Related Experiment Video
Updated: Nov 10, 2025
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Microstructural White Matter Alterations in Cognitively Impaired Patients at Early Stages of Multiple Sclerosis
Ruth Schneider1,2, Britta Matusche3, Erhan Genç4
1Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany. Ruth.Schneider@rub.de.
Purpose:
As conventional quantitative magnetic resonance imaging (MRI) parameters are weakly associated with cognitive impairment (CI) in early multiple sclerosis (MS), we explored microstructural white matter alterations in early MS or clinically isolated syndrome (CIS) comparing patients with or without CI.
Methods:
Based on a preceding tract-based spatial statistics analysis (3 Tesla MRI) which contrasted 106 patients with early MS or CIS and 49 healthy controls, diffusion metrics (fractional anisotropy, FA, mean diffusivity, MD) were extracted from significant clusters using an atlas-based approach. The FA and MD were compared between patients with (Ci_P n = 14) and without (Cp_P n = 81) cognitive impairment in a subset of patients who underwent CI screening.
Results:
The FA was reduced in Ci_P compared to Cp_P in the splenium of corpus callosum (p = 0.001), right parahippocampal cingulum (p = 0.002) and fornix cres./stria terminalis (0.042), left posterior corona radiata (p = 0.012), bilateral cerebral peduncles, medial lemniscus and in cerebellar tracts. Increased MD was detected in the splenium of corpus callosum (p = 0.01). The CI-related localizations overlapped only partially with MS lesions.
Conclusion:
Microstructural white matter alterations at disease onset were detectable in Ci_P compared to Cp_P in known cognitively relevant fiber tracts, indicating the relevance of early treatment initiation in MS and CIS.
Insights
Early multiple sclerosis (MS) patients with cognitive impairment show distinct white matter changes in key brain pathways. These microstructural alterations highlight the need for prompt treatment in MS and clinically isolated syndrome (CIS).
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Conventional quantitative MRI parameters show weak associations with cognitive impairment (CI) in early multiple sclerosis (MS).
- Exploring microstructural white matter alterations is crucial for understanding CI in early MS or clinically isolated syndrome (CIS).
Purpose of the Study:
- To investigate microstructural white matter alterations in early MS or CIS patients with and without cognitive impairment.
- To identify specific white matter tracts affected by cognitive impairment at disease onset.
Main Methods:
- Used 3 Tesla MRI and tract-based spatial statistics on 106 early MS/CIS patients and 49 controls.
- Extracted diffusion metrics (fractional anisotropy - FA, mean diffusivity - MD) from significant clusters using an atlas-based approach.
- Compared FA and MD between patients with (n=14) and without (n=81) cognitive impairment.
Main Results:
- Reduced FA was observed in patients with CI in the splenium of corpus callosum, parahippocampal cingulum, fornix, and other tracts.
- Increased MD was detected in the splenium of corpus callosum in patients with CI.
- CI-related white matter changes showed only partial overlap with MS lesions.
Conclusions:
- Microstructural white matter alterations are detectable in cognitively impaired MS/CIS patients at disease onset.
- These findings underscore the importance of early treatment initiation in MS and CIS to address cognitive decline.
