Correlation between cortical lesions and cognitive impairment in multiple sclerosis

Abstract

ObjectivesGray matter (GM) damage is well known as a fundamental aspect of multiple sclerosis (MS). Above all, cortical lesions (CLs) burden, detectable at MRI with double inversion recovery (DIR) sequences, has been demonstrated to correlate with cognitive impairment (CI). The aim of this study was to investigate the role of CLs number in predicting CI in a cohort of patients with MS in a clinical practice setting.Materials and methodsThirty consecutive patients with MS presenting CLs (CL+) at high‐field (3.0 T) MRI 3D‐DIR sequences and an even group of MS patients without CLs (CL‐) as a control, were investigated with the Rao Brief Repeatable Battery of Neuropsychological Tests (BRB), Version A. Total and lobar CLs number were computed in CL+ patients.ResultsAmong the sixty patients with MS enrolled, forty‐seven (78.3%) had a relapsing‐remitting course, while thirteen (21.7%) a progressive one, eleven secondary progressive, and two primary progressive. Compared to CL−, CL+ patients had a greater proportion of progressive forms (p = .03). The most affected region was the frontal lobe (73.3% of patients), followed by temporal and parietal ones (both 60.0%). Multivariate (logistic regression) analysis revealed a significant correlation between total CLs number and the presence of mild cognitive impairment defined as pathologic score in at least one BRB test (p = .04); it was also correlated with deficit at PASAT 3 (p = .05) and Stroop Test (p = .02).ConclusionsWe confirmed CLs number, evaluated with a technique quite commonly available in clinical practice, as a predictive factor of CI in patients with MS, in order to improve the diagnosis and management of CI and monitor potential neuroprotective effects of therapies.

Ultra-high field 7 T imaging in multiple sclerosis

“…Only few studies have investigated the contribution of CL load assessed at 7T to clinical MS disability. Even if derived from relatively small cohorts (up to 36 patients), the data obtained from cross-sectional studies 27,28 confirm the findings observed at lower field strength [29][30][31][32][33] regarding the relationship between high CL load and higher Expanded Disability Status Scale (EDSS) scores and cognitive impairment. Furthermore, the same studies have shown that CL subtypes might have a different clinical relevance.…”

A Narrative Review on Biopsychosocial Predictors of Cognitive Impairment among Multiple Sclerosis Patients: Directions for Malaysia Studies

“…Burden of lesion is often measured by grey matter damage, which is measured either as cortical lesion (CL) or as cortical atrophy. Total CLs number was also found to predict cognitive impairment in verbal memory, information processing speed, working memory and attention in comparing between 30 MS patients with CL and 30 MS patients without CL (Curti et al 2018).…”

“…According to Curti et al (2018), frontal lobe is the most affected region by CL, followed by temporal and parietal lobe. On the other hand, according to Papadopoulou and colleagues (2013), even though CL volume was correlated with information processing speed, working memory and attention, white matter damage significantly predicted cognitive impairment instead.…”

Longitudinal cortical thinning progression differs across multiple sclerosis phenotypes and is clinically relevant: A multicentre study

“…Damage of the temporal cortices has been associated with cognitive impairment, 30 whereas involvement of the lateral orbitofrontal cortex and the inferior parietal lobule has been correlated with associative dysfunction, ideomotor apraxia, sensory agnosia and visual disturbances, 31 which interfere in the patients’ clinical performance. Indeed, lateral orbitofrontal cortices and the left inferior parietal lobule showed also associations with concomitantly worse EDSS scores, mirroring the sensitivity of the EDSS for the detection of sensorimotor 32 and visual impairment.…”

“…28 In MS patients, a more severe atrophy of the left precuneus (observed especially in RRMS patients) was associated with a higher LV, reinforcing the notion 4,5,12 that overall CTh reduction in the RR disease phases might be (at least partially) originated by Wallerian retrograde degeneration. 29 Damage of the temporal cortices has been associated with cognitive impairment, 30 whereas involvement of the lateral orbitofrontal cortex and the inferior parietal lobule has been correlated with associative dysfunction, ideomotor apraxia, sensory agnosia and visual disturbances, 31 which interfere in the patients' clinical performance. Indeed, lateral orbitofrontal cortices and the left inferior parietal lobule showed also associations with concomitantly worse EDSS scores, mirroring the sensitivity of the EDSS for the detection of sensorimotor 32 and visual impairment.…”