Abstract

Background: Cognitive impairment is common in multiple sclerosis (MS) and adds significantly to the burden of the disease. The ability to predict future cognitive impairment from imaging obtained at disease onset has not been investigated.

Methods: 62 patients imaged within 3 months of a clinically isolated syndrome (CIS) were assessed neuropsychologically 7 years later. Baseline and periodic MRI measures of lesions, atrophy, and normal-appearing white and grey matter (NAWM and NAGM) were regressed against neuropsychological scores to explore the best predictors of cognitive outcome.

Results: Twenty-eight patients had developed clinically definite MS (CDMS) at follow-up and a further nine met revised McDonald criteria for MS. Deficits in speed of information processing and executive function were the commonest abnormalities. Poor performance was correlated with high anxiety ratings. Baseline T1 lesion metrics predicted executive deficits and new T2 lesions at 3-month follow-up predicted slowed information processing. Increase in myoinositol concentration in the NAWM over the first 3 years was associated with poor executive function.

Conclusions: MRI parameters obtained at CIS onset can predict future development of cognitive abnormalities. Our findings may have implications in monitoring and treating patients.