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Kampaite A, Gustafsson R, York EN, Foley P, MacDougall NJJ, Bastin ME, Chandran S, Waldman AD, Meijboom R. Brain connectivity changes underlying depression and fatigue in relapsing-remitting multiple sclerosis: A systematic review. PLoS One 2024; 19:e0299634. [PMID: 38551913 PMCID: PMC10980255 DOI: 10.1371/journal.pone.0299634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/13/2024] [Indexed: 04/01/2024] Open
Abstract
Multiple Sclerosis (MS) is an autoimmune disease affecting the central nervous system, characterised by neuroinflammation and neurodegeneration. Fatigue and depression are common, debilitating, and intertwined symptoms in people with relapsing-remitting MS (pwRRMS). An increased understanding of brain changes and mechanisms underlying fatigue and depression in RRMS could lead to more effective interventions and enhancement of quality of life. To elucidate the relationship between depression and fatigue and brain connectivity in pwRRMS we conducted a systematic review. Searched databases were PubMed, Web-of-Science and Scopus. Inclusion criteria were: studied participants with RRMS (n ≥ 20; ≥ 18 years old) and differentiated between MS subtypes; published between 2001-01-01 and 2023-01-18; used fatigue and depression assessments validated for MS; included brain structural, functional magnetic resonance imaging (fMRI) or diffusion MRI (dMRI). Sixty studies met the criteria: 18 dMRI (15 fatigue, 5 depression) and 22 fMRI (20 fatigue, 5 depression) studies. The literature was heterogeneous; half of studies reported no correlation between brain connectivity measures and fatigue or depression. Positive findings showed that abnormal cortico-limbic structural and functional connectivity was associated with depression. Fatigue was linked to connectivity measures in cortico-thalamic-basal-ganglial networks. Additionally, both depression and fatigue were related to altered cingulum structural connectivity, and functional connectivity involving thalamus, cerebellum, frontal lobe, ventral tegmental area, striatum, default mode and attention networks, and supramarginal, precentral, and postcentral gyri. Qualitative analysis suggests structural and functional connectivity changes, possibly due to axonal and/or myelin loss, in the cortico-thalamic-basal-ganglial and cortico-limbic network may underlie fatigue and depression in pwRRMS, respectively, but the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies. This highlights the need for further studies including advanced MRI to detect more subtle brain changes in association with depression and fatigue. Future studies using optimised imaging protocols and validated depression and fatigue measures are required to clarify the substrates underlying these symptoms in pwRRMS.
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Affiliation(s)
- Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecka Gustafsson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth N. York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Foley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Niall J. J. MacDougall
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Mark E. Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
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Chitnis T, Vandercappellen J, King M, Brichetto G. Symptom Interconnectivity in Multiple Sclerosis: A Narrative Review of Potential Underlying Biological Disease Processes. Neurol Ther 2022; 11:1043-1070. [PMID: 35680693 PMCID: PMC9338216 DOI: 10.1007/s40120-022-00368-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Fatigue, cognitive impairment, depression, and pain are highly prevalent symptoms in multiple sclerosis (MS). These often co-occur and may be explained by a common etiology. By reviewing existing literature, we aimed to identify potential underlying biological processes implicated in the interconnectivity between these symptoms. Methods A literature search was conducted to identify articles reporting research into the biological mechanisms responsible for the manifestation of fatigue, cognitive impairment, depression, and pain in MS. PubMed was used to search for articles published from July 2011 to July 2021. We reviewed and assessed findings from the literature to identify biological processes common to the symptoms of interest. Results Of 693 articles identified from the search, 252 were selected following screening of titles and abstracts and assessing reference lists of review articles. Four biological processes linked with two or more of the symptoms of interest were frequently identified from the literature: (1) direct neuroanatomical changes to brain regions linked with symptoms of interest (e.g., thalamic injury associated with cognitive impairment, fatigue, and depression), (2) pro-inflammatory cytokines associated with so-called ‘sickness behavior,’ including manifestation of fatigue, transient cognitive impairment, depression, and pain, (3) dysregulation of monoaminergic pathways leading to depressive symptoms and fatigue, and (4) hyperactivity of the hypothalamic–pituitary-adrenal (HPA) axis as a result of pro-inflammatory cytokines promoting the release of brain noradrenaline, serotonin, and tryptophan, which is associated with symptoms of depression and cognitive impairment. Conclusion The co-occurrence of fatigue, cognitive impairment, depression, and pain in MS appears to be associated with a common set of etiological factors, namely neuroanatomical changes, pro-inflammatory cytokines, dysregulation of monoaminergic pathways, and a hyperactive HPA axis. This association of symptoms and biological processes has important implications for disease management strategies and, eventually, could help find a common therapeutic pathway that will impact both inflammation and neuroprotection. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00368-2.
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Affiliation(s)
- Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | | | - Miriam King
- Novartis Pharma AG, Fabrikstrasse 12-2, 4056, Basel, Switzerland
| | - Giampaolo Brichetto
- Associazione Italiana Sclerosi Multipla Rehabilitation Center, Via Operai, 30, 16149, Genoa, GE, Italy
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Comparison of the Effects of Cuprizone on Demyelination in the Corpus Callosum and Hippocampal Progenitors in Young Adult and Aged Mice. Neurochem Res 2022; 47:1073-1082. [DOI: 10.1007/s11064-021-03506-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 01/08/2023]
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Baltan S, Jawaid SS, Chomyk AM, Kidd GJ, Chen J, Battapady HD, Chan R, Dutta R, Trapp BD. Neuronal hibernation following hippocampal demyelination. Acta Neuropathol Commun 2021; 9:34. [PMID: 33648591 PMCID: PMC7923530 DOI: 10.1186/s40478-021-01130-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/11/2021] [Indexed: 12/15/2022] Open
Abstract
Cognitive dysfunction occurs in greater than 50% of individuals with multiple sclerosis (MS). Hippocampal demyelination is a prominent feature of postmortem MS brains and hippocampal atrophy correlates with cognitive decline in MS patients. Cellular and molecular mechanisms responsible for neuronal dysfunction in demyelinated hippocampi are not fully understood. Here we investigate a mouse model of hippocampal demyelination where twelve weeks of treatment with the oligodendrocyte toxin, cuprizone, demyelinates over 90% of the hippocampus and causes decreased memory/learning. Long-term potentiation (LTP) of hippocampal CA1 pyramidal neurons is considered to be a major cellular readout of learning and memory in the mammalian brain. In acute slices, we establish that hippocampal demyelination abolishes LTP and excitatory post-synaptic potentials of CA1 neurons, while pre-synaptic function of Schaeffer collateral fibers is preserved. Demyelination also reduced Ca2+-mediated firing of hippocampal neurons in vivo. Using three-dimensional electron microscopy, we investigated the number, shape (mushroom, stubby, thin), and post-synaptic densities (PSDs) of dendritic spines that facilitate LTP. Hippocampal demyelination did not alter the number of dendritic spines. Surprisingly, dendritic spines appeared to be more mature in demyelinated hippocampi, with a significant increase in mushroom-shaped spines, more perforated PSDs, and more astrocyte participation in the tripartite synapse. RNA sequencing experiments identified 400 altered transcripts in demyelinated hippocampi. Gene transcripts that regulate myelination, synaptic signaling, astrocyte function, and innate immunity were altered in demyelinated hippocampi. Hippocampal remyelination rescued synaptic transmission, LTP, and the majority of gene transcript changes. We establish that CA1 neurons projecting demyelinated axons silence their dendritic spines and hibernate in a state that may protect the demyelinated axon and facilitates functional recovery following remyelination.
