Department of Neurosciences, University Hospital of Padova, Multiple Sclerosis Centre of Veneto Region, First Neurology Clinic, 35128 Padova, Italy.
Neurology. 2010 Jan 26;74(4):321-8. doi: 10.1212/WNL.0b013e3181cbcd03.
Although cognitive dysfunction affects a relevant portion of patients with multiple sclerosis (MS), its pathologic substrate has not been clarified and it does not seem entirely explained by white matter changes.
A total of 100 consecutive patients with relapsing remitting MS (RRMS) and 42 normal controls (NC) were enrolled in the study. Cognitive performance was assessed by Rao's Brief Repeatable Battery of Neuropsychological Tests (BRB). Regional cortical thickness (CTh) was evaluated by Freesurfer.
Thirty-one patients with RRMS failed 1 or 2 tests of BRB and were considered to have a mild cognitive impairment (mCI-RRMS), while 8 patients failed at least 3 tests and were classified as markedly impaired (sCI-RRMS). The mean CTh of mCI-RRMS and sCI-RRMS group was significantly lower than in NC (p < 0.001) and cognitively normal patients with RRMS (CN-RRMS) (p < 0.001). The regional analysis revealed significant cortical thinning in frontal and temporal regions (frontotemporal thinning) of CN-RRMS compared to NC, while a widespread pattern of cortical thinning was observed in mCI-RRMS and in sCI-RRMS compared to both CN-RRMS and NC. A correlation was observed between cognitive score (CS) and the mean CTh (r = -0.69, p < 0.001) and between CS and CTh of almost all the cortical areas analyzed (r value between -0.20 and -0.65, p < 0.01). A correlation was found between T2-WM-LV and mean CTh (r = -0.31, p = 0.004) or CS (r = 0.21, p = 0.031). The multivariate analysis confirmed a widespread cortical thinning as the best predictor of cognitive impairment.
A widespread pattern of cortical thinning characterizes patients with cognitive dysfunction, suggesting such dysfunction as expression of a more aggressive and widespread cortical pathology.
尽管认知功能障碍影响了相当一部分多发性硬化症（MS）患者，但它的病理基础尚未阐明，而且似乎并不能完全用白质变化来解释。
本研究共纳入 100 例复发缓解型多发性硬化症（RRMS）患者和 42 例正常对照者（NC）。采用 Rao 的简短可重复神经心理学测试电池（BRB）评估认知表现。采用 Freesurfer 评估皮质厚度（CTh）。
31 例 RRMS 患者在 BRB 中出现 1 项或 2 项测试失败，被认为存在轻度认知障碍（mCI-RRMS），而 8 例患者至少有 3 项测试失败，被归类为明显受损（sCI-RRMS）。mCI-RRMS 和 sCI-RRMS 组的平均 CTh 明显低于 NC（p<0.001）和认知正常 RRMS 患者（CN-RRMS）（p<0.001）。区域分析显示，CN-RRMS 与 NC 相比，额叶和颞叶区域（额颞叶变薄）皮质变薄，而 mCI-RRMS 和 sCI-RRMS 与 CN-RRMS 和 NC 相比，皮质变薄呈广泛模式。认知评分（CS）与平均 CTh 之间存在相关性（r=-0.69，p<0.001），CS 与分析的几乎所有皮质区域的 CTh 之间也存在相关性（r 值在-0.20 至-0.65 之间，p<0.01）。T2-WM-LV 与平均 CTh（r=-0.31，p=0.004）或 CS（r=0.21，p=0.031）之间存在相关性。多元分析证实广泛的皮质变薄是认知障碍的最佳预测因素。
广泛的皮质变薄模式是认知功能障碍患者的特征，表明这种功能障碍是更具侵袭性和广泛的皮质病理学的表现。
