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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; 271:5498-5518. [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] [MESH Headings] [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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Miletic-Drakulic S, Miloradovic I, Jankovic V, Azanjac-Arsic A, Lazarevic S. VEP Score of a Left Eye Had Predictive Values for Achieving NEDA-3 over Ten Years in Patients with Multiple Sclerosis. SENSORS (BASEL, SWITZERLAND) 2022; 22:8849. [PMID: 36433445 PMCID: PMC9696926 DOI: 10.3390/s22228849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The aim of this study was to determine the predictive value of visual evoked potentials (VEPs) in patients with relapsing-remitting multiple sclerosis (RRMS) in achieving no evidence of disease activity-3 (NEDA-3) during up to 10 years of first-line immunomodulatory therapy and to determine whether the lateralization of optic nerve damage may have prognostic significance concerning clinical disability and response to therapy. METHODS In a retrospective study, a total of 83 patients (53 female and 30 male) with RRMS participated. The average age of patients was 38.31 ± 9.01. Patients were followed for 2, 5 or 10 years. VEPs were measured at the beginning of the follow-up and after many years of monitoring. Data on optical neuritis (ON) were obtained from medical history. The degree of disability was estimated by the neurologist (independent rater), and magnetic resonance (MR) imaging of the endocranium was performed with gadolinium contrasts. Achieving NEDA-3 is considered a favorable outcome of treatments. RESULTS Among those treated, 19 (22.9%) reached NEDA-3, while 64 (77.1%) did not reach NEDA-3. The values of the evoked potential (EP) score for the left eye (r = 0.008, odds ratio (OR) = 0.344 (0.156-0.757)) and latency for the left eye (r = 0.042, OR = 0.966 (0.934-0.999)) at the onset of disease were predictive factors for achieving NEDA-3. CONCLUSIONS A normal VEP at the beginning of RRMS increases the chance of reaching NEDA-3 by about six times.
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Petracca M, Pontillo G, Moccia M, Carotenuto A, Cocozza S, Lanzillo R, Brunetti A, Brescia Morra V. Neuroimaging Correlates of Cognitive Dysfunction in Adults with Multiple Sclerosis. Brain Sci 2021; 11:346. [PMID: 33803287 PMCID: PMC8000635 DOI: 10.3390/brainsci11030346] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Cognitive impairment is a frequent and meaningful symptom in multiple sclerosis (MS), caused by the accrual of brain structural damage only partially counteracted by effective functional reorganization. As both these aspects can be successfully investigated through the application of advanced neuroimaging, here, we offer an up-to-date overview of the latest findings on structural, functional and metabolic correlates of cognitive impairment in adults with MS, focusing on the mechanisms sustaining damage accrual and on the identification of useful imaging markers of cognitive decline.
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Affiliation(s)
- Maria Petracca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
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Preziosa P, Pagani E, Mesaros S, Riccitelli GC, Dackovic J, Drulovic J, Filippi M, Rocca MA. Progression of regional atrophy in the left hemisphere contributes to clinical and cognitive deterioration in multiple sclerosis: A 5-year study. Hum Brain Mapp 2017; 38:5648-5665. [PMID: 28792103 DOI: 10.1002/hbm.23755] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/22/2017] [Accepted: 07/25/2017] [Indexed: 01/18/2023] Open
Abstract
In this longitudinal study, we investigated the regional patterns of focal lesions accumulation, and gray (GM) and white matter (WM) atrophy progression over a five-year follow-up (FU) in multiple sclerosis (MS) patients and their association with clinical and cognitive deterioration. Neurological, neuropsychological and brain MRI (dual-echo and 3D T1-weighted sequences) assessments were prospectively performed at baseline (T0) and after a median FU of 4.9 years from 66 MS patients (including relapse-onset and primary progressive MS) and 16 matched controls. Lesion probability maps were obtained. Longitudinal changes of GM and WM volumes and their association with clinical and cognitive deterioration were assessed using tensor-based morphometry and SPM12. At FU, 36/66 (54.5%) MS patients showed a significant disability worsening, 14/66 (21.2%) evolved to a worse clinical phenotype, and 18/63 (28.6%) developed cognitive deterioration. At T0, compared to controls, MS patients showed a widespread pattern of GM atrophy, involving cortex, deep GM and cerebellum, and atrophy of the majority of WM tracts, which further progressed at FU (P < 0.001, uncorrected). Compared to stable patients, those with clinical and cognitive worsening showed a left-lateralized pattern of GM and WM atrophy, involving deep GM, fronto-temporo-parieto-occipital regions, cerebellum, and several WM tracts (P < 0.001, uncorrected).GM and WM atrophy of relevant brain regions occur in MS after 5 years. A different vulnerability of the two brain hemispheres to irreversible structural damage may be among the factors contributing to clinical and cognitive worsening in these patients. Hum Brain Mapp 38:5648-5665, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sarlota Mesaros
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gianna C Riccitelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jelena Dackovic
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Drulovic