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Affiliation(s)
- Selva Baltan
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue/NC30, Cleveland, OH, 44195, USA
- Department of Perioperative Medicine, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Safdar S Jawaid
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue/NC30, Cleveland, OH, 44195, USA
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Anthony M Chomyk
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue/NC30, Cleveland, OH, 44195, USA
| | - Grahame J Kidd
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue/NC30, Cleveland, OH, 44195, USA
| | - Jacqueline Chen
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue/NC30, Cleveland, OH, 44195, USA
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Harsha D Battapady
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue/NC30, Cleveland, OH, 44195, USA
| | - Ricky Chan
- Cleveland Institute for Computational Biology, Cleveland, OH, 44106, USA
| | - Ranjan Dutta
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue/NC30, Cleveland, OH, 44195, USA
| | - Bruce D Trapp
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue/NC30, Cleveland, OH, 44195, USA.
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Carvalho V, Soares C, Gomes I, Carvalho A, Serrazina F, Rodrigues SG, Pinheiro J, Marques IB, Correia F, Correia AS, de Sá J, Sousa L, Vale J, Sá MJ, Sousa C, Ferreira J. RISCOP-Cognitive profile in a Portuguese cohort of radiological isolated syndrome patients: A case-control study. Mult Scler Relat Disord 2021; 50:102832. [PMID: 33596492 DOI: 10.1016/j.msard.2021.102832] [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: 12/11/2020] [Revised: 01/31/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Radiologically isolated syndrome (RIS) refers to the incidental discovery of white matter lesions suggestive of MS, on brain MRI, in asymptomatic patients. Recent studies suggest similar features of cognitive impairment between RIS and MS patients. Also, lower levels of health-related quality of life (QOL) and fatigue are reported in such patients. AIMS characterize and compare the cognitive profile of a multicentric Portuguese cohort of RIS patients with a control group. METHODS multicentric comparative study of a cohort of adult patients with RIS, and age and gender-matched controls followed in the headache outpatient clinic with prior MRI not fulfilling criteria for RIS diagnosis. We conducted interviews with participants, collected clinical data and applied the BICAMS battery and self-reported questionnaires (HADS, MFIS, MSQOL-54). RESULTS we evaluated 31 patients with RIS (median age 46 years, IQR [(Dusankova et al., 2012-52], 72% women) and 19 control individuals (median age 32 years, IQR [(O'Jile et al., 2005-48], 71% women). Prevalence of cognitive impairment did not differ between groups (16% of the RIS and 10% of the controls, p=0.579). We found no differences between groups on the BICAMS tests, although the results of the California Verbal Learning Test (CVLT-II) score presented a trend to significance, with a lower value on the RIS group (53.9 vs. 59.3, p=0.066). There were no significant differences regarding fatigue, QOL, anxiety/depression scores. CONCLUSION this is the first study on a Portuguese cohort of RIS patients assessing cognitive profile with BICAMS. A non-neglectable part of our cohort presented cognitive impairment. Our findings add to previous studies in suggesting that a more pronounced impairment of verbal memory and learning, evaluated by CVLT-II, may be present in RIS patients compared to controls. BICAMS should be assessed on future studies with larger cohorts.
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Affiliation(s)
- Vanessa Carvalho
- Department of Neurology, Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
| | - Carolina Soares
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Inês Gomes
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Andreia Carvalho
- Department of Neurology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Filipa Serrazina
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | | | - Joaquim Pinheiro
- Department of Neurology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Filipe Correia
- Department of Neurology, Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Ana Sofia Correia
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - João de Sá
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Lívia Sousa
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Vale
- Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Maria José Sá
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Health Sciences Faculty, Universidade Fernando Pessoa, Porto, Portugal
| | - Cláudia Sousa
- Department of Psychology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - João Ferreira
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
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Golan D, Doniger GM, Srinivasan J, Sima DM, Zarif M, Bumstead B, Buhse M, Van Hecke W, Wilken J, Gudesblatt M. The association between MRI brain volumes and computerized cognitive scores of people with multiple sclerosis. Brain Cogn 2020; 145:105614. [PMID: 32927305 DOI: 10.1016/j.bandc.2020.105614] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Computerized cognitive assessment facilitates the incorporation of multi-domain cognitive monitoring into routine clinical care. The predictive validity of computerized cognitive assessment among people with multiple sclerosis (PwMS) has scarcely been investigated. OBJECTIVE To explore the associations between brain volumes and cognitive scores from a computerized cognitive assessment battery (CAB, NeuroTrax) among PwMS. METHODS PwMS were evaluated with the CAB and underwent brain MRI within 40 days. Cognitive assessment yielded age- and education-adjusted scores in 9 cognitive domains: memory, executive function, attention, information processing speed, visual spatial, verbal function, motor skills, problem solving, and working memory. The global cognitive score (GCS) is the average of all domain scores. MRI brain and lesion volumes were assessed with icobrain ms, a fully automated tissue and lesion segmentation and quantification software. RESULTS 91 PwMS were included [Age: 52.1 ± 11.7 years, 64 (70%) female, EDSS: 3.4 ± 2.0, 79 (87%) with a relapsing remitting course]. Significant correlations were found between the GCS and whole brain, white matter, grey matter, thalamic, lateral ventricles, hippocampal and lesion volumes (Correlation coefficients: 0.46, 0.40, 0.25, 0.42, -0.36, 0.21, -0.3, respectively). Regression analysis revealed that lateral ventricles and thalamic volumes were the most consistent predictors of all cognitive domain scores. CONCLUSION Computerized cognitive scores were significantly associated with quantified MRI. These findings support the predictive validity of multi-domain computerized cognitive assessment for people with multiple sclerosis.
