2017; 153:73-78. [PMID: 28061362 DOI: 10.1016/j.clineuro.2016.12.015] [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: 02/05/2016] [Revised: 12/22/2016] [Accepted: 12/26/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES One of the most frequently disabling symptoms in Multiple Sclerosis (MS) is cognitive impairment which is often insidious in onset and therefore difficult to recognize in the early stages, for both persons with MS and clinicians. A biomarker that would help identify those at risk of cognitive impairment, or with only mild impairment, would be a useful tool for clinicians. Using MRI, already an integral tool in the diagnosis and monitoring of disease activity in MS, would be ideal. Thus, this study aimed to determine if simple measures on routine MRI could serve as potential biomarkers for cognitive impairment in MS. PATIENTS AND METHODS We retrospectively identified 51 persons with MS who had a cognitive assessment and MRI within six months of the MRI. Simple linear measurements of the hippocampi, bifrontral and third ventricular width, bicaudate width and the anterior, mid and posterior corpus callosum were made. Pearson's correlations examined the relationship between these MRI measures and cognitive tests, and MRI measures were compared in persons with MS who were either normal or cognitively impaired on objective cognitive tests using Analysis of Covariance (ANCOVA). RESULTS Bicaudate span and third ventricular width were both negatively correlated, while corpus callosal measures were positive correlated with cognitive test performance. After controlling for potential confounders, bicaudate span was significant different on measures of immediate recall. Both anterior and posterior corpus collosal measure were significantly different on measures of verbal fluency, immediate recall and higher executive function; while the anterior corpus callosum was also significantly different on processing speed. The middle corpus collosal measure was significantly different on immediate recall and higher executive function. CONCLUSION This study presents data demonstrating that simple to apply MRI measures of atrophy may serve as biomarkers for cognitive impairment in persons with MS. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Sarah A Morrow
- University of Western Ontario (Western), London Health Sciences Center, University Hospital, Department of Clinical Neurological Sciences, LHSC-UH, 339 Windermere Road, London, ON N5A 5A5, Canada; St. Joseph's Health Care, Parkwood Institute, Department of Cognitive Neurology, 550 Wellington Road, London, ON N6C 0A7, Canada.
| | - Suresh Menon
- University of Western Ontario (Western), London Health Sciences Center, University Hospital, Department of Clinical Neurological Sciences, LHSC-UH, 339 Windermere Road, London, ON N5A 5A5, Canada; Present Address: McMaster University, Hamilton General Hospital, 237 Barton Street East, Department of Medicine, Division of Neurology, Hamilton, ON L8L 2X2, Canada
| | - Heather Rosehart
- University of Western Ontario (Western), London Health Sciences Center, University Hospital, Department of Clinical Neurological Sciences, LHSC-UH, 339 Windermere Road, London, ON N5A 5A5, Canada
| | - Manas Sharma
- University of Western Ontario (Western), London Health Sciences Center, University Hospital, Department of Radiology/Medical Imaging, LHSC-UH, 339 Windermere Road B10-006, London, ON N5A 5A5, Canada
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16
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Paul F. Pathology and MRI: exploring cognitive impairment in MS. Acta Neurol Scand 2016; 134 Suppl 200:24-33. [PMID: 27580903 DOI: 10.1111/ane.12649] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/24/2023]
Abstract
Cognitive impairment is a frequent symptom in people with multiple sclerosis, affecting up to 70% of patients. This article reviews the published association of cognitive dysfunction with neuroimaging findings. Cognitive impairment has been related to focal T2 hyperintense lesions, diffuse white matter damage and corical and deep gray matter atrophy. Focal lesions cannot sufficiently explain cognitive dysfunction in MS; microstructural tissue damage detectable by diffusion tensor imaging and gray matter atrophy are probably at least as relevant. Resting state functional magnetic resonance imaging is increasingly used to investigate the contribution of functional connectivity changes to cognitive function in MS. The fact that at least one third of MS patients are not overtly cognitively impaired despite significant radiographic tissue damage argues for protective factors (brain reserve, cognitive reserve) that require further clarification. It is concluded that the reported correlations between imaging findings and cognitive function do not imply causality. Well conceived and sufficiently powered longitudinal studies are lacking. Such studies would help unravel protective mechanisms against cogniitve decline and identify suitable imaging techniques to monitor cognitive function in individual patients with MS.
