Patterns Of Cognitive Impairment In Secondary/Progressive Stable Phase Of Multiple Sclerosis: Correlations With MRI Findings
Nocentini U, Rossini PM, Carlesimo GA, Graceffa A, Grasso MG, Lupoi D, Oliveri M, Orlacchio A, Pozzilli C, Rizzato B, Caltagirone C
Eur Neurol 2001;45(1):11-8
IRCCS S. Lucia, Rome, Italy
Cognitive Impairment is commonly described in Multiple Sclerosis (MS), but conflicting results have been reported about its pattern by previous studies focused on heterogeneous patient groups.
The aim of this study was to investigate the Cognitive skills of a homogeneous group of Secondary/Progressive MS patients, and to examine the relationship of this Impairment to MRI parameters.
Forty-four MS patients underwent a series of NeuroPsychological tests devised to explore the main Cognitive domains, and T1- and T2-weighted Brain MRI.
Results showed the presence of deficits of Attention, Memory, Planning Abilities, Problem-Solving and Conceptual Reasoning (Frontal Functions) in a subgroup of MS patients.
Correlations between the performance in some 'Frontal' tests and the extent of Frontal Lobe MRI lesional area were present, but rather unspecific, the same performance being also correlated with the NonFrontal lesional area.
These findings suggest that in MS, overall macroscopic and microscopic Brain damage is more important than the corresponding focal Brain disease, even in determining deficits of selective Cognitive Domains.
Copyright 2001 S. Karger AG, Basel
Stuss DT, Levine B, Alexander MP, Hong J, Palumbo C, Hamer L, Murphy KJ, Izukawa D
University of Toronto, Rotman Research Institute, Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, Canada
Forty-six patients with single focal lesions (35 Frontal, 11 NonFrontal) were administered the Wisconsin Card Sorting Test (WCST) under three conditions of test administration.
The three conditions varied in the amount of external support provided via specificity of instructions.
The WCST, while a multifactorial test, is specifically sensitive to the effects of Frontal Lobe damage if deficits in Language Comprehension and Visual-Spatial search are controlled.
There is also specificity of functioning within the Frontal Lobes: patients with Inferior Medial Frontal lesions, unilateral or bilateral, were not impaired on the standard measures.
Although they had increased Loss Of Set when informed of the sorting categories.
Verbal instructions may provide a probe to improve diagnosis and prognosis, assessment of the potential efficacy of treatment, and the time frame of plasticity of specific Cognitive Operations.
Cortical Cerebral Metabolism Correlates With MRI Lesion Load And Cognitive Dysfunction In MS
Blinkenberg M, Rune K, Jensen CV, Ravnborg M, Kyllingsbaek S, Holm S, Paulson OB, Sorensen PS
Neurology 2000 Feb 8;54(3):558-64
Copenhagen University Hospital, MS Research Unit, Denmark
To study the association between the Cortical Cerebral metabolic rate of Glucose (CMRglc), MRI T2-weighted total lesion area (TLA), Cognitive Dysfunction, and Neurologic disability in MS.
MRI lesion load is widely used in the clinical evaluation of the MS patient but little is known about the associated changes in Cortical activation.
Twenty-three patients with Clinically Definite MS underwent measurements of CMRglc, TLA, Motor Evoked Potentials (MEPs), and Cognitive and Neurologic disability.
CMRglc was calculated using PET and 18-F-DeoxyGlucose and compared with nine normal control subjects.
Reductions in CMRglc (p < 0.01) were found in the Cortical global and regional Lobar measurements.
Furthermore, regional CMRglc (rCMRglc) was reduced in the DorsoLateral PreFrontal Cortex, OrbitoFrontal Cortex, Caudate, Putamen, Thalamus, and Hippocampus.
Global Cortical CMRglc correlated with TLA (Spearman rank correlation coefficient [SRCC] = -0.66, p = 0.001), and rCMRglc correlated with Regional Lesion Load in all Cerebral Lobes (p < or = 0.05).
Global Cortical CMRglc and Cognitive disability also correlated (SRCC = 0.58, p = 0.015), and stepwise regression analysis showed a significant association between rCMRglc of the Right Thalamus and Cognitive performance as well as TLA.
There was no correlation between CMRglc and Neurologic disability (Expanded Disability Status Scale) or MEP.
Global and regional Cortical CMRglc is reduced significantly in MS patients compared with normal control subjects.
Furthermore, the CMRglc reductions correlate with TLA as well as with Cognitive Dysfunction, which indicates that MRI White Matter lesion burden has a deteriorating effect on Cortical Cerebral Neural function.
Cognitive Dysfunction In Multiple Sclerosis: Natural History, PathoPhysiology And Management
Bagert B, Camplair P, Bourdette D
CNS Drugs 2002;16(7):445-55
Research and Neurology Services, Department of Veterans Affairs Medical Center, Portland, Oregon, USA
Cognitive Dysfunction is a major cause of disability in patients with Multiple Sclerosis (MS). The prevalence of Cognitive Dysfunction is estimated at 45 to 65%.
Natural history studies suggest that once Cognitive Dysfunction develops in a patient with MS, it is not likely to remit.
Unlike physical disability in MS, Cognitive disability correlates weakly with T2 lesion burden on Brain Magnetic Resonance Imaging (MRI).
More robust correlations exist with Magnetization Transfer imaging and MRI measures of Brain Atrophy.
Patients with MS who have Cognitive Impairment most commonly display deficits in the Cognitive domains of Memory, Learning, Attention and Information Processing.
In diagnosing Cognitive Dysfunction in a patient with MS, it is important first to recognize and treat the common comorbidities of Fatigue and Depression.
The first step in the treatment of Cognitive Dysfunction is to delay disease progression.
And, there are currently five such disease-modifying agents approved for the treatment of MS (two preparations of Interferon-beta-1a, Interferon-beta-1b, Glatiramer Acetate and Mitoxantrone).
NonPharmacological measures, such as Cognitive Rehabilitation, Occupational Therapy and PsychoTherapy, are the mainstays of symptomatic treatment.
Pharmacological symptomatic therapy centres on the treatment of comorbid Fatigue and Depression. There are currently no effective pharmacological agents approved as symptomatic therapy of Cognitive Dysfunction in MS.