Summers M, Swanton J, Fernando K, Dalton C, Miller D H, Cipolotti L, Ron M A
Institute of Neurology, University College London, Queen Square, London, UK.
J Neurol Neurosurg Psychiatry. 2008 Aug;79(8):955-8. doi: 10.1136/jnnp.2007.138685. Epub 2008 Mar 13.
Cognitive impairment is common in multiple sclerosis (MS) and adds significantly to the burden of the disease. The ability to predict future cognitive impairment from imaging obtained at disease onset has not been investigated.
62 patients imaged within 3 months of a clinically isolated syndrome were assessed neuropsychologically 7 years later. Baseline and periodic MRI measures of lesions, atrophy and normal-appearing white and grey matter were regressed against neuropsychological scores to explore the best predictors of cognitive outcome.
28 patients had developed clinically definite MS at follow-up and a further nine met revised McDonald criteria for MS. Deficits in speed of information processing and executive function were the most common abnormalities. Poor performance correlated with high anxiety ratings. Baseline T(1) lesion metrics predicted executive deficits, and new T(2) lesions at the 3-month follow-up predicted slowed information processing. An increase in myo-inositol concentration in normal-appearing white matter over the first 3 years was associated with poor executive function.
MRI variables obtained at the onset of a clinically isolated syndrome can predict future development of cognitive abnormalities. Our findings may have implications in monitoring and treating patients.
认知障碍在多发性硬化症（MS）中很常见，并且显著增加了该疾病的负担。尚未研究从疾病发作时获得的影像学检查预测未来认知障碍的能力。
对62例在临床孤立综合征发病3个月内接受成像检查的患者在7年后进行神经心理学评估。将基线以及病变、萎缩和外观正常的白质和灰质的定期MRI测量结果与神经心理学评分进行回归分析，以探索认知结果的最佳预测指标。
随访时有28例患者发展为临床确诊的MS，另有9例符合修改后的MS McDonald标准。信息处理速度和执行功能缺陷是最常见的异常情况。表现不佳与高焦虑评分相关。基线T(1)病变指标可预测执行功能缺陷，3个月随访时新出现的T(2)病变可预测信息处理速度减慢。在最初3年中，外观正常的白质中肌醇浓度升高与执行功能不佳有关。
在临床孤立综合征发作时获得的MRI变量可以预测未来认知异常的发展。我们的发现可能对患者的监测和治疗具有启示意义。