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Affiliation(s)
- Daniel Golan
- Department of Neurology & Multiple Sclerosis Center, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | | | - Diana M Sima
- Research and Development Department, icometrix, Leuven, Belgium
| | - Myassar Zarif
- South Shore Neurologic Associates, Patchogue, NY, USA
| | | | | | - Wim Van Hecke
- Research and Development Department, icometrix, Leuven, Belgium
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA; Department of Neurology, Georgetown University, Washington DC, USA
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Matias-Guiu JA, Cortés-Martínez A, Valles-Salgado M, Oreja-Guevara C, Pytel V, Montero P, Moreno-Ramos T, Matias-Guiu J. Functional Components of Cognitive Impairment in Multiple Sclerosis: A Cross-Sectional Investigation. Front Neurol 2017; 8:643. [PMID: 29234305 PMCID: PMC5712315 DOI: 10.3389/fneur.2017.00643] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022] Open
Abstract
Background Cognitive impairment is frequent and disabling in multiple sclerosis (MS). Changes in information processing speed constitute the most important cognitive deficit in MS. However, given the clinical and topographical variability of the disease, cognitive impairment may vary greatly and appear in other forms in addition to slower information processing speed. Our aim was to determine the frequency of cognitive impairment, the principal cognitive domains, and components involved in MS and to identify factors associated with presence of cognitive impairment in these patients in a large series of patients. Methods Cross-sectional study of 311 patients with MS [236 with relapsing-remitting MS (RRMS), 52 with secondary progressive MS (SPMS), and 23 with primary progressive MS (PPMS)]. Patients' cognitive function was assessed with a comprehensive neuropsychological assessment protocol. Patients displaying deficits in 2 or more cognitive domains were considered to have cognitive impairment associated with MS. We conducted a principal component analysis to detect different cognitive patterns by identifying clusters of tests highly correlated to one another. Results Cognitive impairment was detected in 41.5% of the sample, and it was more frequent in patients with SPMS and PPMS (P = 0.002). Expanded Disability Status Scale scores and education were independent predictors of cognitive impairment. Principal component analysis identified seven clusters: attention and basic executive function (including information processing speed), planning and high-level executive function, verbal memory and language, executive and visuospatial performance time, fatigue-depression, visuospatial function, and basic attention and verbal/visual working memory. Mean scoring of components 2 (high-order executive functioning) and 3 (verbal memory-language) was higher in patients with RRMS than in those with PPMS (component 2) and SPMS (component 3). Conclusion MS is linked to multiple cognitive profiles and disturbances in different domains. This suggests that cognitive alterations in MS are heterogeneous and affect other domains in addition to information processing speed.
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Affiliation(s)
- Jordi A Matias-Guiu
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Cortés-Martínez
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - María Valles-Salgado
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Celia Oreja-Guevara
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Vanesa Pytel
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Paloma Montero
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Teresa Moreno-Ramos
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Matias-Guiu
- Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
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Cognitive impairment and structural brain changes in patients with clinically isolated syndrome at high risk for multiple sclerosis. J Neurol 2016; 264:482-493. [DOI: 10.1007/s00415-016-8368-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/10/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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Vollmer T, Huynh L, Kelley C, Galebach P, Signorovitch J, DiBernardo A, Sasane R. Relationship between brain volume loss and cognitive outcomes among patients with multiple sclerosis: a systematic literature review. Neurol Sci 2015; 37:165-79. [PMID: 26537494 DOI: 10.1007/s10072-015-2400-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022]
Abstract
Patients with multiple sclerosis (MS) experience varying rates of brain volume (BV) loss ranging from 0.5 to 1.5 % per year. In addition, 66 % of patients with MS experience cognitive impairment, resulting in impact on daily activities. A systematic literature review (2003-2013) was conducted to identify all studies reporting a relationship between whole BV measures and selected patient outcomes measuring cognition, including the Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT) and MS Functional Composite (MSFC) scores. We identified 18 studies reporting associations between whole BV and cognitive outcomes. Six studies (33 %) examined the association between BV and SDMT; all six studies reported that BV loss (BVL) was significantly associated with a decline in SDMT scores (all p < 0.05). Among 14 studies (78 %) that examined the association between BV and PASAT scores, 12 (86 %) found a significant relationship between BVL and lower PASAT scores (all p < 0.05). Of the seven studies (39 %) that looked at BV and MSFC, six studies (86 %) found BVL significantly associated with lower MSFC scores (all p < 0.05). Our study demonstrated that BVL is associated with declines in cognition in MS patients across several cognition measures. The results of this study suggest that BV is a critical component of disease activity and progression in MS and has implications for treatment decisions to minimize BVL and preserve cognitive functioning.
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Affiliation(s)
- Timothy Vollmer
- Department of Neurology, University of Colorado Denver, 12631 East 17th Avenue, Aurora, CO, 80045, USA
| | - Lynn Huynh
- Analysis Group, Inc., 111 Huntington Avenue, 10th floor, Boston, MA, 02199, USA
| | - Caroline Kelley
- Analysis Group, Inc., 111 Huntington Avenue, 10th floor, Boston, MA, 02199, USA
| | - Philip Galebach
- Analysis Group, Inc., 111 Huntington Avenue, 10th floor, Boston, MA, 02199, USA
| | - James Signorovitch
- Analysis Group, Inc., 111 Huntington Avenue, 10th floor, Boston, MA, 02199, USA.
