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A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation (tDCS) in Multiple Sclerosis (MS)

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Disconnection as a mechanism for cognitive dysfunction in multiple sclerosis.

R A Dineen¹, J Vilisaar, J Hlinka

¹Department of Academic Radiology, Queen's Medical Centre, University of Nottingham, Nottingham, UK . robert.dineen@nhs.net

Brain : a Journal of Neurology

|October 28, 2008

Summary

White matter tract injury, measured by fractional anisotropy (FA) reduction, is linked to cognitive deficits in multiple sclerosis patients. Tract-based spatial statistics identified specific white matter pathways affecting attention, memory, and processing speed.

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Area of Science:

Neuroimaging and Neuroscience
Neurology
Cognitive Science

Background:

Cognitive dysfunction in multiple sclerosis (MS) is often linked to white matter damage.
The specific contribution of injury to distinct white matter tracts on cognitive domains in MS remains understudied.
Understanding these relationships is crucial for diagnosing and managing cognitive impairment in MS.

Purpose of the Study:

To investigate the association between white matter tract integrity and cognitive performance in MS patients.
To identify specific white matter tracts where reduced fractional anisotropy (FA) predicts cognitive dysfunction using tract-based spatial statistics (TBSS).

Main Methods:

Thirty-seven MS patients in remission underwent 3 Tesla MRI with diffusion tensor imaging (DTI).
Tract-based spatial statistics (TBSS) was applied to DTI data to analyze fractional anisotropy (FA) values.
Cognitive performance was assessed across multiple domains, and normalized scores were statistically mapped against FA values, controlling for age.

Main Results:

Reduced FA in specific white matter tracts correlated with impaired performance in sustained attention, working memory, processing speed, visual working memory, and verbal learning/recall.
No significant association was found between FA and frontal lobe function or visuospatial perception.
Identified white matter abnormalities partially overlapped with FLAIR lesions, highlighting the role of normal-appearing white matter in cognitive dysfunction.

Conclusions:

Tract-based spatial statistics effectively reveals functionally relevant white matter tract injury underlying cognitive dysfunction in multiple sclerosis.
The findings suggest that damage to specific white matter tracts interconnecting cortical regions contributes to cognitive impairments in MS.
This approach may offer insights into the neuroanatomical basis of cognitive deficits and potential therapeutic targets in MS.