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Cognitive impairment in relapsing—remitting multiple sclerosis can be predicted by imaging performed several years earlier

NMR Research Unit, Institute of Neurology, University College London, London, UK

LK Fisniku

NMR Research Unit, Institute of Neurology, University College London, London, UK

VM Anderson

NMR Research Unit, Institute of Neurology, University College London, London, UK, Dementia Research Group, Institute of Neurology, University College London, London, UK

DH Miller

NMR Research Unit, Institute of Neurology, University College London, London, UK

L. Cipolotti

Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK, Department of Psychology, University of Palermo, Italy

MA Ron

NMR Research Unit, Institute of Neurology, University College London, London, UK, m.ron{at}ion.ucl.ac.uk

Cognitive deficits in multiple sclerosis (MS) are common and correlate with contemporary MRI brain abnormalities, particularly atrophy, but the ability of imaging early in the disease to predict later cognitive impairment remains to be determined. Thirty relapsing—remitting MS patients recruited within three years of the onset of the disease, and in whom MRI had been performed at baseline and a year later, were assessed neuropsychologically five years later. Imaging parameters accounting for significant variance in cognitive performance were identified using multiple regressions, once confounding variables were controlled. Patients performed significantly worse than expected on tests of attention/speed of information processing and half of them had experienced some decline in IQ in relation to premorbid estimates. The rate of global brain atrophy in the first year of the study accounted for significant variance in the overall cognitive performance, and in memory and attention/speed of information processing. Poor performance on attention tests was associated with high T1-weighted lesion volume and reduced magnetization transfer ratio (MTR) in normal-appearing white matter (NAWM). These results suggest that neuroaxonal loss was identified early in the disease, and its rate of progression, predicted cognitive impairment later in the disease. Neuroaxonal loss is likely to affect commissural and association fibres that subserve the cognitive processes impaired in MS. Multiple Sclerosis 2008; 14: 197—204. http://msj.sagepub.com

Key Words: cognition • brain atrophy • magnetic resonance imaging (MRI) • multiple sclerosis

This version was published on March 1, 2008

Multiple Sclerosis, Vol. 14, No. 2, 197-204 (2008)
DOI: 10.1177/1352458507082353


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