| | - Allitia DiBernardo
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hannover, NJ, 07936, USA
| | - Rahul Sasane
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hannover, NJ, 07936, USA
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Lee S, Zipunnikov V, Reich DS, Pham DL. Statistical image analysis of longitudinal RAVENS images. Front Neurosci 2015; 9:368. [PMID: 26539071 PMCID: PMC4611144 DOI: 10.3389/fnins.2015.00368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 09/23/2015] [Indexed: 11/13/2022] Open
Abstract
Regional analysis of volumes examined in normalized space (RAVENS) are transformation images used in the study of brain morphometry. In this paper, RAVENS images are analyzed using a longitudinal variant of voxel-based morphometry (VBM) and longitudinal functional principal component analysis (LFPCA) for high-dimensional images. We demonstrate that the latter overcomes the limitations of standard longitudinal VBM analyses, which does not separate registration errors from other longitudinal changes and baseline patterns. This is especially important in contexts where longitudinal changes are only a small fraction of the overall observed variability, which is typical in normal aging and many chronic diseases. Our simulation study shows that LFPCA effectively separates registration error from baseline and longitudinal signals of interest by decomposing RAVENS images measured at multiple visits into three components: a subject-specific imaging random intercept that quantifies the cross-sectional variability, a subject-specific imaging slope that quantifies the irreversible changes over multiple visits, and a subject-visit specific imaging deviation. We describe strategies to identify baseline/longitudinal variation and registration errors combined with covariates of interest. Our analysis suggests that specific regional brain atrophy and ventricular enlargement are associated with multiple sclerosis (MS) disease progression.
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Affiliation(s)
- Seonjoo Lee
- Department of Psychiatry and Biostatistics, Columbia University New York, NY, USA ; New York State Psychiatric Institute New York, NY, USA
| | - Vadim Zipunnikov
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University Baltimore, MD, USA
| | - Daniel S Reich
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University Baltimore, MD, USA ; Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, MD, USA
| | - Dzung L Pham
- Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine Bethesda, MD, USA
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11
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Hanken K, Manousi A, Klein J, Kastrup A, Eling P, Hildebrandt H. On the relation between self-reported cognitive fatigue and the posterior hypothalamic-brainstem network. Eur J Neurol 2015; 23:101-9. [PMID: 26278274 DOI: 10.1111/ene.12815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Various causes have been suggested for multiple sclerosis (MS) related fatigue. Hypothalamus-brainstem fibres play a role in sleep-wake regulation and in hypothalamic deactivation during inflammatory states. Hence, they may play a role for experiencing fatigue by changing bottom-up hypothalamic activation. METHODS Multiple sclerosis patients with and without self-reported cognitive fatigue and healthy controls were analysed with respect to the integrity of hypothalamus-brainstem fibres using diffusion-tensor imaging based tractography, focusing on the anterior, medial and posterior hypothalamic areas, controlling for clinical impairment and excluding participants with depressive mood. RESULTS Multiple sclerosis patients without self-reported cognitive fatigue showed increased axial and radial diffusivity levels specifically for fibres connecting the right posterior hypothalamus with the right locus coeruleus, but not for the medial hypothalamus and the corpus callosum. Moreover, there were no differences between MS patients with and without fatigue in brain atrophy and lesion load, which could explain our results. CONCLUSION Multiple sclerosis patients not experiencing fatigue show increased axial and radial diffusivity for fibres connecting the posterior hypothalamus and the brainstem, which might prevent bottom-up activation of the posterior hypothalamus and therefore downregulation of structures responsible for wakefulness and exploratory states of mind.
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Affiliation(s)
- K Hanken
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany.,Department of Neuropsychology and Behavioral Neurobiology, Universität Bremen, Bremen, Germany
| | - A Manousi
- Department of Neuropsychology and Behavioral Neurobiology, Universität Bremen, Bremen, Germany
| | - J Klein
- Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
| | - A Kastrup
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - P Eling
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - H Hildebrandt
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany.,Department of Psychology, University of Oldenburg, Oldenburg, Germany
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12
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DeLuca GC, Yates RL, Beale H, Morrow SA. Cognitive impairment in multiple sclerosis: clinical, radiologic and pathologic insights. Brain Pathol 2015; 25:79-98. [PMID: 25521179 PMCID: PMC8029470 DOI: 10.1111/bpa.12220] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 01/18/2023] Open
Abstract
Cognitive impairment is a common and debilitating feature of multiple sclerosis (MS) that has only recent gained considerable attention. Clinical neuropsychological studies have made apparent the multifaceted nature of cognitive troubles often encountered in MS and continue to broaden our understanding of its complexity. Radiographic studies have started to decipher the neuroanatomic substrate of MS-related cognitive impairment and have shed light onto its pathogenesis. Where radiographic studies have been limited by inadequate resolution or non-specificity, pathological studies have come to the fore. This review aims to provide an overview of the nature of cognitive impairment typically seen in MS and to explore the literature on imaging and pathological studies relevant to its evolution. In particular, the relative contributions of gray (i.e., cerebral cortex, hippocampus, thalamus and basal ganglia) and white matter to MS-related cognitive impairment will be discussed and the importance of interconnectivity between structures highlighted. The pressing need for longitudinal studies combining standardized neuropsychometric, paraclinical and radiographic outcomes obtained during life with post-mortem tissue analysis after death is presented.
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Affiliation(s)
- Gabriele C. DeLuca
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Richard L. Yates
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Harry Beale
- Oxford Medical SchoolUniversity of OxfordOxfordUK
| | - Sarah A. Morrow
- Department of Clinical Neurological SciencesThe University of Western OntarioLondonCanada
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13
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Hildebrandt H, Eling P. A longitudinal study on fatigue, depression, and their relation to neurocognition in multiple sclerosis. J Clin Exp Neuropsychol 2014; 36:410-7. [DOI: 10.1080/13803395.2014.903900] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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14
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Correlations between MRI and Information Processing Speed in MS: A Meta-Analysis. Mult Scler Int 2014; 2014:975803. [PMID: 24795824 PMCID: PMC3984845 DOI: 10.1155/2014/975803] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/25/2014] [Accepted: 02/09/2014] [Indexed: 12/03/2022] Open
Abstract
Objectives. To examine relationships between conventional MRI measures and the paced auditory serial addition test (PASAT) and symbol digit modalities test (SDMT). Methods. A systematic literature review was conducted. Included studies had ≥30 multiple sclerosis (MS) patients, administered the SDMT or PASAT, and measured T2LV or brain atrophy. Meta-analysis of MRI/information processing speed (IPS) correlations, analysis of MRI/IPS significance tests to account for reporting bias, and binomial testing to detect trends when comparing correlation strengths of SDMT versus PASAT and T2LV versus atrophy were conducted. Results. The 39 studies identified frequently reported only significant correlations, suggesting reporting bias. Direct meta-analysis was only feasible for correlations between SDMT and T2LV (r = −0.45, P < 0.001) and atrophy in patients with mixed-MS subtypes (r = −0.54, P < 0.001). Familywise Holm-Bonferroni testing found that selective reporting was not the source of at least half of significant results reported. Binomial tests (P = 0.006) favored SDMT over PASAT in strength of MRI correlations. Conclusions. A moderate-to-strong correlation exists between impaired IPS and MRI in mixed MS populations. Correlations with MRI were stronger for SDMT than for PASAT. Neither heterogeneity among populations nor reporting bias appeared to be responsible for these findings.
