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Abstract
Objective: To determine MRI predictors for cognitive outcome in patients with early relapsing-remitting multiple sclerosis (MS).
Methods: Forty-four patients recently diagnosed with clinically definite MS were followed up with clinical and cognitive evaluations at 1, 2, 5, and 7 years and underwent brain MRI including magnetization transfer (MT) imaging at baseline and 2 years. Cognitive evaluation was also performed in 56 matched healthy subjects at baseline. Cognitive testing included the Brief Repeatable Battery. Imaging parameters included lesion load, brain parenchymal fraction (BPF), ventricular fraction (VF), and mean MT ratio (MTR) of lesion and normal-appearing brain tissue (NABT) masks.
Results: At baseline, patients presented deficits of memory, attention, and information processing speed (IPS). Over 2 years, all magnetic resonance parameters deteriorated significantly. Over 7 years, Expanded Disability Status Scale score deteriorated significantly. Fifty percent of patients deteriorated on memory cognitive domain and 22.7%of patients on IPS domain. Seven-year change of memory scores was significantly associated with baseline diffuse brain damage (NABT MTR). IPS z score change over 7 years was correlated with baseline global atrophy (BPF), baseline diffuse brain damage, and central brain atrophy (VF) change over 2 years.
Conclusion: The main predictors of cognitive changes over 7 years are baseline diffuse brain damage and progressive central brain atrophy over the 2 years after MS diagnosis.
Footnotes
Study funding: Supported in part by research grants from Association pour la Recherche contre la Sclérose en Plaques (ARSEP, France) and Bayer Healthcare France SA. Sponsors did not participate in design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.
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- BPF
- brain parenchymal fraction
- BRB
- Brief Repeatable Battery
- CDMS
- clinically definite multiple sclerosis
- CI
- confidence interval
- CIS
- clinically isolated syndrome
- DR
- delayed recall
- EDSS
- Expanded Disability Status Scale
- IPS
- information processing speed
- LL
- lesion load
- LTS
- long-term storage
- MADRS
- Montgomery-Åsberg Depression Rating Scale
- MR
- magnetic resonance
- MS
- multiple sclerosis
- MSFC
- Multiple Sclerosis Functional Composite
- MT
- magnetization transfer
- MTR
- magnetization transfer ratio
- NABT
- normal-appearing brain tissue
- OR
- odds ratio
- PASAT
- Paced Auditory Serial Addition Test
- PCI
- patient cognitively impaired
- PCU
- patient cognitively unimpaired
- RRMS
- relapsing-remitting multiple sclerosis
- SDMT
- Symbol Digit Modalities Test
- SPART
- Spatial Recall Test
- SRT
- Selective Reminding Test
- SRT-CLTR
- consistent long-term retrieval
- TE
- echo time
- TI
- inversion time
- TR
- repetition time
- VF
- ventricular fraction
- WLG
- Word List Generation
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Supplemental data at www.neurology.org
- Received May 18, 2010.
- Accepted December 22, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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