Gray Matters in Multiple Sclerosis: Cognitive Impairment and Structural MRI

Messina, Silvia; Patti, Francesco

doi:10.1155/2014/609694

Cited by 52 publications

(55 citation statements)

References 101 publications

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“…Higher correlations are observed between cognitive performance and third ventricle width, which is traditionally considered the best single MRI predictor for MS-related cognitive impairment (Benedict et al, 2004(Benedict et al, , 2006. More recent research highlights cortical pathology as one of the major substrates of cognitive decline in MS (for a review see Messina & Patti, 2014). Our clinico-anatomical correlation analyses revealed two main findings that survived Bonferroni correction: First, increased counting in MS patients was associated with higher cortical lesion load.…”

Section: Discussionmentioning

confidence: 62%

Random number generation deficits in patients with multiple sclerosis: Characteristics and neural correlates

Geisseler

Pflugshaupt

Buchmann

et al. 2016

Cortex

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Human subjects typically deviate systematically from randomness when attempting to produce a sequence of random numbers. Despite an increasing number of behavioral and functional neuroimaging studies on random number generation (RNG), its structural correlates have never been investigated. We set out to fill this gap in 44 patients with multiple sclerosis (MS), a disease whose impact on RNG has never been studied. The RNG task required the paced (1 Hz) generation of the numbers from 1 to 6 in a sequence as random as possible. The same task was administered in 39 matched healthy controls. To assess neuroanatomical correlates such as cortical thickness, lesion load and third ventricle width, all subjects underwent high-resolution structural MRI. Compared to controls, MS patients exhibited an enhanced tendency to arrange consecutive numbers in an ascending order ("forward counting"). Furthermore, patients showed a higher susceptibility to rule breaks (producing out-of-category digits like 7) and to skip beats of the metronome. Clinico-anatomical correlation analyses revealed two main findings: First, increased counting in MS patients was associated with higher cortical lesion load. Second, increased number of skipped beats was related to widespread cortical thinning. In conclusion, our test results illustrate a loss of behavioral complexity in the course of MS, while the imaging results suggest an association between this loss and cortical pathology. AbstractHuman subjects typically deviate systematically from randomness when attempting to produce a sequence of random numbers. Despite an increasing number of behavioral and functional neuroimaging studies on random number generation (RNG), its structural correlates have never been investigated. We set out to fill this gap in 44 patients with multiple sclerosis (MS), a disease whose impact on RNG has never been studied. The RNG task required the paced (1 Hz) generation of the numbers from 1 to 6 in a sequence as random as possible. The same task was administered in 39 matched healthy controls. To assess neuroanatomical correlates such as cortical thickness, lesion load and third ventricle width, all subjects underwent high-resolution structural MRI. Compared to controls, MS patients exhibited an enhanced tendency to arrange consecutive numbers in an ascending order ("forward counting"). Furthermore, patients showed a higher susceptibility to rule breaks (producing out-of-category digits like 7) and to skip beats of the metronome. Clinicoanatomical correlation analyses revealed two main findings: First, increased counting in MS patients was associated with higher cortical lesion load. Second, increased number of skipped beats was related to widespread cortical thinning. In conclusion, our test results illustrate a loss of behavioral complexity in the course of multiple sclerosis, while the imaging results suggest an association between this loss and cortical pathology. KeywordsRandom number generation; mental dice task; multiple sclerosis, neural correlates

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Section: Discussionmentioning

confidence: 62%

Random number generation deficits in patients with multiple sclerosis: Characteristics and neural correlates

Geisseler

Pflugshaupt

Buchmann

et al. 2016

Cortex

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“…Many patients also experience impairments in cognitive function, including memory loss, decreased mental processing speed, and diminished executive function. These symptoms can occur early in disease and often worsen with time, even if physical symptoms remain stable [8, 9]. …”