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15
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Shkil’nyuk GG, Il’ves AG, Kataeva GV, Prakhova LN, Reznikova TN, Seliverstova NA, Stolyarov ID. The Role of Changes in Glucose Metabolism in the Brain in the Formation of Cognitive Impairments in Patients with Remitting and Secondary-Progressive Multiple Sclerosis. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s11055-013-9772-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Horakova D, Kalincik T, Dusankova JB, Dolezal O. Clinical correlates of grey matter pathology in multiple sclerosis. BMC Neurol 2012; 12:10. [PMID: 22397707 PMCID: PMC3311149 DOI: 10.1186/1471-2377-12-10] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 03/07/2012] [Indexed: 12/26/2022] Open
Abstract
Traditionally, multiple sclerosis has been viewed as a disease predominantly affecting white matter. However, this view has lately been subject to numerous changes, as new evidence of anatomical and histological changes as well as of molecular targets within the grey matter has arisen. This advance was driven mainly by novel imaging techniques, however, these have not yet been implemented in routine clinical practice. The changes in the grey matter are related to physical and cognitive disability seen in individuals with multiple sclerosis. Furthermore, damage to several grey matter structures can be associated with impairment of specific functions. Therefore, we conclude that grey matter damage - global and regional - has the potential to become a marker of disease activity, complementary to the currently used magnetic resonance markers (global brain atrophy and T2 hyperintense lesions). Furthermore, it may improve the prediction of the future disease course and response to therapy in individual patients and may also become a reliable additional surrogate marker of treatment effect.
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Affiliation(s)
- Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
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17
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Sämann PG, Knop M, Golgor E, Messler S, Czisch M, Weber F. Brain volume and diffusion markers as predictors of disability and short-term disease evolution in multiple sclerosis. AJNR Am J Neuroradiol 2012; 33:1356-62. [PMID: 22383242 DOI: 10.3174/ajnr.a2972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MRI markers of neuroaxonal damage in MS have emerged as critical long-term predictors of MS-related disability. Here we investigated the potential of whole-brain diffusivity and brain volume for the prediction of cross-sectional disability and short- to medium-term clinical evolution. MATERIALS AND METHODS In this multimodal prospective longitudinal MRI study of 54 patients with MS (87% under immunomodulatory therapy, baseline and follow-up at a median of 12 months), ADC histogram analysis, WM lesion load, BPF, whole-brain atrophy rate, MSFC score, and EDSS score were obtained. A total of 44 patients with no relapse at both time points were included. RESULTS At both time points, ADC histogram analysis provided robust predictors of the MSFC scores (maximal R(2) = 0.576, P < .001), incorporated cognition and fine-motor skill subscores, and EDSS scores. Significant changes beyond physiologic age-related changes at follow-up were noted for ADC histogram markers and BPF. Stronger diffusivity alterations and brain volume at baseline predicted MSFC decline, as demonstrated by multiple linear regression analysis (mean ADC, R(2) = 0.203; P = .003) and lower baseline BPF in patients with declined compared with stable MSFC scores (P = .001). Results were independent of intercurrent relapses. CONCLUSIONS Diffusion histogram analysis provided stable surrogates of disability in MS and proved sensitive for monitoring disease progression during a median of 12 months. Advanced neuroaxonal pathology at baseline was indicative of an increased risk for sustained progression during a median of 12 months, independent of intercurrent relapses.
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Affiliation(s)
- P G Sämann
- Neuroimaging Research Group, Max Planck Institute of Psychiatry, Munich, Germany.
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18
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Calabrese M, Rinaldi F, Grossi P, Gallo P. Cortical pathology and cognitive impairment in multiple sclerosis. Expert Rev Neurother 2011; 11:425-32. [PMID: 21375447 DOI: 10.1586/ern.10.155] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cognitive impairment constitutes a relevant clinical aspect of multiple sclerosis (MS). Depending on the disease phase and type, 40-65% of MS patients develop various degrees of cognitive dysfunction. Pathological and MRI studies have failed to demonstrate the existence of a strict relationship between cognitive impairment and subcortical white matter pathology. The correlation is also poor when MRI metrics of whole brain (white plus gray matter) atrophy are considered. Over the last decade, increasing observations have provided evidence of a primary role of cortical pathology - that is, inflammatory focal lesions (cortical lesions) and atrophy (cortical thickness) - in determining global and/or selective cognitive disability in MS. By applying a new semi-automated software (Freesurfer) to analyze the global and regional cortical thickness and the double inversion recovery sequence to identify cortical lesions, it has been observed that specific cognitive deficits, such as memory impairment, attention deficits and reduced mental processing speed, could be better explained by cortical structural abnormalities rather than subcortical white matter lesions. Therefore, MRI evaluation of cortical pathology should be included in the routine examination of MS patients, especially those with initial signs/symptoms of cognitive dysfunctions.
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Affiliation(s)
- Massimiliano Calabrese
- Multiple Sclerosis Centre of Veneto Region, First Neurology Clinic, Department of Neurosciences, University Hospital of Padova, Padova, 35128, Italy
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19
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Deloire MSA, Ruet A, Hamel D, Bonnet M, Dousset V, Brochet B. MRI predictors of cognitive outcome in early multiple sclerosis. Neurology 2011; 76:1161-7. [PMID: 21444901 DOI: 10.1212/wnl.0b013e318212a8be] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine MRI predictors for cognitive outcome in patients with early relapsing-remitting multiple sclerosis (MS). METHODS Forty-four patients recently diagnosed with clinically definite MS were followed up with clinical and cognitive evaluations at 1, 2, 5, and 7 years and underwent brain MRI including magnetization transfer (MT) imaging at baseline and 2 years. Cognitive evaluation was also performed in 56 matched healthy subjects at baseline. Cognitive testing included the Brief Repeatable Battery. Imaging parameters included lesion load, brain parenchymal fraction (BPF), ventricular fraction (VF), and mean MT ratio (MTR) of lesion and normal-appearing brain tissue (NABT) masks. RESULTS At baseline, patients presented deficits of memory, attention, and information processing speed (IPS). Over 2 years, all magnetic resonance parameters deteriorated significantly. Over 7 years, Expanded Disability Status Scale score deteriorated significantly. Fifty percent of patients deteriorated on memory cognitive domain and 22.7%of patients on IPS domain. Seven-year change of memory scores was significantly associated with baseline diffuse brain damage (NABT MTR). IPS z score change over 7 years was correlated with baseline global atrophy (BPF), baseline diffuse brain damage, and central brain atrophy (VF) change over 2 years. CONCLUSION The main predictors of cognitive changes over 7 years are baseline diffuse brain damage and progressive central brain atrophy over the 2 years after MS diagnosis.
