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Cognition in multiple sclerosis: relevance of lesions, brain atrophy and proton MR spectroscopy

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Abstract

The overall burden of brain MRI-visible lesions does not fully account for cognitive impairment in multiple sclerosis (MS). Several MRI studies have highlighted the importance of brain damage in the normal-appearing brain tissue. Brain atrophy (global, cortical, white and deep grey matter) is related to cognitive deficits in MS patients and this holds true since the earliest disease stages. Non-conventional MRI techniques such as proton MR spectroscopy have related metabolic changes in specific brain areas to specific cognitive deficits. Overall, data provided by MRI support the notion that cognitive disturbances need to be considered for a more complete clinical characterisation of patients with MS, including those with “benign” MS.

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References

  1. Glanz BI, Holland CM, Gauthier SA, Amunwa EL, Liptak Z, Houtchens MK, Sperling RA, Khoury SJ, Guttmann CR, Weiner HL (2007) Cognitive dysfunction in patients with clinically isolated syndromes or newly diagnosed multiple sclerosis. Mult Scler 13(8):1004–1010

    Article  CAS  PubMed  Google Scholar 

  2. Ranjeva JP, Audoin B, Au Duong MV, Confort-Gouny S, Malikova I, Viout P, Soulier E, Pelletier J, Cozzone PJ (2006) Structural and functional surrogates of cognitive impairment at the very early stage of multiple sclerosis. J Neurol Sci 245(1–2):161–167

    Article  PubMed  Google Scholar 

  3. Rovaris M, Barkhof F, Calabrese M, De Stefano N, Fazekas F, Miller DH, Montalban X, Polman C, Rocca MA, Thompson AJ, Yousry TA, Filippi M (2009) MRI features of benign multiple sclerosis: toward a new definition of this disease phenotype. Neurology 72(19):1693–1701

    Article  CAS  PubMed  Google Scholar 

  4. Amato MP, Portaccio E, Stromillo ML, Goretti B, Zipoli V, Siracusa G, Battaglini M, Giorgio A, Bartolozzi ML, Guidi L, Sorbi S, Federico A, De Stefano N (2008) Cognitive assessment and quantitative magnetic resonance metrics can help to identify benign multiple sclerosis. Neurology 71(9):632–638

    Article  CAS  PubMed  Google Scholar 

  5. Rao SM, Leo GJ, Haughton VM, St Aubin-Faubert P, Bernardin L (1989) Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis. Neurology 39(2 Pt 1):161–166

    CAS  PubMed  Google Scholar 

  6. Swirsky-Sacchetti T, Mitchell DR, Seward J, Gonzales C, Lublin F, Knobler R, Field HL (1992) Neuropsychological and structural brain lesions in multiple sclerosis: a regional analysis. Neurology 42(7):1291–1295

    CAS  PubMed  Google Scholar 

  7. Portaccio E, Stromillo ML, Goretti B, Zipoli V, Siracusa G, Battaglini M, Giorgio A, Bartolozzi ML, Guidi L, Sorbi S, Federico A, Amato MP, De Stefano N (2009) Neuropsychological and MRI measures predict short-term evolution in benign multiple sclerosis. Neurology 73(7):498–503

    Article  CAS  PubMed  Google Scholar 

  8. De Stefano N, Matthews PM, Filippi M, Agosta F, De Luca M, Bartolozzi ML, Guidi L, Ghezzi A, Montanari E, Cifelli A, Federico A, Smith SM (2003) Evidence of early cortical atrophy in MS: relevance to white matter changes and disability. Neurology 60(7):1157–1162

    PubMed  Google Scholar 

  9. De Stefano N, Giorgio A, Battaglini M, Rovaris M, Sormani MP, Barkhof F, Korteweg T, Enzinger C, Fazekas F, Calabrese M, Dinacci D, Tedeschi G, Gass A, Montalban X, Rovira A, Thompson A, Comi G, Miller D, Filippi M (2010) Assessing brain atrophy rates in a large population of untreated multiple sclerosis subtypes. Neurology 74(23):1868–1876

    Article  PubMed  Google Scholar 

  10. Rao SM, Bernardin L, Leo GJ, Ellington L, Ryan SB, Burg LS (1989) Cerebral disconnection in multiple sclerosis. Relationship to atrophy of the corpus callosum. Arch Neurol 46(8):918–920