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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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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Caucheteux N, Maarouf A, Genevray M, Leray E, Deschamps R, Chaunu MP, Daelman L, Ferré JC, Gout O, Pelletier J, Pierot L, Edan G, Tourbah A. Criteria improving multiple sclerosis diagnosis at the first MRI. J Neurol 2015; 262:979-87. [DOI: 10.1007/s00415-015-7668-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 10/24/2022]
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Ruet A, Hamel D, Deloire MSA, Charré-Morin J, Saubusse A, Brochet B. Information processing speed impairment and cerebellar dysfunction in relapsing–remitting multiple sclerosis. J Neurol Sci 2014; 347:246-50. [DOI: 10.1016/j.jns.2014.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/30/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Aurélie Ruet
- Service de Neurologie, CHU de Bordeaux, F-33076 Bordeaux, France; INSERM-CHU CIC-P 0005, CHU de Bordeaux, F-33076 Bordeaux, France
| | - Delphine Hamel
- Neurocentre Magendie, INSERM U862, Université de Bordeaux, F-33076 Bordeaux, France; Translational Research and Advanced Imaging Laboratory (TRAIL) cluster of excellence, Université de Bordeaux, F-33076 Bordeaux, France
| | - Mathilde S A Deloire
- Service de Neurologie, CHU de Bordeaux, F-33076 Bordeaux, France; INSERM-CHU CIC-P 0005, CHU de Bordeaux, F-33076 Bordeaux, France
| | - Julie Charré-Morin
- Service de Neurologie, CHU de Bordeaux, F-33076 Bordeaux, France; INSERM-CHU CIC-P 0005, CHU de Bordeaux, F-33076 Bordeaux, France
| | - Aurore Saubusse
- Service de Neurologie, CHU de Bordeaux, F-33076 Bordeaux, France; INSERM-CHU CIC-P 0005, CHU de Bordeaux, F-33076 Bordeaux, France
| | - Bruno Brochet
- Service de Neurologie, CHU de Bordeaux, F-33076 Bordeaux, France; INSERM-CHU CIC-P 0005, CHU de Bordeaux, F-33076 Bordeaux, France; Neurocentre Magendie, INSERM U862, Université de Bordeaux, F-33076 Bordeaux, France; Translational Research and Advanced Imaging Laboratory (TRAIL) cluster of excellence, Université de Bordeaux, F-33076 Bordeaux, France.
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Eliasova I, Anderkova L, Marecek R, Rektorova I. Non-invasive brain stimulation of the right inferior frontal gyrus may improve attention in early Alzheimer's disease: a pilot study. J Neurol Sci 2014; 346:318-22. [PMID: 25216556 DOI: 10.1016/j.jns.2014.08.036] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/02/2014] [Accepted: 08/24/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive tool for modulating cortical activity. OBJECTIVES In this pilot study, we evaluated the effects of high frequency rTMS applied over the right inferior frontal gyrus (IFG) on cognitive functions in patients with amnestic mild cognitive impairment (MCI) or incipient dementia due to Alzheimer's disease (AD). METHODS Ten patients (6 men; 4 women, mean age of 72 ± 8 years; MMSE 23 ± 3.56) were enrolled in a randomized, placebo-controlled study with a crossover design. All participants received 2 sessions of 10 Hz rTMS over the non-dominant right hemisphere in random order: IFG (active stimulation site) and vertex (control stimulation site). Intensities were adjusted to 90% of resting motor threshold. A total of 2250 pulses were applied in a session. The Trail Making Test (TMT), the Stroop test, and the complex visual scene encoding task (CVSET) were administered before and immediately after each session. The Wilcoxon paired test was used for data analysis. RESULTS Stimulation applied over the IFG induced improvement in the TMT parts A (p = 0.037) and B (p = 0.049). No significant changes were found in the Stroop test or the CVSET after the IFG stimulation. We observed no significant cognitive aftereffects of rTMS applied over the vertex. CONCLUSIONS High frequency rTMS of the right IFG induced significant improvement of attention and psychomotor speed in patients with MCI/mild dementia due to AD. This pilot study is part of a more complex protocol and ongoing research.
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Affiliation(s)
- Ilona Eliasova
- First Department of Neurology, St. Anne's University Hospital, School of Medicine, Masaryk University, Brno, Czech Republic; Brain and Mind Research Program, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Lubomira Anderkova
- First Department of Neurology, St. Anne's University Hospital, School of Medicine, Masaryk University, Brno, Czech Republic; Brain and Mind Research Program, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Radek Marecek
- First Department of Neurology, St. Anne's University Hospital, School of Medicine, Masaryk University, Brno, Czech Republic; Brain and Mind Research Program, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Irena Rektorova
- First Department of Neurology, St. Anne's University Hospital, School of Medicine, Masaryk University, Brno, Czech Republic; Brain and Mind Research Program, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic.
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Lansley J, Mataix-Cols D, Grau M, Radua J, Sastre-Garriga J. Localized grey matter atrophy in multiple sclerosis: A meta-analysis of voxel-based morphometry studies and associations with functional disability. Neurosci Biobehav Rev 2013; 37:819-30. [DOI: 10.1016/j.neubiorev.2013.03.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/27/2013] [Accepted: 03/11/2013] [Indexed: 01/01/2023]
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Habek M. Evaluation of brainstem involvement in multiple sclerosis. Expert Rev Neurother 2013; 13:299-311. [DOI: 10.1586/ern.13.18] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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