Thursday, 9 April 2015

Predicting cognitive problems

Patti F, De Stefano M, Lavorgna L, Messina S, Chisari CG, Ippolito D, Lanzillo R, Vacchiano V, Realmuto S, Valentino P, Coniglio G, Buccafusca M, Paolicelli D, D'Ambrosio A, Montella P, Brescia Morra V, Savettieri G, Alfano B, Gallo A, Simone I, Viterbo R, Zappia M, Bonavita S, Tedeschi G. Lesion load may predict long-term cognitive dysfunction in multiple sclerosis patients. PLoS One. 2015;10(3):e0120754.

BACKGROUND:Magnetic Resonance Imaging (MRI) techniques provided evidences into the understanding of cognitive impairment (CIm) in Multiple Sclerosis (MS).
OBJECTIVES:To investigate the role of white matter (WM) and gray matter (GM) in predicting long-term CIm in a cohort of MS patients.
METHODS: 303 out of 597 patients participating in a previous multicenter clinical-MRI study were enrolled (49.4% were lost at follow-up). The following MRI parameters, expressed as fraction (f) of intracranial volume, were evaluated: cerebrospinal fluid (CSF-f), WM-f, GM-f and abnormal WM (AWM-f), a measure of lesion load. Nine years later, cognitive status was assessed in 241 patients using the Symbol Digit Modalities Test (SDMT), the Semantically Related Word List Test (SRWL), the Modified Card Sorting Test (MCST), and the Paced Auditory Serial Addition Test (PASAT). In particular, being SRWL a memory test, both immediate recall and delayed recall were evaluated. MCST scoring was calculated based on the number of categories, number of perseverative and non-perseverative errors.
RESULTS: AWM-f was predictive of an impaired performance 9 years ahead in SDMT (OR 1.49, CI 1.12-1.97 p = 0.006), PASAT (OR 1.43, CI 1.14-1.80 p = 0.002), SRWL-immediate recall (OR 1.72 CI 1.35-2.20 p<0.001), SRWL-delayed recall (OR 1.61 CI 1.28-2.03 p<0.001), MCST-category (OR 1.52, CI 1.2-1.9 p<0.001), MCST-perseverative error(OR 1.51 CI 1.2-1.9 p = 0.001), MCST-non perseverative error (OR 1.26 CI 1.02-1.55 p = 0.032).
CONCLUSION: In our large MS cohort, focal WM damage appeared to be the most relevant predictor of the long-term cognitive outcome.

This study says that if you have white matter lesions it may help predict if you will get cognitive problems. This is perhaps not that surprising as damage to the the axons in the white matter will probably lead to damage to their nerve cell bodies in the grey matter. Some of these grey matter nerves are going to be in areas that control cognition.


  1. Great just great.... cognitive problems are the best.

    MD, what work is being done on repairing cognitive damage? Preventative measures such as increasing cognitive reserve won't help me anymore.

    1. we know that grey matter areas can remyelinate even in very old MSers...get MS under control and that is a good start.
      Brain training increase cognitive reserve and any form of repair strategy may be of value...although unproven in terms of repair of higher cognitive function

  2. I don't know much about neuropsychological testing, but... what are the controls here? If a person is tested and retested 9 years later, the results are going to be worse :-). MS or not MS, aging of the CNS affects everybody.

  3. I apologize for saying this, but the image used in this article is not from the study it cites. This image is from a project done by NIMH that shows a 15 year project of neuroimaging time-lapses from several healthy individuals as they grew between 5 and twenty years of age. The decrease in gray matter shows typical synaptic pruning, not damage to the brain acquired through MS.

    1. The images are often wall paper and are taken from google. Sometimes they are supposed to be informative and sometimes they are just a picture to brighten up the post. I think it is pretty obvious they are not from the same article. Best wishes


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