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Looking into cognitive impairment in primary-progressive multiple sclerosis.

M Petracca1,2, J Sumowski1, M Fabian1

  • 1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

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Retinal atrophy, specifically the ganglion cell + inner plexiform layer (GCIPL), can predict cognitive decline in primary-progressive multiple sclerosis (PP-MS). This non-invasive measure offers a practical alternative to brain volume computation for monitoring neurodegeneration.

Keywords:
atrophycognitionneurodegenerationoptical coherence tomographyprogressive multiple sclerosis

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Radiology

Background:

  • Cognitive impairment in primary-progressive multiple sclerosis (PP-MS) is linked to brain atrophy.
  • Brain volume computation is resource-intensive and not widely available clinically.
  • Retinal atrophy metrics may serve as a proxy for gray matter atrophy in PP-MS.

Purpose of the Study:

  • To investigate the predictive role of retinal atrophy metrics on cognitive decline in PP-MS.
  • To assess optical coherence tomography (OCT) metrics as potential indicators of neurodegeneration.
  • To explore the mediating role of gray matter atrophy in the relationship between retinal measures and cognition.

Main Methods:

  • Twenty-five PP-MS patients underwent OCT and 3.0-T MRI.
  • Cognitive function was assessed using the Brief International Cognitive Assessment for Multiple Sclerosis.
  • Stepwise logistic regression analyzed OCT metrics (retinal nerve fiber layer, GCIPL, macular volume) for prediction of cognitive impairment.

Main Results:

  • Ganglion cell + inner plexiform layer (GCIPL) thickness was associated with and predictive of cognitive impairment (P=0.036).
  • GCIPL correlated with normalized brain volume (P=0.047) and thalamic volume (P=0.001).
  • Thalamic volume showed a near-mediating effect between GCIPL and cognitive scores (P=0.063).

Conclusions:

  • GCIPL thickness is a valid indicator of neurodegeneration in PP-MS.
  • GCIPL offers higher specificity for neuronal loss compared to brain atrophy.
  • GCIPL provides a non-invasive, quantitative method for monitoring cognitive impairment related to neuronal loss in PP-MS.