Tuesday, 12 March 2013

Research: White matter lesions contribute to cognitive impairment

Epub: Papadopoulou et al. Contribution of cortical and white matter lesions to cognitive impairment in multiple sclerosis. Mult Scler. 2013 Mar 4.

BACKGROUND: Cortical lesions (CLs) have been reported to be a better predictor for cognitive impairment than white matter (WM) lesions in relapsing-remitting multiple sclerosis (RRMS).

OBJECTIVES: The objectives of this article are to investigate the contribution of CLs and WM lesions to cognitive impairment in 91 patients with MS and clinically isolated syndrome, and to test potential associations of CLs and WM lesions with fatigue and depression.

METHODS: Lesions were scored and segmented on 3D double inversion recovery sequences, according to their location (cortical, WM). Normalised grey matter volume was also determined. Cognitive performance was assessed with the SDMT and PASAT-3, fatigue with the FSMC and depression with the German version of the CES-D.

RESULTS: CL volume did not correlate with fatigue or depression, but correlated significantly with both neuropsychological outcome measures: PASAT-3 (r = -0.275, p = 0.009) and SDMT (r = -0.377, p < 0.001). Multiple regression analyses with age, WM lesions, CLs and GM volume as independent variables, however, did not reveal CL volume as a significant predictor of neuropsychological outcomes, whereas WM lesion volume significantly predicted SDMT and by trend PASAT performance.

CONCLUSIONS: These findings suggest a role of WM lesions in the development of cognitive deficits, especially information-processing speed, which may be higher than previously assumed.



Both Grey (nerve bodies) and white (axons) matter lesions will influence brain processing. Cortical lesions on the outer part of the brain have been difficult to spot by MRI at 3T and below. This study suggests that white matter lesions in the cortical regions are involved in cognitive deficits. Grey matter lesions will also contribute to this. Will preventing white matter lesion development prevent or delay cognitive impairment? How many white matter lesions do you have on your MRI?

3 comments:

  1. I have more than 20 lesions on my MRI but I suspect it's closer to 30 if the counting would have been done via a software (if there were any) and not manually by a not so diligent neuro. So is my cognition affected? A BIT. Not much. My short memory is affected when many new facts are presented at work but with time I manage. I can't remember any significant memory lapses or other cognitive deficits. However I was always rubbish at spatio-visual thing. On the other hand I am speaking quite a few languanges and had an above-avarage memory so maybe I have bigger reserves.... My main problems with MS are mild spasticity and dizziness.

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  2. How would I know the resolution / sensitivity of the MRI scans I have ? And if I find out, unless they are above 3T, it won't make a difference to the ability to identify white matter lesions.

    Is it legitimate to ask to be sent to a hospital with a better quality scanner to see if I have white matter lesions ?

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    1. It is only worth having a scan if it is going to change your diagnosis of alter your therapy! I suspect neither.

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