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Affiliation(s)
- F. Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité - Universitaetsmedizin Berlin; Berlin Germany
- Experimental and Clinical Research Center; Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin; Berlin Germany
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17
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Tobyne SM, Boratyn D, Johnson JA, Greve DN, Mainero C, Klawiter EC. A surface-based technique for mapping homotopic interhemispheric connectivity: Development, characterization, and clinical application. Hum Brain Mapp 2016; 37:2849-68. [PMID: 27219660 DOI: 10.1002/hbm.23214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 02/01/2023] Open
Abstract
The functional organization of the human brain consists of a high degree of connectivity between interhemispheric homologous regions. The degree of homotopic organization is known to vary across the cortex and homotopic connectivity is high in regions that share cross-hemisphere structural connections or are activated by common input streams (e.g., the visual system). Damage to one or both regions, as well as damage to the connections between homotopic regions, could disrupt this functional organization. Here were introduce and test a computationally efficient technique, surface-based homotopic interhermispheric connectivity (sHIC), that leverages surface-based registration and processing techniques in an attempt to improve the spatial specificity and accuracy of cortical interhemispheric connectivity estimated with resting state functional connectivity. This technique is shown to be reliable both within and across subjects. sHIC is also characterized in a dataset of nearly 1000 subjects. We confirm previous results showing increased interhemispheric connectivity in primary sensory regions, and reveal a novel rostro-caudal functionally defined network level pattern of sHIC across the brain. In addition, we demonstrate a structural-functional relationship between sHIC and atrophy of the corpus callosum in multiple sclerosis (r = 0.2979, p = 0.0461). sHIC presents as a sensitive and reliable measure of cortical homotopy that may prove useful as a biomarker in neurologic disease. Hum Brain Mapp 37:2849-2868, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sean M Tobyne
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daria Boratyn
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Douglas N Greve
- Athinoula a. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Caterina Mainero
- Athinoula a. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric C Klawiter
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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18
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Zivadinov R, Jakimovski D, Gandhi S, Ahmed R, Dwyer MG, Horakova D, Weinstock-Guttman B, Benedict RRH, Vaneckova M, Barnett M, Bergsland N. Clinical relevance of brain atrophy assessment in multiple sclerosis. Implications for its use in a clinical routine. Expert Rev Neurother 2016; 16:777-93. [PMID: 27105209 DOI: 10.1080/14737175.2016.1181543] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Brain atrophy measurement in multiple sclerosis (MS) has become an important outcome for determining patients at risk for developing physical and cognitive disability. AREAS COVERED In this article, we discuss the methodological issues related to using this MRI metric routinely, in a clinical setting. Understanding trajectories of annualized whole brain, gray and white matter, thalamic volume loss, and enlargement of ventricular space in specific MS phenotypes is becoming increasingly important. Evidence is mounting that disease-modifying treatments exert a positive effect on slowing brain atrophy progression in MS. Expert Commentary: While there is a need to translate measurement of brain atrophy to clinical routine at the individual patient level, there are still a number of challenges to be met before this can actually happen, including how to account for biological confounding factors and pseudoatrophy, standardize acquisition and analyses parameters, which can influence the accuracy of the assessments.
