Cortical atrophy accelerates as cognitive decline worsens in multiple sclerosis

Area of Science:

• Neuroscience
• Neurology
• Radiology

Background:

• Multiple Sclerosis (MS) is a chronic neurological disease.
• Cognitive decline is a significant disability in MS patients.
• Understanding the pathological drivers of cognitive decline is crucial for MS management.

Purpose of the Study:

• To identify the pathological processes driving accelerated cognitive decline in Multiple Sclerosis (MS).
• To investigate the relationship between structural MRI changes and cognitive decline in relapsing-remitting MS (RRMS) and progressive MS (PMS).

Main Methods:

• A prospective cohort study of 230 MS patients and 59 controls was conducted.
• Longitudinal 3T MRI scans were used to measure gray matter atrophy and lesion volume over a 5-year interval.
• Cognitive function was assessed extensively at two time points and correlated with MRI-derived rates of change.

Main Results:

• Faster cortical atrophy was observed in PMS compared to RRMS patients.
• Cognitive decline was significantly faster in PMS than in RRMS.
• Cognitive decline correlated with lesion volume increase in stable RRMS, deep gray matter atrophy in converting RRMS, and cortical atrophy in PMS.

Conclusions:

• Cortical atrophy and cognitive decline accelerate concurrently in MS.
• The pathological substrate for cognitive decline evolves throughout the MS disease course.
• These findings highlight the distinct pathological mechanisms underlying cognitive impairment in different MS phenotypes.