Related Experiment Video
Updated: Apr 12, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
The HV3 Score: A New Simple Tool to Suspect Cognitive Impairment in Multiple Sclerosis in Clinical Practice
Muriel Laffon1, Grégoire Malandain2, Heloise Joly3
1Department of Neurology, Pasteur Hospital, University of Nice, 30 Avenue de la Voie Romaine, Nice, France ; Institut National de Recherche en Informatique et Automatique (INRIA) Sophia Antipolis, Nice, France.
Introduction:
Cognitive impairment in multiple sclerosis (MS) is common even in the early stages of the disease. Our objective was to improve early detection of cognitive impairment in MS.
Methods:
Seventy-five patients with relapsing remitting (RR) MS and 20 controls were enrolled. Two RRMS groups were defined according to their results at the Paced Auditory Serial Addition Test (PASAT). Patients with a z score below two standard deviations were considered impaired. We quantified T2 and T1 lesion volumes, and cerebral white and grey matter volumes on a conventional brain magnetic resonance imaging (MRI) scan. Global brain atrophy was evaluated using the third ventricle (V3) width (in mm). An average brain model was built based on controls and compared with the patient's MRI to quantify regional volumetric changes.
Results:
Sixteen (21.3%) patients with RRMS had low PASAT performance. They had a higher Expanded Disability Status Scale (EDSS) score (P = 0.019). T2 and T1 lesion volumes, and grey and white matter volumes were the same in both groups. An enlargement of the V3 width was observed in the low performer group (P = 0.044) and V3 width was correlated with the PASAT score (r = -0.271; P = 0.021). A composite score, named HV3, was obtained by adding the EDSS and V3 width (in mm) and correlated with the PASAT (r = -0.325; P = 0.006). A cutoff HV3 score of over 5.5 identified patients with low PASAT performance, with a positive predictive value of 92.5% and an accuracy of 70.1%. Focal atrophy was detected in the supplementary motor area, the cingulate gyrus, the right thalamus, and the inferior parietal lobules of patients with lower PASAT performance.
Conclusion:
Specific brain morphological changes, including an enlargement of the V3 width, are associated with low PASAT performance in patients with RRMS. The HV3 score is an additional and complementary tool, accessible in clinical practice, to suspect easily cognitive impairment in patients with RRMS and to better identify patients requiring a complete cognitive assessment.
Insights
Early detection of cognitive impairment in multiple sclerosis (MS) is improved by measuring third ventricle (V3) width. A new HV3 score combining V3 width and disability score effectively identifies patients needing further cognitive assessment.
Area of Science:
- Neurology
- Neuroimaging
- Cognitive Science
Background:
- Cognitive impairment is prevalent in early multiple sclerosis (MS).
- Early detection of cognitive deficits in MS is crucial for timely intervention.
- Current methods for assessing cognitive function in MS can be improved.
Purpose of the Study:
- To enhance early detection of cognitive impairment in patients with relapsing-remitting multiple sclerosis (RRMS).
- To investigate the association between brain morphology and cognitive performance in RRMS.
- To introduce a novel composite score for identifying cognitive impairment in RRMS.
Main Methods:
- Seventy-five RRMS patients and 20 controls underwent brain MRI.
- Cognitive function was assessed using the Paced Auditory Serial Addition Test (PASAT).
- T2/T1 lesion volumes, grey/white matter volumes, and third ventricle (V3) width were quantified. Regional atrophy was assessed using an average brain model.
Main Results:
- Sixteen percent of RRMS patients exhibited low PASAT performance, correlating with higher disability scores.
- Enlarged V3 width was observed in low PASAT performers and correlated with PASAT scores.
- A composite HV3 score (EDSS + V3 width) accurately identified patients with low PASAT performance (92.5% positive predictive value).
- Focal atrophy was detected in specific brain regions of patients with lower PASAT performance.
Conclusions:
- Enlargement of the V3 width is linked to impaired cognitive performance in RRMS.
- The HV3 score serves as a practical tool to suspect cognitive impairment in RRMS patients.
- The HV3 score aids in identifying RRMS patients who require comprehensive cognitive evaluation.
