Magnetic resonance imaging predictors of executive functioning in patients with pediatric-onset multiple sclerosis

Executive functions (EFs) are vulnerable to disruption in pediatric-onset multiple sclerosis (MS) patients. We describe the pattern and correlates of executive dysfunction in 34 adolescents with MS on neuropsychological tests and the parent version of the Behavior Rating Inventory of Executive Function (BRIEF). The adolescents with MS performed lower than age-matched controls in several areas of executive functioning, with 44% of patients being impaired on the Trail Making Test-Part B. On the BRIEF, problems in working memory and planning/organization were identified in the patient group compared with controls, particularly in patients with a younger age at disease onset. Task performance and parent-ratings of EF skills were strongly related to whole brain and regional brain volume metrics and, to a lesser extent, T(2)-weighted lesion volume. Working memory and attention switching are at greatest risk of impairment. Results support the inclusion of neuropsychological assessment alongside parent-report measures of EF skills in childhood-onset MS.