Amato M P, Bartolozzi M L, Zipoli V, Portaccio E, Mortilla M, Guidi L, Siracusa G, Sorbi S, Federico A, De Stefano N
Department of Neurology, University of Florence, Viale Morgagni, 85-50134 Florence, Italy.
Neurology. 2004 Jul 13;63(1):89-93. doi: 10.1212/01.wnl.0000129544.79539.d5.
To assess neocortical changes and their relevance to cognitive impairment in early relapsing-remitting (RR) multiple sclerosis (MS).
Conventional MR was acquired in 41 patients with RR MS and 16 demographically matched normal control subjects (NCs). An automated analysis tool was used with conventional T1-weighted MRI to obtain measures of cortical brain volumes normalized for head size. Neuropsychological performance of MS patients was assessed using the Rao Brief Repeatable Battery. Relationship between volumetric MR measures and neuropsychological scores was assessed.
Neuropsychological assessment allowed for the identification of 18 cognitively preserved (MS-cp) and 23 cognitively impaired (MS-ci) MS patients. The whole MS sample showed lower values of normalized cortical volumes (NCVs) than did the NC group (p = 0.01). Upon grouping of MS patients according to cognitive performance, NCV values were lower (p = 0.02) in MS-ci patients than in both MS-cp patients and NCs. Moreover, there were positive correlations between NCV values and measures of verbal memory (r = 0.51, p = 0.02), verbal fluency (r = 0.51, p = 0.01), and attention/concentration (r = 0.65, p < 0.001) in MS-ci patients. Furthermore, NCV values were decreased in patients who scored lower on a greater number of tests (r = -0.58, p < 0.01) in the MS-ci group. None of the neuropsychological measures correlated to NCV values in the MS-cp patient group.
Cortical atrophy was found only in cognitively impaired patients and was significantly correlated with a poorer performance on tests of verbal memory, attention/concentration, and verbal fluency. Gray matter pathology may contribute to the development of cognitive impairment in MS from the earliest stages of the disease.
评估早期复发缓解型(RR)多发性硬化(MS)患者新皮层的变化及其与认知障碍的相关性。
对41例RR型MS患者和16例人口统计学匹配的正常对照者(NCs)进行常规磁共振成像(MR)检查。使用自动化分析工具结合常规T1加权MRI,获取经头部大小标准化后的皮质脑容量测量值。采用Rao简易重复成套测验评估MS患者的神经心理学表现。评估容积性MR测量值与神经心理学评分之间的关系。
神经心理学评估确定了18例认知功能保留的(MS-cp)和23例认知功能受损的(MS-ci)MS患者。整个MS样本的标准化皮质体积(NCV)值低于NC组(p = 0.01)。根据认知表现对MS患者进行分组后,MS-ci患者的NCV值低于MS-cp患者和NCs(p = 0.02)。此外,MS-ci患者的NCV值与言语记忆测量值(r = 0.51,p = 0.02)、言语流畅性(r = 0.51,p = 0.01)以及注意力/专注力(r = 0.65,p < 0.001)之间存在正相关。此外,在MS-ci组中,在更多测试中得分较低的患者NCV值降低(r = -0.58,p < 0.01)。MS-cp患者组中,没有任何神经心理学测量值与NCV值相关。
仅在认知功能受损的患者中发现皮质萎缩,且与言语记忆、注意力/专注力和言语流畅性测试中的较差表现显著相关。灰质病变可能在MS疾病的最早阶段就对认知障碍的发展起作用。