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Affiliation(s)
- M S A Deloire
- INSERM U 1049, University Victor Segalen, case 78, 146 rue Léo Saignat, 33076 Bordeaux cedex, France
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Kiy G, Lehmann P, Hahn HK, Eling P, Kastrup A, Hildebrandt H. Decreased hippocampal volume, indirectly measured, is associated with depressive symptoms and consolidation deficits in multiple sclerosis. Mult Scler 2011; 17:1088-97. [PMID: 21546523 DOI: 10.1177/1352458511403530] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The human hippocampus plays a role in episodic memory and depression. Recently, it has been shown, using manual tracings, that the hippocampus is smaller in volume in MS patients compared with healthy controls, and that, at least for depression, hippocampal atrophy correlates with symptom severity. METHODS Because manual tracing of the hippocampus is time consuming, we used a semi-automatic procedure for temporal horn volumetry in 72 multiple sclerosis (MS) patients and 16 control subjects as an indirect measure of hippocampal volume. We analysed memory performance with the California Verbal Learning Test (using separate indices for encoding, consolidation and retrieval) and depressive mood with the Beck's Depression Inventory (distinguishing between psychic and somatic aspects). RESULTS MS patients had significantly larger temporal horn volumes and volume correlated with psychic symptoms of depressive mood. Temporal horn volume was also associated with consolidation, in particular in the most impaired group. CONCLUSIONS Temporal horn volume can be measured relatively easily and appears to correlate with two major clinical problems in MS patients: memory performance and depressive mood. The link between temporal horn volume, consolidation and depression may be hippocampal atrophy, as suggested by their adjacent neuroanatomical localization, and by the similarity in functional loss following impairment of these two structures.
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Affiliation(s)
- Gevrey Kiy
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
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21
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Hippocampal atrophy in relapsing-remitting and primary progressive MS: a comparative study. Mult Scler 2010; 16:1083-90. [DOI: 10.1177/1352458510374893] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In multiple sclerosis (MS), demyelination and neuroaxonal damage are seen in the hippocampus, and MRI has revealed hippocampal atrophy. Objectives: To investigate and compare hippocampal volume loss in patients with relapsing—remitting MS (RRMS) and primary progressive MS (PPMS) using manual volumetry, and explore its association with memory dysfunction. Methods: Hippocampi were manually delineated on volumetric MRI of 34 patients with RRMS, 23 patients with PPMS and 18 controls. Patients underwent neuropsychological tests of verbal and visuospatial recall memory. Linear regression was used to compare hippocampal volumes between subject groups, and to assess the association with memory function. Results: Hippocampal volumes were smaller in MS patients compared with controls, and were similar in patients with RRMS and PPMS. The mean decrease in hippocampal volume in MS patients was 317 mm3 (9.4%; 95% CI 86 to 549; p = 0.008) on the right and 284 mm3 (8.9%; 95% CI 61 to 508; p = 0.013) on the left. A borderline association of hippocampal volume with memory performance was observed only in patients with PPMS. Conclusion: Hippocampal atrophy occurs in patients with RRMS and PPMS. Factors additional to hippocampal atrophy may impact on memory performance.
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Lebrun C, Blanc F, Brassat D, Zephir H, de Seze J. Cognitive function in radiologically isolated syndrome. Mult Scler 2010; 16:919-25. [DOI: 10.1177/1352458510375707] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Radiologically isolated syndrome (RIS) is characterized by patients with asymptomatic T2 hypersignals detected by brain MRI fulfilling dissemination in space criteria and is suggestive of subclinical multiple sclerosis (MS). In previous studies, it was demonstrated that visual evoked potential and cerebrospinal fluid help to identify pejorative markers in converting to MS. Objective: To date the cognitive function has never been investigated in a cohort of RIS. The objective of this study was to investigate cognitive function in a cohort of 26 RIS patients. Methods: We prospectively assessed the BCcogSEP (a French adaptation of the Brief Repeatable Battery (BRB) including eight cognitive tests) of 26 patients with RIS, compared with 26 MS patients and 26 healthy subjects matched for age, sex and level of education. Results: When comparing the three groups, the cognitive performance was significantly lower in the RIS and MS groups compared with healthy subjects for the Paced Auditory Serial Addition Test (PASAT) 3 seconds ( p = 0.002), phonemic fluencies ( p = 0.02), the code of the WAIS ( p = 0.05), the direct ( p = 0.002) or indirect ( p = 0.007) digit span test, the cross-taping test ( p = 0.019) and Go—No-Go ( p = 0.001). When we compared RIS and MS, the cognitive performance was significantly lower in MS patients for the direct span number ( p = 0.003) and cross-tapping test ( p = 0.05). We did not find significant differences between the three groups for the other tests. We did not find a correlation between clinical, biological and MRI results and cognitive dysfunctions. Conclusions: This study confirms the recently developed concept of RIS patients who present similar features to MS patients. Further studies are necessary to confirm these initial results and to correlate cognitive disorders with MRI surrogate markers.
