Tuesday, 10 January 2017

Using MRI to assess memory

Clin Neurol Neurosurg. 2016 Dec 29;153:73-78. doi: 10.1016/j.clineuro.2016.12.015. [Epub ahead of print]

Developing easy to perform routine MRI measurements as potential surrogates for cognitive impairment in MS.

Morrow SA, Menon S, Rosehart H, Sharma M.

Abstract

OBJECTIVES:

One of the most frequently disabling symptoms in Multiple Sclerosis (MS) is cognitive impairment which is often insidious in onset and therefore difficult to recognize in the early stages, for both persons with MS and clinicians. A biomarker that would help identify those at risk of cognitive impairment, or with only mild impairment, would be a useful tool for clinicians. Using MRI, already an integral tool in the diagnosis and monitoring of disease activity in MS, would be ideal. Thus, this study aimed to determine if simple measures on routine MRI could serve as potential biomarkers for cognitive impairment in MS.

PATIENTS AND METHODS:

We retrospectively identified 51 persons with MS who had a cognitive assessment and MRI within six months of the MRI. Simple linear measurements of the hippocampi, bifrontral and third ventricular width, bicaudate width and the anterior, mid and posterior corpus callosum were made. Pearson's correlations examined the relationship between these MRI measures and cognitive tests, and MRI measures were compared in persons with MS who were either normal or cognitively impaired on objective cognitive tests using Analysis of Covariance (ANCOVA).

RESULTS:

Bicaudate span and third ventricular width were both negatively correlated, while corpus callosal measures were positive correlated with cognitive test performance. After controlling for potential confounders, bicaudate span was significant different on measures of immediate recall. Both anterior and posterior corpus collosal measure were significantly different on measures of verbal fluency, immediate recall and higher executive function; while the anterior corpus callosum was also significantly different on processing speed. The middle corpus collosal measure was significantly different on immediate recall and higher executive function.

CONCLUSION:

This study presents data demonstrating that simple to apply MRI measures of atrophy may serve as biomarkers for cognitive impairment in persons with MS. Further prospective studies are needed to validate these findings.


Figure: A) Hippocampal height B) Corpus callosum thickness C) Bicaudate width (2) D) Third ventricular width.

Memory loss and forgetfulness affects six out of ten PwMS. It often takes a back seat in MS care, but is responsible for a significant proportion of the morbidity reported (for example, performance at work, relationship difficulties and coping strategies). To date, the ability to assess this in the clinic has been limited by the strict reproducibility criteria only available in the context of research studies. Here, Morrow et al. report that it may be possible to do this on spot scans.

They report that corpus callosum thickness (see Figure), bicaudate span and third ventricular width measurements are most predictive of poor performance at memory and processing tests.

These findings make sense as the corpus callosum interconnects the two brain hemispheres, the caudate nuclei deal with verbal fluency and verbal learning/memory, while third ventricular width is a snapshot of brain volume loss occurring in the brain and is a predictor of memory and processing speed.

This then raises the question whether the MS world is ready to know this?

Sometimes it's better not to know, at other times knowing is not enough.

14 comments:

  1. I'm glad this is getting attention. Since diagnosis I've noticed small speech slurring and concentration issues. So slight most wouldn't notice. I don't expect a miracle but, would anyone advise on practical daily tips to keep thought process as optimal as possible?

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    1. I tried to answer this question before, but my post wasn't approved I assume because I recommended a drug. I will not make that mistake this time, but my favorite episode of South Park is Timmy 2000 which is season 4 episode 3.

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    2. Got any underlay? What! Is that a rug reference?

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    3. Ah. I understand you. Thanks for the nods, I'll certainly keep poking around

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    4. Something more straightforward:
      1) non-fiction reading
      2) crosswords

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    5. Thank you, I started taking minor tests in the morning and doing more puzzles, I'll add that to the list!

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  2. No, the world of MS isn't yet prepared to see that the disease affects cognition in all its aspects as well as affect other functions.

    Even because I think even logical: it's a pathology that affects the CNS par excellence, so if it didn't affect cognition would be very difficult.

    These times I debated with a neurology resident about MS affecting cognition and she told me that "I'm very attached to scientific studies, that it wasn't quite like this blablabla".

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  3. Having experienced losing total use of an arm and a leg simutaneously, for me, the cognitive impairments were far more life changing. I don't understand why they seem to be an after thought. Perhaps it is because they are unseen, or harder to imagine so don't get the attention. The way I see it is that you can get around in a wheelchair if your legs stop working and carry on with a career and a social life, but if you lose cognition, depending on the severity, you may not be able to, however mobile you are.

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    1. Some examples;

      I was careful to brown both sides of the turkey steak I cooked for my husbands dinner. It wasn't till he had eaten 3/4 of it that we realised I had forgotten that the inside needs to be cooked too, it was totally raw. I stayed up all night waiting for food poisoning to kick in, astonishingly and thankfully, it didn't.
      Not realising I wasn't fit to drive I tried to turn in to a dual carriageway going the wrong way. Other drivers reacted in time and I was shocked out of the manouvre.
      I made purchases inappropriate for our budget.
      For months I incurred late payment fees on my credit card because even though the due date was on the calendar in front of me I couldn't retain the information for long enough, and when I did try to use the automated telephone system for paying it, typing out the long number on my debit card was too confusing so I would give up.
      I had to be abandon my studies and give up on my ambition to teach science to teenagers.
      Sorry to go on about this but we can get into all kinds of trouble with cognitive damage. How do we show the banks, the police, our employers or whoever we have wronged what is happening to us or prove it? It concerns me enormously that there are periods when I could cause harm to others.
      I don't think it is a case of are we ready to know about this, it is why don't we already?

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    2. This is why MS is truly a brand of dementia. No-one seems to acknowledge this fact.

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    3. Perhaps if we were re-labelled as such we would be cared for and supported. I don't mind how they label me but my family and I do mind being unsupported.

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    4. Prof G suggested just that a while back. It caused a bit of a stir.
      http://multiple-sclerosis-research.blogspot.com/2013/06/rebranding-ms-as-dementia.html

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    5. 'It caused a bit of a stir'

      Cripes, you're not kidding, what a carry on!

      Goes to show how we perceive certain words differently, much like the recent progressive/advanced debate. I am personally not too hung up on the labels, more interested in the motives and the outcomes.

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  4. Always nice to know that data can be reproduced. Way back in 2012 the 16 year follow-up of the original interferon-beta-1b cohort confirmed that the baseline third ventricular size correlated with cognitive impairment.

    https://www.ncbi.nlm.nih.gov/pubmed/22193561

    Isn't simplicity beautiful? A 2D measure using a ruler, nothing more, nothing less.

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