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Atrophy Patterns in Patients With Multiple Sclerosis With Cognitive Impairment, Fatigue, and Mood Disorders.

Carolina de Medeiros Rimkus1, Mariana Penteado Nucci1, Isabella B Avolio1

  • 1From the Department of Radiology and Oncology (C.d.M.R., C.C.L.), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP); LIM 44 (C.d.M.R., M.P.N., I.B.A., C.C.L.), Laboratory of Medical Investigation in Magnetic Resonance of the University of São Paulo, São Paulo, Brazil; MS Center Amsterdam (C.d.M.R., M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Department of Neurology (S.L.A.-P., D.C.), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP); Department of Epidemiology and Biostatistics (M.B.W.), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS); Department of Epidemiology and Biostatistics (M.B.W.), School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brazil; MS Center Amsterdam (F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, the Netherlands; and Queen Square MS Center (F.B.), Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, and Centre for Medical Image Computing (CMIC) (F.B.), Department of Medical Physics and Biomedical Engineering, University College London (UCL), United Kingdom.

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Summary

Cognitive impairment in multiple sclerosis (MS) is linked to deep gray matter atrophy, while fatigue, anxiety, and depression are associated with cerebellar atrophy. Combined symptoms correlate with increased global and deep gray matter atrophy.

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Area of Science:

  • Neuroscience
  • Neurology
  • Medical Imaging

Background:

  • Cognitive impairment, fatigue, and mood disorders are prevalent in multiple sclerosis (MS).
  • The interplay and neurological basis of these symptoms in MS are not fully understood.
  • Identifying atrophy patterns associated with these symptoms is crucial for understanding MS progression.

Purpose of the Study:

  • To identify specific patterns of brain atrophy in patients with multiple sclerosis (MS).
  • To investigate the relationship between cognitive impairment, fatigue, anxiety, and depression in MS patients.
  • To correlate these symptoms with distinct patterns of cortical and deep gray matter atrophy.

Main Methods:

  • Cross-sectional cohort study including relapsing-remitting MS patients and healthy controls.
  • Utilized cognitive assessments, fatigue, anxiety, and depression inventories, and Expanded Disability Status Scale (EDSS).
  • Employed K-means clustering for symptom grouping and FreeSurfer for assessing cortical, deep gray matter, and infratentorial atrophy.

Main Results:

  • Four MS patient clusters were identified based on cognitive status and symptom presence.
  • Cognitive impairment correlated with deep gray matter atrophy (hippocampus, amygdala, thalamus, basal ganglia).
  • Fatigue, anxiety, and depression were associated with cerebellar and widespread cortical atrophy.

Conclusions:

  • Cognitive impairment and mood/fatigue symptoms in MS can occur independently or together.
  • Deep gray matter atrophy is linked to cognitive impairment, while cerebellar atrophy is linked to fatigue, anxiety, and depression.
  • Progressive accumulation of these symptoms correlates with increased global and deep gray matter atrophy in MS.