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Affiliation(s)
- Robert Zivadinov
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Dejan Jakimovski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Sirin Gandhi
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Rahil Ahmed
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Michael G Dwyer
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Dana Horakova
- c Department of Neurology and Center of Clinical Neuroscience , Charles University in Prague, First Faculty of Medicine and General University Hospital , Prague , Czech Republic
| | - Bianca Weinstock-Guttman
- d Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Ralph R H Benedict
- d Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Manuela Vaneckova
- e Department of Radiology, First Faculty of Medicine and General University Hospital , Charles University , Prague , Czech Republic
| | - Michael Barnett
- f Sydney Neuroimaging Analysis Centre; Brain & Mind Centre , University of Sydney , Sydney , Australia
| | - Niels Bergsland
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,g IRCCS 'S.Maria Nascente' , Don Gnocchi Foundation , Milan , Italy
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19
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Costa SL, Genova HM, DeLuca J, Chiaravalloti ND. Information processing speed in multiple sclerosis: Past, present, and future. Mult Scler 2016; 23:772-789. [PMID: 27207446 DOI: 10.1177/1352458516645869] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Information processing speed (IPS) is a prevalent cognitive impairment in multiple sclerosis (MS). OBJECTIVES This review aims to summarize the methods applied to assess IPS in MS and its theoretical conceptualization. A PubMed search was performed to select articles published between 1 January 2004 and 31 December 2013, resulting in 157 articles included. RESULTS The majority (54%) of studies assessed IPS with heterogeneous samples (several disease courses). Studies often report controlling for presence of other neurological disorders (60.5%), age (58.6%), education (51.6%), alcohol history (47.8%), or use of steroids (39.5%). Potential confounding variables, such as recent relapses (50.3%), history of developmental disorders (19.1%), and visual problems (29.9%), were often neglected. Assessments used to study IPS were heterogeneous (ranging from simple to complex tasks) among the studies under review, with 62 different tasks used. Only 9.6% of articles defined the construct of IPS and 22.3% discussed IPS in relation to a theoretical model. FUTURE DIRECTIONS The challenges for the upcoming decade include clarification of the definition of IPS as well as its theoretical conceptualization and a consensus on assessment. Based on the results obtained, we propose a new theoretical model, the tri-factor model of IPS.
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Affiliation(s)
- Silvana L Costa
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Helen M Genova
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - John DeLuca
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA/Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nancy D Chiaravalloti
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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20
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Giddaluru S, Espeseth T, Salami A, Westlye LT, Lundquist A, Christoforou A, Cichon S, Adolfsson R, Steen VM, Reinvang I, Nilsson LG, Le Hellard S, Nyberg L. Genetics of structural connectivity and information processing in the brain. Brain Struct Funct 2016; 221:4643-4661. [PMID: 26852023 PMCID: PMC5102980 DOI: 10.1007/s00429-016-1194-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 01/22/2016] [Indexed: 12/20/2022]
Abstract
Understanding the genetic factors underlying brain structural connectivity is a major challenge in imaging genetics. Here, we present results from genome-wide association studies (GWASs) of whole-brain white matter (WM) fractional anisotropy (FA), an index of microstructural coherence measured using diffusion tensor imaging. Data from independent GWASs of 355 Swedish and 250 Norwegian healthy adults were integrated by meta-analysis to enhance power. Complementary GWASs on behavioral data reflecting processing speed, which is related to microstructural properties of WM pathways, were performed and integrated with WM FA results via multimodal analysis to identify shared genetic associations. One locus on chromosome 17 (rs145994492) showed genome-wide significant association with WM FA (meta P value = 1.87 × 10-08). Suggestive associations (Meta P value <1 × 10-06) were observed for 12 loci, including one containing ZFPM2 (lowest meta P value = 7.44 × 10-08). This locus was also implicated in multimodal analysis of WM FA and processing speed (lowest Fisher P value = 8.56 × 10-07). ZFPM2 is relevant in specification of corticothalamic neurons during brain development. Analysis of SNPs associated with processing speed revealed association with a locus that included SSPO (lowest meta P value = 4.37 × 10-08), which has been linked to commissural axon growth. An intergenic SNP (rs183854424) 14 kb downstream of CSMD1, which is implicated in schizophrenia, showed suggestive evidence of association in the WM FA meta-analysis (meta P value = 1.43 × 10-07) and the multimodal analysis (Fisher P value = 1 × 10-07). These findings provide novel data on the genetics of WM pathways and processing speed, and highlight a role of ZFPM2 and CSMD1 in information processing in the brain.
