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Diffusion Tensor Imaging Abnormalities in Cognitively Impaired Multiple Sclerosis Patients

Published online by Cambridge University Press:  02 December 2014

Nadine Akbar ,
Nancy J. Lobaugh ,
Paul O'Connor ,
Linda Moradzadeh ,
Christopher J. M. Scott  and
Anthony Feinstein
Nadine Akbar*
Affiliation:
Department of Psychiatry, Sunnybrook Health Sciences Centre University of Toronto
Nancy J. Lobaugh
Affiliation:
Department of Psychiatry, Sunnybrook Health Sciences Centre University of Toronto
Paul O'Connor
Affiliation:
University of Toronto St. Michael's Hospital, Toronto, Ontario, Canada
Linda Moradzadeh
Affiliation:
Department of Psychiatry, Sunnybrook Health Sciences Centre
Christopher J. M. Scott
Affiliation:
Department of Psychiatry, Sunnybrook Health Sciences Centre
Anthony Feinstein
Affiliation:
Department of Psychiatry, Sunnybrook Health Sciences Centre University of Toronto
*
Sunnybrook Health Sciences Centre, Department of Psychiatry, Room FG08, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
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Abstract

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Background:

Cognitive impairment can add to the burden of disease in patients with multiple sclerosis (MS). The aim of this study was to assess the relative importance of diffusion tensor imaging (DTI) indices derived from normal appearing white matter (NAWM) and grey matter (NAGM) in determining cognitive dysfunction in MS patients.

Methods:

Sixty two MS patients [51 female, mean age= 41 (sd=9.6) years, median expanded disability status scale (EDSS)=2.5] meeting modified McDonald criteria for MS underwent neuropsychological testing using the Neuropsychological Screening Battery for MS (NSBMS) and magnetic resonance imaging (MRI, 1.5T GE) that included DTI sequences. Total T1 hypointense and T2 hyperintense lesion volumes were obtained using semi-automated software. Lesion volumes were subtracted from whole-brain parenchyma to obtain measures of NAWM and NAGM. Fractional anisotropy (FA) of NAWM and mean diffusivity (MD) of NAGM were obtained.

Results:

Cognitive impairment was present in 11 patients (18%). These patients had higher EDSS scores, were less educated, and were more likely to have secondary progressive MS. They also had higher hypointense (p=0.001) and hyperintense (p=0.004) lesion volumes, greater NAWM atrophy (p=0.007), lower FA of total NAWM (p=0.003), and higher MD of total NAGM (p=0.015). Using a logistic regression analysis, and after controlling for demographic and disease-related differences between groups, FA of NAWM emerged as a significant predictor of cognitive impairment adding to the variance derived from lesion and atrophy data.

Conclusion:

This study underlies the important role of normal-appearing brain tissue in the pathogenesis of MS-related cognitive impairment.

Résumé:

RÉSUMÉ:Contexte:

L’atteinte cognitive peut augmenter le fardeau de la maladie chez les patients atteints de sclérose en plaques (SP). Le but de cette étude était d’évaluer l’importance relative d’indices à l’imagerie en tenseur de diffusion dérivés de la substance blanche et de la substance grise d’aspect normal (SBAN et SGAN) pour objectiver la dysfonction cognitive chez les patients atteints de SP.

Méthodes:

Soixante-deux patients atteints de SP (51 femmes ; àge moyen 41 ans -écart type 9,6 ; médiane EDSS 2,5) qui rencontraient les critères modifiés de McDonald pour la SP, ont subi une évaluation neuropsychologique au moyen de la Neuropsychological Screening Battery pour la SP et une imagerie par résonance magnétique (IRM, 1,5T GE) qui incluait des séquences DTI. Le volume total des lésions hypo intenses en T1 et hyper intenses en T2 a été évalué au moyen d’un logiciel semi-automatisé. Le volume des lésions était soustrait du parenchyme cérébral total pour obtenir les mesures de SBAN et de SGAN. L’anisotropie fractionnée (AF) de la SBAN et la diffusivité moyenne (DM) de la SGAN ont été évaluées.

Résultats:

Une atteinte cognitive était présente chez 11 patients (18%). Ces patients avaient des scores plus élevés à l’EDSS, étaient moins instruits et étaient plus susceptibles d’avoir une SP secondairement progressive. Ils avaient également un volume de lésions hypo intenses et hyper intenses plus élevé (p = 0,001 et p = 0,004 respectivement), plus d’atrophie de la SBAN (p = 0,007), une AF de la SBAN totale plus basse (p = 0,003) et une DM de la SGAN totale plus élevée (p = 0,015). L’analyse de régression logistique, après ajustement pour les différences démographiques et les différences liées à la maladie entre les groupes, a montré que l’AF de la SBAN est un facteur de prédiction significatif de l’atteinte cognitive, ce qui ajoute à la variance dérivée des données sur les lésions et sur l’atrophie.

Conclusion:

Cette étude souligne le role important du tissu cérébral d’apparence normale dans la pathogenèse de l’atteinte cognitive liée à la SP.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 5 , September 2010 , pp. 608 - 614
Copyright
Copyright © The Canadian Journal of Neurological 2010

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