    CAS  PubMed  Google Scholar 

  11. Benedict RH, Bruce JM, Dwyer MG, Abdelrahman N, Hussein S, Weinstock-Guttman B, Garg N, Munschauer F, Zivadinov R (2006) Neocortical atrophy, third ventricular width, and cognitive dysfunction in multiple sclerosis. Arch Neurol 63(9):1301–1306

    Article  PubMed  Google Scholar 

  12. Christodoulou C, Krupp LB, Liang Z, Huang W, Melville P, Roque C, Scherl WF, Morgan T, MacAllister WS, Li L, Tudorica LA, Li X, Roche P, Peyster R (2003) Cognitive performance and MR markers of cerebral injury in cognitively impaired MS patients. Neurology 60(11):1793–1798

    CAS  PubMed  Google Scholar 

  13. Amato MP, Bartolozzi ML, Zipoli V, Portaccio E, Mortilla M, Guidi L, Siracusa G, Sorbi S, Federico A, De Stefano N (2004) Neocortical volume decrease in relapsing–remitting MS patients with mild cognitive impairment. Neurology 63(1):89–93

    CAS  PubMed  Google Scholar 

  14. Tekok-Kilic A, Benedict RH, Weinstock-Guttman B, Dwyer MG, Carone D, Srinivasaraghavan B, Yella V, Abdelrahman N, Munschauer F, Bakshi R, Zivadinov R (2007) Independent contributions of cortical gray matter atrophy and ventricle enlargement for predicting neuropsychological impairment in multiple sclerosis. Neuroimage 36(4):1294–1300

    Article  PubMed  Google Scholar 

  15. Houtchens MK, Benedict RH, Killiany R, Sharma J, Jaisani Z, Singh B, Weinstock-Guttman B, Guttmann CR, Bakshi R (2007) Thalamic atrophy and cognition in multiple sclerosis. Neurology 69(12):1213–1223

    Article  CAS  PubMed  Google Scholar 

  16. Sicotte NL, Kern KC, Giesser BS, Arshanapalli A, Schultz A, Montag M, Wang H, Bookheimer SY (2008) Regional hippocampal atrophy in multiple sclerosis. Brain 131(Pt 4):1134–1141

    Article  CAS  PubMed  Google Scholar 

  17. Summers M, Fisniku L, Anderson V, Miller D, Cipolotti L, Ron M (2008) Cognitive impairment in relapsing–remitting multiple sclerosis can be predicted by imaging performed several years earlier. Mult Scler 14(2):197–204

    Article  PubMed  Google Scholar 

  18. Amato MP, Portaccio E, Goretti B, Zipoli V, Battaglini M, Bartolozzi ML, Stromillo ML, Guidi L, Siracusa G, Sorbi S, Federico A, De Stefano N (2007) Association of neocortical volume changes with cognitive deterioration in relapsing–remitting multiple sclerosis. Arch Neurol 64(8):1157–1161

    Article  PubMed  Google Scholar 

  19. Hildebrandt H, Lanz M, Hahn HK, Hoffmann E, Schwarze B, Schwendemann G, Kraus JA (2007) Cognitive training in MS: effects and relation to brain atrophy. Restor Neurol Neurosci 25(1):33–43

    PubMed  Google Scholar 

  20. De Stefano N, Filippi M (2007) MR spectroscopy in multiple sclerosis. J Neuroimaging 17 Suppl(1):31S–35S

    Article  Google Scholar 

  21. Okuda DT, Mowry EM, Beheshtian A, Waubant E, Baranzini SE, Goodin DS, Hauser SL, Pelletier D (2009) Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome. Neurology 72(9):800–805

    Article  CAS  PubMed  Google Scholar 

  22. Gadea M, Martinez-Bisbal MC, Marti-Bonmati L, Espert R, Casanova B, Coret F, Celda B (2004) Spectroscopic axonal damage of the right locus coeruleus relates to selective attention impairment in early stage relapsing–remitting multiple sclerosis. Brain 127(Pt 1):89–98

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest related to the publication of this article.

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Authors and Affiliations

  1. Quantitative Neuroimaging Lab, Department of Neurological and Behavioural Sciences, University of Siena, Viale Bracci 2, 53100, Siena, Italy

    Antonio Giorgio & Nicola De Stefano

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  1. Antonio Giorgio
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  2. Nicola De Stefano
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Correspondence to Nicola De Stefano.

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Giorgio, A., De Stefano, N. Cognition in multiple sclerosis: relevance of lesions, brain atrophy and proton MR spectroscopy. Neurol Sci 31 (Suppl 2), 245–248 (2010). https://doi.org/10.1007/s10072-010-0370-x

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