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The unique impact of changes in normal appearing brain tissue on cognitive dysfunction in secondary progressive multiple sclerosis patients

Department of Neurology, University of California, San Francisco, CA, USA

Daniel Pelletier

Department of Neurology, University of California, San Francisco, CA, USA

Claude Genain

Department of Neurology, University of California, San Francisco, CA, USA

Sharmila Majumdar

Department of Radiology, University of California, San Francisco, CA, USA

Ying Lu

Department of Radiology, University of California, San Francisco, CA, USA

Sarah Nelson

Department of Radiology, University of California, San Francisco, CA, USA

David C Mohr

Department of Neurology, University of California, San Francisco, CA, USA, Department of Psychiatry, University of California, San Francisco, CA, USA, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA, dmohr{at}itsa.ucsf.edu

Objective: The purpose of this study was to examine the relationships between cognitive functioning, whole brain magnetic transfer ratio (MTR) imaging, supratentorial ¹H-magnetic resonance spectroscopy imaging (¹HMRSI), and conventional T₁ and T₂ imaging in a homogenous sample of SPMS patients. Methods: Nineteen patients underwent a single 90-min imaging session that obtained T₁-and T₂-weighted images and MTR. ¹HMRSI was obtained on 14 of these patients. Patients underwent a neuropsychological battery, which was used to create an integrated measure of cognitive impairment. Cognitive impairment was the dependent variable in two hierarchical multiple regression analyses in which T₂ lesion load, T₁ lesion load, and MTR or NAA/Cr were entered sequentially. Results: MTR was significantly related to cognitive functioning (R²= 0.22, P= 0.02) after accounting for T₂ lesion load (R²=0.33, P= 0.01) and T₁ lesion load (R²= 0.00, P=0.98). NAA/Cr was not significantly related to cognitive functioning. Conclusions: Cognitive dysfunction may act as a clinical marker of normal appearing brain tissue pathology in multiple sclerosis.

Key Words: multiple sclerosis • MRI • cognitive impairment • neuropsychological assessment • spectroscopy • magnetic transfer ratio imaging

Multiple Sclerosis, Vol. 10, No. 6, 626-629 (2004)
DOI: 10.1191/1352458504ms1095oa


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