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Affiliation(s)
- Sudheer Giddaluru
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,K.G.Jebsen Center for Psychosis Research and the Norwegian Center for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Thomas Espeseth
- K.G. Jebsen Center for Psychosis Research, Norwegian Center for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, 0424, Oslo, Norway.,Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Alireza Salami
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, 90187, Umeå, Sweden.,Aging Research Center, Karolinska Institutet and Stockholm University, 11330, Stockholm, Sweden
| | - Lars T Westlye
- K.G. Jebsen Center for Psychosis Research, Norwegian Center for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, 0424, Oslo, Norway.,Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Anders Lundquist
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, 90187, Umeå, Sweden.,Department of Statistics, USBF, Umeå University, 90187, Umeå, Sweden
| | - Andrea Christoforou
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,K.G.Jebsen Center for Psychosis Research and the Norwegian Center for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Sven Cichon
- Division of Medical Genetics, Department of Biomedicine, University of Basel, 4058, Basel, Switzerland.,Institute of Neuroscience and Medicine (INM-1), Research Center Juelich, 52425, Juelich, Germany.,Department of Genomics, Life and Brain Center, University of Bonn, 53127, Bonn, Germany
| | - Rolf Adolfsson
- Department of Clinical Sciences, Psychiatry, Umeå University, 90187, Umeå, Sweden
| | - Vidar M Steen
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,K.G.Jebsen Center for Psychosis Research and the Norwegian Center for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Ivar Reinvang
- Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Lars Göran Nilsson
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, 90187, Umeå, Sweden.,ARC, Karolinska Institutet, Stockholm, Sweden
| | - Stéphanie Le Hellard
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,K.G.Jebsen Center for Psychosis Research and the Norwegian Center for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Lars Nyberg
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, 90187, Umeå, Sweden. .,Department of Radiation Sciences, Umeå University, 90187, Umeå, Sweden. .,Department of Integrative Medical Biology, Umeå University, 90187, Umeå, Sweden.
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22
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Granberg T, Bergendal G, Shams S, Aspelin P, Kristoffersen-Wiberg M, Fredrikson S, Martola J. MRI-Defined Corpus Callosal Atrophy in Multiple Sclerosis: A Comparison of Volumetric Measurements, Corpus Callosum Area and Index. J Neuroimaging 2015; 25:996-1001. [DOI: 10.1111/jon.12237] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Tobias Granberg
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
| | - Gösta Bergendal
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Neurology; Karolinska University Hospital; Stockholm Sweden
| | - Sara Shams
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
| | - Peter Aspelin
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
| | - Maria Kristoffersen-Wiberg
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Neurology; Karolinska University Hospital; Stockholm Sweden
| | - Juha Martola
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
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23
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Granberg T, Martola J, Bergendal G, Shams S, Damangir S, Aspelin P, Fredrikson S, Kristoffersen-Wiberg M. Corpus callosum atrophy is strongly associated with cognitive impairment in multiple sclerosis: Results of a 17-year longitudinal study. Mult Scler 2014; 21:1151-8. [DOI: 10.1177/1352458514560928] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/30/2014] [Indexed: 11/15/2022]
Abstract
Background: Cognitive impairment is common in multiple sclerosis (MS) and may be subtle. The corpus callosum is essential for connectivity-demanding cognitive tasks and is significantly affected in MS, therefore it may serve as a marker for cognitive function. Objective: The objective of this paper is to longitudinally study the normalized corpus callosum area (nCCA) as a marker of cognitive function and disability in MS. Methods: Thirty-seven MS patients were followed from 1996 with follow-ups in 2004 and 2013. A healthy matched control group was recruited. The Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT) were assessed. The nCCA was measured on T2-weighted images. Volumetry was performed with FreeSurfer. Results: Disease duration spanned five decades (1.6–46 years). Annual corpus callosal atrophy rate decreased with disease duration. nCCA was strongly correlated with SDMT ( r = 0.793, p < 0.001) and moderately correlated with EDSS ( r = −0.545, p < 0.001) after adjusting for disease duration, age and sex. The correlations of brain parenchymal fraction, white matter fraction, gray matter fraction and normalized lesion volume were less strong. Conclusions: The nCCA correlates well with physical and cognitive disability in time perspectives close to two decades, outperforming volumetric measurements. The nCCA is fast and could be feasible for clinical implementation where it may help identify patients in need of neuropsychological evaluation.