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Fink F, Eling P, Rischkau E, Beyer N, Tomandl B, Klein J, Hildebrandt H. The association between California Verbal Learning Test performance and fibre impairment in multiple sclerosis: evidence from diffusion tensor imaging. Mult Scler 2010; 16:332-41. [PMID: 20150400 DOI: 10.1177/1352458509356367] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The California Verbal Learning Test (CVLT) is recognized as a standard clinical tool for assessing episodic memory difficulties in multiple sclerosis (MS), but its neural correlates have not yet been examined in detail in this patient population. We combined neuropsychological examination and diffusion tensor imaging (DTI) analysis in a group of MS patients (N = 50) and demographically matched healthy participants (N = 20). We investigated the degree of impairment of the uncinate fascicle (UF), the superior longitudinal fascicle (SLF), the fornix (FX) and the cingulum (CG). The patients were impaired on all CVLT parameters and the DTI parameters correlated moderately with disease-related variables. Regression analyses in the complete study sample showed that CVLT learning scores correlated with impairment of the right UF. This association reached marginal significance in the patient sample. In contrast to other studies claiming retrieval deficits, our results suggest that encoding and consolidation deficits may play a major role in verbal memory impairments in MS. The findings also provide evidence for an association between degree of myelination of prefrontal fibre pathways and encoding efficiency. Finally, DTI-derived measurements appear to reflect disease progression in MS. The results are discussed in light of functional MRI studies investigating compensatory brain activity during cognitive processing in MS.
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Affiliation(s)
- Frauke Fink
- Klinikum Bremen-Ost, Department of Neurology, Züricher Strasse 40, 28325 Bremen, Germany.
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Stegen S, Stepanov I, Cookfair D, Schwartz E, Hojnacki D, Weinstock-Guttman B, Benedict RHB. Validity of the California Verbal Learning Test–II in Multiple Sclerosis. Clin Neuropsychol 2010; 24:189-202. [DOI: 10.1080/13854040903266910] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Giesel FL, Hart AR, Hahn HK, Wignall E, Rengier F, Talanow R, Wilkinson ID, Zechmann CM, Weber MA, Kauczor HU, Essig M, Griffiths PD. 3D reconstructions of the cerebral ventricles and volume quantification in children with brain malformations. Acad Radiol 2009; 16:610-7. [PMID: 19345902 DOI: 10.1016/j.acra.2008.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 10/11/2008] [Accepted: 11/11/2008] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to assess the ability of a semiautomated process to produce three-dimensional reconstructions of the ventricles and calculate ventricular volumes from magnetic resonance (MR) imaging data in children with structural brain abnormalities. MATERIALS AND METHODS Fourteen children referred for MR imaging of the brain for neurologic symptoms were selected. Seven participants had structural brain abnormalities on MR imaging; seven further participants were age-matched controls with normal brain morphology. MR imaging included T1-weighted volumetric images in all cases. Semiautomated postprocessing techniques were performed on the MR imaging data to generate three-dimensional reconstructions of the ventricles. These were analyzed for morphologic changes, and volumes were calculated. Inter- and intrarater agreement of ventricular volumes were calculated. RESULTS This technique produced detailed three-dimensional reconstructions of the ventricles, even in children with grossly abnormal ventricular morphology. All MR imaging data were successfully postprocessed in <5 minutes. Inter- and intrarater reliability was excellent, with correlation coefficients of 0.99 and 0.92, respectively. CONCLUSION This methodology can create detailed three-dimensional visualizations and volumetric measurements of morphologically abnormal ventricles. This technique could help physicians and parents comprehend abnormal ventricular anatomy better and may have future clinical uses in monitoring disease progression or neurosurgical planning.
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Affiliation(s)
- Frederik L Giesel
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
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Reuter F, Audoin B, Rico A, Malikova I, Ranjeva JP, Pelletier J. [Cognitive impairment]. Rev Neurol (Paris) 2009; 165 Suppl 4:S113-22. [PMID: 19361675 DOI: 10.1016/s0035-3787(09)72122-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cognitive impairment is common in multiple sclerosis (MS), occurring at all stages of the disease, even at the earliest, and can be a major source of disability, social impairment, and impoverished quality of life. Cognitive dysfunction is mainly focused on working memory, conceptual reasoning, verbal fluency, speed of information processing, attention and executive function. Measures of information-processing speed appear to be the most robust and sensitive markers of cognitive impairment in MS patients. Cognitive testing in MS patients is complex and cognitive screening tests are time- and cost-saving test instruments. A comprehensive and sensitive cognitive test procedure should be administered to detect cognitive dysfunction, and recent studies demonstrate that single, predominantly speed-related cognitive tests may be superior to extensive and time-consuming test batteries in screening cognitive decline. Additional clinical factors, including disease course, fatigue, and affective disturbance, can impact the degree of MS-related cognitive impairment. Despite weak correlation with disease duration and physical disability status, the degree of cognitive impairment in MS has been related to the extent of topographically specific neuronal tissue damage and loss. Numerous studies have applied conventional and quantitative magnetic resonance imaging (MRI) techniques to correlate the profile and degree of cognitive impairment with various MRI-detectable abnormalities. The burden of MRI-visible lesions does not fully account for the degree of MS-related cognitive impairment. Nonconventional MRI findings suggest the extent of subtle tissue damage in normal-appearing white and grey matter to correlate best with the severity of cognitive impairment in MS patients. Structural MRI approaches have recently been extended by functional MRI studies scrutinizing the brain's ability for adaptive functional reorganization in the presence of widespread tissue damage. Cognitive impairment in MS seems to be not simply the result of tissue destruction, but also a balance between tissue destruction, tissue repair, and adaptive functional reorganization. These findings highlight the need to screen for cognitive deficits in MS patients to conduct potential cognitive rehabilitation intervention.
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Affiliation(s)
- F Reuter
- Pôle de Neurosciences Cliniques, Service de Neurologie, CHU Timone, Rue Saint Pierre, 13385 Marseille cedex 5, France
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Haussleiter IS, Brüne M, Juckel G. Psychopathology in multiple sclerosis: diagnosis, prevalence and treatment. Ther Adv Neurol Disord 2009; 2:13-29. [PMID: 21180640 PMCID: PMC3002616 DOI: 10.1177/1756285608100325] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system. Demyelinization of nerve fibres not only affects the motor and sensory systems functionally, but may also cause psychopathological signs and symptoms. In addition to the psychiatric manifestations of MS, many patients have reactive psychological problems that are often hard to distinguish from the 'organic' causation of psychopathology. In any event, psychiatric comorbidity in MS deserves greater clinical attention than has been previously paid, because the presence of psychopathology may have deleterious effects on the disease process and impair coping with disability.