Section: Overview Of Multiple Sclerosis (Ms)mentioning

confidence: 99%

The meninges: new therapeutic targets for multiple sclerosis

Russi

Brown

2015

Translational Research

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The CNS is largely comprised of non-regenerating cells, including neurons and myelin-producing oligodendrocytes, which are particularly vulnerable to immune cell mediated damage. To protect the CNS, mechanisms exist that normally restrict the transit of peripheral immune cells into the brain and spinal cord, conferring an “immune specialized” status. Thus, there has been a long-standing debate as to how these restrictions are overcome in several inflammatory diseases of the CNS, including multiple sclerosis (MS). In this review, we highlight the role of the meninges, tissues that surround and protect the CNS and enclose the cerebral spinal fluid, in promoting chronic inflammation that leads to neuronal damage. Although the meninges have traditionally been considered structures that provide physical protection for the brain and spinal cord, new data has established these tissues as sites of active immunity. It has been hypothesized that the meninges are important players in normal immunosurveillance of the CNS but also serve as initial sites of anti-myelin immune responses. The resulting robust meningeal inflammation elicits loss of localized blood barrier integrity and facilitates a large-scale influx of immune cells into the CNS parenchyma. We propose that targeting of the cells and molecules mediating these inflammatory responses within the meninges offers promising therapies for MS that are free from the constraints imposed by the blood brain barrier. Importantly, such therapies may avoid the systemic immunosuppression often associated with the existing treatments.

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“…WM demyelination is correlated moderately with cognitive impairment, suggesting that WM abnormalities alone probably cannot fully explain the extent of clinical symptoms in MS, including cognitive impairment. Several MRI techniques have shown the involvement of GM in MS and the association between GM damage, physical disability, and cognitive impairment [67].…”

Section: Mrimentioning

confidence: 99%

Some neuropsychiatric and MRI manifestations in patients with multiple sclerosis

Allam¹,

EL-Hamady²,

Morad³

et al. 2015

Middle East Current Psychiatry

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BackgroundNeuropsychiatric abnormalities are common in multiple sclerosis (MS) patients. Cognitive dysfunction affects B40% of MS patients. Advances in neuroimaging are increasing our understanding of the pathogenesis of these disorders. Aim This study aimed to assess the possible neurological and psychiatric complications and cognitive impairment in MS patients and to correlate the psychiatric symptoms with clinical types, severity, and MRI findings in MS patients. Participants and methods This is a cross-sectional descriptive study that was carried out on 25 patients diagnosed with definite MS according to McDonald's criteria. All patients were subjected to a semi-structured interview that included demographic data and full neurological and psychiatric examination, Expanded Disability Status Scale (EDSS) evaluation, Mini-Mental State Examination (MMSE), and MRI brain with assessment of the lesions number, site, and brain atrophy. ResultsThis study included 25 adults, 19 women and six men. They ranged in age from 22 to 55 years, mean age 33 ± 9 years. The mean disease duration was 6.4 ± 3 years. Sixty-four percent of the patients were married. Sixty-four percent of the patients had the relapsing remitting type of MS. Fatigue was the most prevalent symptom (96%), followed by sphincter troubles, (80%) visual symptoms (76%), dizziness (64%), sexual dysfunction (60%), and pain (56%). EDSS showed that 44% of the patients had moderate disability, 32% of the patients needed intermittent or constant unilateral assistance, and 24% of the patients needed constant bilateral support. On applying the Structural Clinical Interview for DSM-IV Axis I (SCID-I), it was found that depression (60%), dysthymia (60%), and generalized anxiety disorder (68%) were the most prevalent psychiatric presentations. For the MMSE, 24% of the patients showed an MMSE score between 17 and 25 and 4% the patients showed scores less than 17. Assessment of MRI brain showed that atrophic brain changes were present in 72% of the patients. All the patients studied had supratentorial plaques and 44% had frontal plaques. Infratentorial lesions were present in 72% of MS patients. Conclusion and recommendationsAttention should be focused on the other important presentations of the disease such as psychiatric disorders and cognitive impairments, and a comprehensive biopsychosocial neuropsychiatric approach should be adopted, which is essential for optimal care of patients with MS.

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Gray Matters in Multiple Sclerosis: Cognitive Impairment and Structural MRI

Cited by 52 publications

References 101 publications

Random number generation deficits in patients with multiple sclerosis: Characteristics and neural correlates

Random number generation deficits in patients with multiple sclerosis: Characteristics and neural correlates

The meninges: new therapeutic targets for multiple sclerosis

Some neuropsychiatric and MRI manifestations in patients with multiple sclerosis

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