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Functional and structural brain MRI changes associated with cognitive worsening in multiple sclerosis: a 3-year
Matteo Azzimonti1,2, Paolo Preziosa1,2,3, Elisabetta Pagani1
1Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
Journal of Neurology
|May 18, 2023
Summary
Cognitive worsening in multiple sclerosis (MS) is linked to gray matter atrophy and reduced functional connectivity in key brain networks. These changes in gray matter and brain networks are the primary drivers of cognitive decline in MS patients.
Area of Science:
- Neuroimaging
- Neurology
- Cognitive Science
Background:
- Multiple Sclerosis (MS) is associated with heterogeneous processes that can lead to cognitive impairment.
- Understanding the underlying mechanisms of cognitive decline in MS is crucial for developing effective interventions.
Purpose of the Study:
- To investigate the longitudinal changes in brain structure and function associated with cognitive worsening in MS patients.
- To identify specific MRI-based biomarkers predictive of cognitive decline in MS.
Main Methods:
- A longitudinal multiparametric MRI approach was used, including functional and structural scans.
- 35 MS patients and 22 healthy controls (HC) underwent MRI at baseline and after a median follow-up of 3.4 years.
- Cognitive function was assessed using Rao's battery, and cognitive worsening was defined by a reliable change index score < -1.25.
Main Results:
- At follow-up, 29% of MS patients showed cognitive worsening.
- Cognitively worsened MS patients exhibited more severe gray matter (GM) atrophy in the anterior cingulate cortex and supplementary motor area compared to stable patients.
- Decreased resting-state functional connectivity (RS FC) was observed in the hippocampus (working memory network) and insula (default mode network) in cognitively worsened MS patients.
Conclusions:
- Gray matter atrophy progression in critical cognitive regions is a key substrate for cognitive worsening in MS.
- Functional impoverishment in brain networks involved in cognitive functions contributes significantly to cognitive decline in MS.
- Longitudinal multiparametric MRI can identify mechanisms underlying cognitive worsening in MS.
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