Subcortical gray matter atrophy is associated with cognitive deficit in multiple sclerosis but not in systemic lupus erythematosus patients

Kalinowska-Łyszczarz, Alicja; Pawlak, Mikołaj A.; Pietrzak, Anna; Pawlak-Buś, Katarzyna; Leszczyński, Piotr; Puszczewicz, Mariusz; Majewski, Dominik; Paprzycki, W; Kozubski, Wojciech; Michalak, Sławomir

doi:10.1177/0961203317735186

Cited by 11 publications

(12 citation statements)

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“…27 Only a limited number of studies have previously focused on the association between cognitive function and brain volumes on MRI in patients with SLE without major nervous system involvement ('non-NPSLE'). [28][29][30][31][32][33][34][35][36][37] Several studies found an association between global cognitive impairment and reduced grey matter 36 or white matter volume 28 30 36 and in one study this association was not found. 31 In our study, we demonstrated that brain volumes were indeed associated with cognitive function (all domains) in patients with SLE, but differences were present between NPSLE phenotypes.…”

Section: Lupus Lupus Lupusmentioning

confidence: 96%

White matter hyperintensities associate with cognitive slowing in patients with systemic lupus erythematosus and neuropsychiatric symptoms

et al. 2021

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ObjectiveTo compare cognitive function between patients with different phenotypes of neuropsychiatric systemic lupus erythematosus (NPSLE) and assess its association with brain and white matter hyperintensity (WMH) volumes.MethodsPatients attending the Leiden University Medical Centre NPSLE clinic between 2007 and 2015 without large brain infarcts were included (n=151; 42±13 years, 91% women). In a multidisciplinary consensus meeting, neuropsychiatric symptoms were attributed to systemic lupus erythematosus (SLE) (NPSLE, inflammatory (n=24) or ischaemic (n=12)) or to minor/non-NPSLE (n=115). Multiple regression analyses were performed to compare cognitive function between NPSLE phenotypes and to assess associations between brain and WMH volumes and cognitive function cross-sectionally.ResultsGlobal cognitive function was impaired in 5%, learning and memory (LM) in 46%, executive function and complex attention (EFCA) in 39% and psychomotor speed (PS) in 46% of all patients. Patients with inflammatory NPSLE showed the most cognitive impairment in all domains (p≤0.05).Higher WMH volume associated with lower PS in the total group (B: −0.14 (95% CI −0.32 to −0.02)); especially in inflammatory NPSLE (B: −0.36 (95% CI −0.60 to −0.12). In the total group, lower total brain volume and grey matter volume associated with lower cognitive functioning in all domains (all: 0.00/0.01 (0.00;0.01)) and lower white matter volume associated with lower LM, EFCA and PS (all: 0.00/0.01 (0.00;0.01)).ConclusionWe demonstrated that an association between brain and WMH volumes and cognitive function is present in patients with SLE, but differs between (NP)SLE phenotypes. WMHs associated with PS especially in inflammatory NPSLE, which suggests a different, potentially more severe underlying pathophysiological mechanism of cognitive impairment in this phenotype.

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Section: Lupus Lupus Lupusmentioning

confidence: 96%

White matter hyperintensities associate with cognitive slowing in patients with systemic lupus erythematosus and neuropsychiatric symptoms

et al. 2021

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“…In fact, all patients were assessed for cognitive impairment with a battery of neuropsychological tests, as published in our previous manuscript. 35 It has to be noted that although the SLEDAI score of our SLE group was relatively high, this was caused by the fact that they were all defined as NPSLE, so they were arbitrarily added eight points, even if NP symptomatology was headache or mild cognitive impairment. Those symptoms do not necessarily reflect high disease activity.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, all patients were assessed for cognitive impairment with a battery of neuropsychological tests, as published in our previous manuscript. 35…”

Section: Discussionmentioning

confidence: 99%

Distinct regional brain atrophy pattern in multiple sclerosis and neuropsychiatric systemic lupus erythematosus patients