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Affiliation(s)
- Tobias Granberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Juha Martola
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gösta Bergendal
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Shams
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Soheil Damangir
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Kristoffersen-Wiberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
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Klawiter EC, Ceccarelli A, Arora A, Jackson J, Bakshi S, Kim G, Miller J, Tauhid S, von Gizycki C, Bakshi R, Neema M. Corpus callosum atrophy correlates with gray matter atrophy in patients with multiple sclerosis. J Neuroimaging 2014; 25:62-7. [PMID: 24816394 DOI: 10.1111/jon.12124] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/12/2014] [Accepted: 03/02/2014] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Atrophy of the corpus callosum is a recognized characteristic of multiple sclerosis (MS). We describe a new reliable method for measuring corpus callosum atrophy and correlate this with global cerebral atrophy measures. METHODS Whole brain 3T MRI was performed in 38 relapsing-remitting MS subjects and 21 healthy controls (HC). Brain global gray and white matter volumes were segmented with SPM8. The contour of the corpus callosum was outlined on the midline of 3-D T1-weighted images by a semiautomated edge-detection technique to determine the corpus callosum area (CCA). Normalized CCA was correlated with other brain atrophy measures in MS subjects. RESULTS CCA was disproportionately lower in MS subjects vs. HC (20.1% mean decrease; P < .001), with a large effect size (d = .62) when compared with global atrophy measures. In MS subjects, CCA correlated with brain parenchymal fraction (r = .55; P < .001) and gray matter fraction (r = .45; P = .005) but not white matter fraction (r = .18; P = .29). An inverse correlation with FLAIR hyperintense lesion volume (r = -.40; P = .01) was detected for CCA. CONCLUSION Measurement of atrophy of the corpus callosum can have sensitivity as a useful imaging biomarker in patients with MS, even in patients with low disability levels. Both gray and white matter involvement in MS contribute to corpus callosum atrophy.
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Affiliation(s)
- Eric C Klawiter
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Yaldizli Ö, Penner IK, Frontzek K, Naegelin Y, Amann M, Papadopoulou A, Sprenger T, Kuhle J, Calabrese P, Radü EW, Kappos L, Gass A. The relationship between total and regional corpus callosum atrophy, cognitive impairment and fatigue in multiple sclerosis patients. Mult Scler 2013; 20:356-64. [DOI: 10.1177/1352458513496880] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: The objective of this paper is to investigate the relationship between total and regional corpus callosum (CC) atrophy, neuropsychological test performance and fatigue in multiple sclerosis (MS) patients. Methods: We conducted a cross-sectional study in 113 MS patients: mean age 48±11 years, 75/113 women, 84/113 relapsing–remitting MS, mean disease duration 21±9 years, mean Expanded Disability Status Scale (EDSS) score 3.2±1.7. All patients underwent brain magnetic resonance imaging, standardised neurological assessment and comprehensive cognitive testing including assessments for fatigue and depression. Total and regional CC atrophy was assessed using the corpus callosum index (CCI). Results: CCI correlated more strongly with T2- and T1-lesion volume and whole brain volume than with disease duration or EDSS score. CCI correlated strongly with the verbal fluency test (VFT), Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT). Multivariate regression analysis revealed that atrophy of the posterior CC segment was significantly associated with poor outcome in the PASAT, VFT and SDMT. In contrast, atrophy of the anterior CC segment was significantly associated with fatigue severity and poor outcome in the long-term memory test. Conclusions: Atrophy of the CC is associated with cognitive impairment and fatigue. Regional CCI results indicate that these associations are partially spatially segregated.
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Affiliation(s)
- Özgür Yaldizli
- Department of Neurology, University Hospital Basel, Switzerland
| | - Iris-Katharina Penner
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Cognitive Psychology and Methodology, University of Basel, Switzerland
| | - Karl Frontzek
- Institute of Neuropathology, University Hospital Zurich, Switzerland
| | - Yvonne Naegelin
- Department of Neurology, University Hospital Basel, Switzerland
| | - Michael Amann
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Neuroradiology, University Hospital Basel, Switzerland
| | - Athina Papadopoulou
- Department of Neurology, University Hospital Basel, Switzerland
- Medical Image Analysis Center, Switzerland
| | - Till Sprenger
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Neuroradiology, University Hospital Basel, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Switzerland
- Bone and Joint Research Unit/Neuroimmunology Unit, William Harvey Research Institute/Blizard Institute at Barts and the London School of Medicine and Dentistry, UK
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Switzerland
| | | | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Switzerland
| | - Achim Gass
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Neurology, University Hospital Mannheim, Germany
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