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Updated: Feb 16, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
A structural MRI study of cholinergic pathways and cognition in multiple sclerosis
Yukio Kimura1, Noriko Sato1, Miho Ota2
1Department of Radiology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
Background:
White matter hyperintensities (WMH) in the cholinergic pathways are associated with cognitive performance in Alzheimer's disease. This study aimed to evaluate the relationship between the volume reduction of cholinergic pathways and cognitive function in patients with multiple sclerosis (MS).
Methods:
Thirty-two MS patients underwent a brain MRI and cognitive measurements including the Mini-Mental State Examination (MMSE) and the Japanese version of the Montreal Cognitive Assessment (MoCA-J). The extent of WMH within the cholinergic pathways was assessed using the Cholinergic Pathways Hyperintensities Scale (CHIPS). Computerized WMH volumes were also obtained. FreeSurfer was used to measure regional volumes including the cortical and subcortical volumes. The correlations among the CHIPS, the WMH volume, and the clinical data were assessed, in addition to the correlations between the cognitive scores and regional volumes measured by FreeSurfer.
Results:
The CHIPS score and the WMH volume were strongly positively correlated with each other (r = 0.87, P < 0.001). The CHIPS score had significantly negative correlations with the MMSE (r = - 0.49, P = 0.003) and the MoCA-J (r = - 0.47, P = 0.005) results. The WMH volume had significantly negative correlations with the MMSE (r = - 0.54, P = 0.001) and the MoCA-J (r = - 0.57, P < 0.001) results. In the analysis by FreeSurfer, both the MMSE and MoCA-J scores had significant positive correlations only with the volume of the corpus callosum.
Conclusions:
The CHIPS score tended to be less sensitive to the WMH volume in cognitive function evaluation, although the difference did not reach the level of statistical significance. Thus the CHIPS method may not be as effective in MS patients.
Insights
White matter hyperintensities (WMH) in multiple sclerosis (MS) correlate with cognitive decline. The Cholinergic Pathways Hyperintensities Scale (CHIPS) showed less sensitivity to WMH volume compared to direct volume measurements in assessing cognitive function.
Area of Science:
- Neuroimaging
- Neurology
- Cognitive Science
Background:
- White matter hyperintensities (WMH) in cholinergic pathways are linked to cognitive deficits in Alzheimer's disease.
- Investigating WMH and cholinergic pathway volume reduction in multiple sclerosis (MS) is crucial for understanding cognitive impairment.
Purpose of the Study:
- To evaluate the relationship between cholinergic pathway volume reduction and cognitive function in MS patients.
- To compare the effectiveness of the Cholinergic Pathways Hyperintensities Scale (CHIPS) with direct WMH volume measurements.
Main Methods:
- Thirty-two MS patients underwent MRI for WMH assessment (CHIPS, direct volume) and cognitive tests (MMSE, MoCA-J).
- Regional brain volumes, including cortical and subcortical structures, were measured using FreeSurfer.
- Correlations between CHIPS scores, WMH volumes, and cognitive scores were analyzed.
Main Results:
- CHIPS scores and WMH volumes were highly correlated (r=0.87).
- Both CHIPS scores and WMH volumes negatively correlated with MMSE and MoCA-J scores.
- Cognitive scores positively correlated with corpus callosum volume, as measured by FreeSurfer.
Conclusions:
- Direct WMH volume measurements appear more sensitive than CHIPS in reflecting cognitive function in MS.
- The CHIPS method may be less effective for evaluating cognitive impact in MS patients.
- Further research is needed to refine WMH assessment in MS-related cognitive decline.