Kalinowska-Łyszczarz

Pawlak

Pietrzak

et al. 2018

Lupus

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Differentiation of systemic lupus erythematosus (SLE) from multiple sclerosis (MS) can be challenging, especially when neuropsychiatric (NP) symptoms are accompanied by white matter lesions in the brain. Given the lack of discriminative power of currently applied tools for their differentiation, there is an unmet need for other measures that can aid in distinguishing between the two autoimmune disorders. In this study we aimed at exploring whether brain atrophy measures could serve as markers differentiating MS and SLE. Thirty-seven relapsing-remitting MS and 38 SLE patients with nervous system manifestations, matched according to age and disease duration, underwent 1.5 Tesla magnetic resonance imaging (MRI), including volumetric sequences, and clinical assessment. Voxelwise analysis was performed using ANTS-SyN elastic registration protocol, FSL Randomise and Gamma methods. Cortical and subcortical segmentation was performed with Freesurfer 5.3 pipeline using T1-weighted MPRAGE sequence data. Using MRI volumetric markers of general and subcortical gray matter atrophy and clinical variables, we built a stepwise multivariable logistic diagnostic model to identify MRI parameters that best differentiate MS and SLE patients. We found that the best volumetric predictors to distinguish them were: fourth ventricle volume (sensitivity 0.86, specificity 0.57, area under the curve, AUC 0.77), posterior corpus callosum (sensitivity 0.81, specificity 0.57, AUC 0.68), and third ventricle to thalamus ratio (sensitivity 0.42, specificity 0.84, AUC 0.65). The same classifiers were identified in a subgroup analysis that included patients with a short disease duration. In MS brain atrophy and lesion load correlated with clinical disability, while in SLE age was the main determinant of brain volume. This study proposes new imaging parameters for differential diagnosis of MS and SLE with central nervous system involvement. We show there is a different pattern of atrophy in MS and SLE, and the key structural volumes that are differentially affected include fourth ventricle and posterior section of corpus callosum, followed by third ventricle to thalamus ratio. Different correlation patterns between volumetric and clinical data may suggest that while in MS atrophy is driven mainly by disease activity, in SLE it is mostly associated with age. However, these results need further replication in a larger cohort.

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“…En relación a las medidas de volumen general, nuestro estudio encontró asociación moderada únicamente con el test PASAT (tiempo y aciertos). Coincidentes con estudios previos como el de Kalinowska-Lyszczarz [26] o Lazeron [27], los resultados obtenidos subrayan la sensibilidad de este test en la valoración de las funciones ejecutivas en EM, mostrando consonancia con estudios que incluso llegan a proponerlo como el test con mayor sensibilidad en la medida del cociente intelectual en este tipo de población [28].…”

Section: Discussionunclassified

Análisis de correlación entre medidas volumétricas y funciones ejecutivas en esclerosis múltiple

2020

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La esclerosis múltiple (EM) es una enfermedad crónica y neurodegenerativa del Sistema Nervioso Central con clara prevalencia de alteraciones cognitivas, especialmente atención, memoria y funciones ejecutivas. Los estudios de volumetría han mostrado la estrecha relación entre el volumen cerebral y el rendimiento cognitivo, sin embargo, son pocos los trabajos que han analizado las funciones ejecutivas en profundidad. Por ello, el objetivo del presente trabajo fue esclarecer la relación entre estas variables, a través de medidas de volumen global y regional (volumen bitalámico), con un amplio protocolo de funciones ejecutivas. Para ello 40 personas con EM participaron en este estudio transversal. Los resultados obtenidos mediante correlaciones bivariadas muestran relación moderada y positiva entre el volumen global y el rendimiento cognitivo en la memoria de trabajo. Igualmente se halla relación fuerte y moderada entre el volumen bitálamico y la ejecución en dominios cognitivos como la velocidad de procesamiento, la memoria de trabajo y la fluidez verbal semántica. Los resultados obtenidos muestran mayor sensibilidad de la memoria de trabajo en este tipo de estudios, y abren la posibilidad a la implantación de nuevos instrumentos de valoración cognitiva en la práctica clínica.

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Subcortical gray matter atrophy is associated with cognitive deficit in multiple sclerosis but not in systemic lupus erythematosus patients

Cited by 11 publications

References 47 publications

White matter hyperintensities associate with cognitive slowing in patients with systemic lupus erythematosus and neuropsychiatric symptoms

White matter hyperintensities associate with cognitive slowing in patients with systemic lupus erythematosus and neuropsychiatric symptoms

Distinct regional brain atrophy pattern in multiple sclerosis and neuropsychiatric systemic lupus erythematosus patients

Análisis de correlación entre medidas volumétricas y funciones ejecutivas en esclerosis múltiple

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