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Affiliation(s)
- Ida S Haussleiter
- Department of Pharmacology and Neuroscience, Institute for Aging and Alzheimer's Disease Research, Center FOR HER (Focused On Resources for her Health, Education and Research), University of North Texas Health Science Center, Fort Worth, TX, USA
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Sánchez MP, Nieto A, Barroso J, Martín V, Hernández MA. Brain atrophy as a marker of cognitive impairment in mildly disabling relapsing-remitting multiple sclerosis. Eur J Neurol 2008; 15:1091-9. [DOI: 10.1111/j.1468-1331.2008.02259.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brochet B, Deloire MSA, Bonnet M, Salort-Campana E, Ouallet JC, Petry KG, Dousset V. Should SDMT substitute for PASAT in MSFC? A 5-year longitudinal study. Mult Scler 2008; 14:1242-9. [PMID: 18653737 DOI: 10.1177/1352458508094398] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The multiple sclerosis functional composite (MSFC) includes the Paced Auditory Serial Addition test (PASAT) as a measure of cognition. OBJECTIVES AND METHODS We compared the MSFC incorporating the Symbol Digit Modalities test (SDMT) (MSFC [sdmt]) to the usually applied MSFC (MSFC [pasat]) in a sample of 46 ptients with relapsing-remitting MS who were followed over a five-year period. Magnetic resonance imaging was performed at baseline. RESULTS The Expanded Disability Status scale (EDSS) deteriorated significantly over 5 years (P < 0.01), but MSFC scores remained stable. MSFC [sdmt] correlated with EDSS at all time points of evaluation, but MSFC [pasat] correlated with EDSS only at baseline, 1, and 5 years. The 5-year EDSS correlated significantly with baseline MSFC [sdmt] and MSFC [pasat] but did not correlate after adjustment for baseline EDSS. No significant correlation was found at baseline between MSFC and imaging parameters (lesion load, brain parenchymal fraction [BPF], ventricular fraction, mean magnetization transfer ratio of lesions and normal-appearing brain tissue), but baseline BPF correlated significantly with changes of SDMT z score (P = 0.0003), MSFC [pasat] (P = 0.006), and MSFC [sdmt] (P = 0.0002) over 5 years. CONCLUSION We propose not to substitute PASAT by SDMT in the MSFC but to consider SDMT as a complementary useful approach to evaluate overall MS disease.
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Affiliation(s)
- B Brochet
- EA 2966, Université de Bordeaux, and Services de Neurologie et Neuroradiologie, CHU de Bordeaux, Bordeaux, France.
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Summers M, Fisniku L, Anderson V, Miller D, Cipolotti L, Ron M. Cognitive impairment in relapsing-remitting multiple sclerosis can be predicted by imaging performed several years earlier. Mult Scler 2007; 14:197-204. [PMID: 17986503 DOI: 10.1177/1352458507082353] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cognitive deficits in multiple sclerosis (MS) are common and correlate with contemporary MRI brain abnormalities, particularly atrophy, but the ability of imaging early in the disease to predict later cognitive impairment remains to be determined. Thirty relapsing-remitting MS patients recruited within three years of the onset of the disease, and in whom MRI had been performed at baseline and a year later, were assessed neuropsychologically five years later. Imaging parameters accounting for significant variance in cognitive performance were identified using multiple regressions, once confounding variables were controlled. Patients performed significantly worse than expected on tests of attention/speed of information processing and half of them had experienced some decline in IQ in relation to premorbid estimates. The rate of global brain atrophy in the first year of the study accounted for significant variance in the overall cognitive performance, and in memory and attention/speed of information processing. Poor performance on attention tests was associated with high T1-weighted lesion volume and reduced magnetization transfer ratio (MTR) in normal-appearing white matter (NAWM). These results suggest that neuroaxonal loss was identified early in the disease, and its rate of progression, predicted cognitive impairment later in the disease. Neuroaxonal loss is likely to affect commissural and association fibres that subserve the cognitive processes impaired in MS.
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Affiliation(s)
- Mm Summers
- NMR Research Unit, Institute of Neurology, University College London, London, UK
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Geurts JJG, Bö L, Roosendaal SD, Hazes T, Daniëls R, Barkhof F, Witter MP, Huitinga I, van der Valk P. Extensive Hippocampal Demyelination in Multiple Sclerosis. J Neuropathol Exp Neurol 2007; 66:819-27. [PMID: 17805012 DOI: 10.1097/nen.0b013e3181461f54] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Memory impairment is especially prominent within the spectrum of cognitive deficits in multiple sclerosis (MS), and a crucial role for hippocampal pathology may therefore be expected in this disease. This study is the first to systematically assess hippocampal demyelination in MS. Hippocampal tissue samples of 19 chronic MS cases and 7 controls with non-neurologic disease were stained immunohistochemically for myelin proteolipid protein. Subsequently, number, location, and size of demyelinated lesions were assessed. Furthermore, the specimens were stained for HLA-DR to investigate microglia/macrophage activity. An unexpectedly high number of lesions (n = 37) was found in 15 of the 19 MS cases. Mixed intrahippocampal-perihippocampal lesions, which were more often found in cases with cognitive decline, were large and did not respect anatomical borders. Moderate microglial activation was frequently observed at the edges of these mixed lesions. Isolated intrahippocampal lesions were also frequently found. These were smaller than the mixed lesions and had a specific anatomical predilection: the cornu ammonis 2 subregion and the hilus of the dentate gyrus were consistently spared. Microglial activation was rare in isolated intrahippocampal lesions. Our results indicate that hippocampal demyelination is frequent and extensive in MS and that anatomical localization, size, and inflammatory activity vary for different lesion types.
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Affiliation(s)
- Jeroen J G Geurts
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
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Lanz M, Hahn HK, Hildebrandt H. Brain atrophy and cognitive impairment in multiple sclerosis: a review. J Neurol 2007; 254 Suppl 2:II43-8. [PMID: 17503128 DOI: 10.1007/s00415-007-2011-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis (MS) is a common neurological disease in the Western hemisphere that leads to neurological dysfunctions and frequently from its onset to cognitive impairment, which together predict quality of life. Recent pathological and imaging studies have focused on brain atrophy representing axonal injury and loss as being crucial for developing disability and neuropsychological impairment. Brain atrophy has therefore been proposed to be a tool for monitoring disease progress. Here, we review the possible origins of brain atrophy and its correlation with cognitive impairment in MS.
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Affiliation(s)
- Michael Lanz
- Dept. of Neurology, Klinikum Bremen-Ost, Züricher Str. 40, 28325, Bremen, Germany.
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