Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands.
Neurology. 2012 Oct 23;79(17):1754-61. doi: 10.1212/WNL.0b013e3182703f46. Epub 2012 Sep 26.
Gray matter (GM) atrophy is common in multiple sclerosis (MS), as is cognitive dysfunction. Understanding the exact relationship between atrophy and cognition requires further investigation. The aim of this study was to investigate the relationship between subcortical GM atrophy and cognition in early relapsing onset MS.
Structural MRI and neuropsychological evaluations were performed in 120 patients (80 women) and 50 controls (30 women), part of an early inception cohort, 6 years postdiagnosis. Deep GM volumes were segmented automatically. Cognition was assessed in 7 domains. Stepwise linear regression was used to predict average cognition in the patient group.
Most deep GM volumes were reduced in patients, with larger effects on average in men (-11%) than in women (-6.3%). Only the bilateral hippocampus, amygdala, and right nucleus accumbens in men, and right hippocampus and nucleus accumbens, bilateral amygdala, and putamen in women, showed no atrophy compared to controls. All cognitive domains except visuospatial memory were affected in men; none were significantly affected in women. In the MS group, average cognition was best predicted by thalamic volume, sex, and education (adjusted R(2) = 0.31), while lesion volume was not a significant predictor in the model.
Six years postdiagnosis, almost all subcortical structures were affected by MS, especially in men. Cognition was most severely affected in male patients. Thalamic volume, sex, and education best predicted average cognition. These results underline the relevance of specific subcortical structures to cognition, as well as the relevance of (sex-specific) atrophy in MS.
灰质（GM）萎缩在多发性硬化症（MS）中很常见，认知功能障碍也是如此。要了解萎缩与认知之间的确切关系，需要进一步研究。本研究旨在探讨早期复发型 MS 患者皮质下 GM 萎缩与认知之间的关系。
对 120 例患者（80 例女性）和 50 例对照者（30 例女性）进行了结构磁共振成像和神经心理学评估，这些患者均为早期发病队列的一部分，在诊断后 6 年进行了评估。采用自动分割技术对深部 GM 容积进行分割。采用逐步线性回归分析预测患者组的平均认知。
大多数深部 GM 容积在患者中减少，男性的平均效应较大（-11%），女性为-6.3%。仅男性的双侧海马体、杏仁核和右侧伏隔核，以及女性的右侧海马体和伏隔核、双侧杏仁核、壳核和苍白球与对照组相比没有萎缩。除视空间记忆外，所有认知领域在男性中均受到影响；在女性中没有明显影响。在 MS 组中，平均认知最好由丘脑体积、性别和教育程度来预测（调整 R²=0.31），而在该模型中，病变体积不是一个显著的预测因子。
在诊断后 6 年，几乎所有的皮质下结构都受到 MS 的影响，尤其是在男性中。认知在男性患者中受到的影响最大。丘脑体积、性别和教育程度最好地预测了平均认知。这些结果强调了特定的皮质下结构对认知的相关性，以及 MS 中（性别特异性）萎缩的相关性。
