Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Department of Neurofarba, Section of Neurosciences, University of Florence, Florence, Italy.
Lancet Neurol. 2015 Mar;14(3):302-17. doi: 10.1016/S1474-4422(14)70250-9. Epub 2015 Feb 4.
In patients with multiple sclerosis (MS), grey matter damage is widespread and might underlie many of the clinical symptoms, especially cognitive impairment. This relation between grey matter damage and cognitive impairment has been lent support by findings from clinical and MRI studies. However, many aspects of cognitive impairment in patients with MS still need to be characterised. Standardised neuropsychological tests that are easy to administer and sensitive to disease-related abnormalities are needed to gain a better understanding of the factors affecting cognitive performance in patients with MS than exists at present. Imaging measures of the grey matter are necessary, but not sufficient to fully characterise cognitive decline in MS. Imaging measures of both lesioned and normal-appearing white matter lend support to the hypothesis of the existence of an underlying disconnection syndrome that causes clinical symptoms to trigger. Findings on cortical reorganisation support the contribution of brain plasticity and cognitive reserve in limiting cognitive deficits. The development of clinical and imaging biomarkers that can monitor disease development and treatment response is crucial to allow early identification of patients with MS who are at risk of cognitive impairment.
在多发性硬化症（MS）患者中，灰质损伤广泛存在，可能是许多临床症状的基础，尤其是认知障碍。临床和 MRI 研究的结果支持了灰质损伤与认知障碍之间的这种关系。然而，MS 患者认知障碍的许多方面仍需要进一步明确。需要使用标准化的神经心理学测试，这些测试易于实施且对疾病相关异常敏感，以便比目前更好地了解影响 MS 患者认知表现的因素。灰质的影像学测量是必要的，但不足以充分描述 MS 中的认知下降。病变和正常外观的白质的影像学测量支持存在潜在的连接综合征的假设，该综合征导致临床症状触发。皮质重组的研究结果支持大脑可塑性和认知储备在限制认知缺陷方面的贡献。开发能够监测疾病发展和治疗反应的临床和影像学生物标志物对于早期识别有认知障碍风险的 MS 患者至关重要。
