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Cognitive impairment in relation to MRI metrics in patients with clinically isolated syndrome
M Khalil1, C Enzinger, C Langkammer
1Department of Neurology, Medical University of Graz, Austria.
Background:
Cognitive deficits are frequent in multiple sclerosis (MS) and have been associated with morphologic brain changes. Less information exists on their extent and relation to MRI findings in clinically isolated syndrome (CIS). It is also unclear if structural changes as detected by magnetization transfer (MT) imaging may provide an additional explanation for cognitive dysfunction.
Objective:
To analyse the extent of cognitive deficits and their relation to MRI metrics including MT imaging in CIS compared to relapsing-remitting MS (RRMS).
Methods:
Forty-four CIS and 80 RRMS patients underwent the Brief Repeatable Battery of Neuropsychological Tests (BRB-N) and a 3 T MRI scan.
Results:
BRB-N subtests revealed similar results in CIS and RRMS. Impaired mental processing speed was most prevalent in both groups (CIS 13.6%; RRMS 16.3%) and thus served for correlation with MRI metrics. Using stepwise linear regression analyses, the strongest predictor for decreased mental processing speed was normalized cortex volume (p < 0.001) followed by T₂-lesion load (p < 0.05) in RRMS, whereas cortical MT ratio was the only MRI parameter associated with decreased mental processing speed in CIS (p < 0.005).
Conclusion:
Cognitive dysfunction occurs in CIS in a pattern similar to RRMS, with impaired mental processing speed being most prevalent. Cortical MT-ratio changes may be an early sign for tissue changes related to impaired mental processing speed in CIS while this association shifts to increased signs of cortical atrophy and lesion load in RRMS.
Insights
Cognitive deficits, particularly slowed processing speed, are common in early multiple sclerosis (MS) and clinically isolated syndrome (CIS). Early brain tissue changes, not just atrophy, may predict this decline in CIS.
Area of Science:
- Neuroimaging
- Neurology
- Cognitive Neuroscience
Background:
- Cognitive deficits are common in multiple sclerosis (MS) and linked to brain changes.
- The extent and MRI correlates of cognitive dysfunction in clinically isolated syndrome (CIS) are less understood.
- Magnetization transfer (MT) imaging may reveal structural changes contributing to cognitive issues.
Purpose of the Study:
- To compare cognitive deficits and their relationship with MRI findings, including MT imaging, in CIS and relapsing-remitting MS (RRMS).
Main Methods:
- Forty-four CIS and 80 RRMS patients completed neuropsychological testing (BRB-N) and 3T MRI scans.
Main Results:
- Both CIS and RRMS groups showed similar cognitive deficits, with impaired mental processing speed being most prevalent.
- In RRMS, reduced mental processing speed correlated with lower normalized cortex volume and higher T₂-lesion load.
- In CIS, only the cortical MT ratio was significantly associated with decreased mental processing speed.
Conclusions:
- Cognitive dysfunction patterns in CIS resemble those in RRMS, with slowed processing speed being a key issue.
- Cortical MT ratio changes may indicate early tissue alterations linked to cognitive decline in CIS.
- In established RRMS, cognitive decline is associated with cortical atrophy and increased lesion load.
