Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neuroradiology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland.
Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Mult Scler. 2017 Dec;23(14):1864-1874. doi: 10.1177/1352458517692886. Epub 2017 Feb 7.
Cognitive impairment and depression frequently affects patients with multiple sclerosis (MS). However, the relationship between the occurrence of depression and cognitive impairment and the development of cortical atrophy has not been fully elucidated yet.
To investigate the association of cortical and deep gray matter (GM) volume with depression and cognitive impairment in MS.
Three-dimensional (3D) T1-weighted scans were obtained from 126 MS patients and 59 matched healthy controls. Cognitive impairment was assessed using the Brief Repeatable Battery of Neuropsychological Tests and depression with the Montgomery-Asberg Depression Rating Scale (MADRS). Using FreeSurfer and FIRST software, we assessed cortical thickness (CTh) and deep GM volumetry. Magnetic resonance imaging (MRI) variables explaining depression and cognitive impairment were investigated using factorial and classification analysis. Multivariate regression models correlated GM abnormalities with symptoms severity.
Compared with controls, MS patients exhibited widespread bilateral cortical thinning involving all brain lobes. Depressed MS showed selective CTh decrease in fronto-temporal regions, whereas cognitive impairment MS exhibited widespread fronto-parietal cortical and subcortical GM atrophy. Frontal cortical thinning was the best predictor of depression ( C-statistic = 0.7), whereas thinning of the right precuneus and high T2 lesion volume best predicted cognitive impairment ( C-statistic = 0.8). MADRS severity correlated with right entorhinal cortex thinning, whereas cognitive impairment severity correlated with left entorhinal and thalamus atrophy.
MS-related depression is linked to circumscribed CTh changes in areas deputed to emotional behavior, whereas cognitive impairment is correlated with cortical and subcortical GM atrophy of circuits involved in cognition.
认知障碍和抑郁常发生于多发性硬化（MS）患者中。然而，抑郁的发生与认知障碍和皮质萎缩的发展之间的关系尚未完全阐明。
探讨 MS 患者皮质和深部灰质（GM）体积与抑郁和认知障碍的关系。
对 126 例 MS 患者和 59 例匹配的健康对照者进行了三维（3D）T1 加权扫描。使用简短重复神经心理测试（Brief Repeatable Battery of Neuropsychological Tests）评估认知障碍，使用蒙哥马利-阿斯伯格抑郁评定量表（Montgomery-Asberg Depression Rating Scale，MADRS）评估抑郁。使用 FreeSurfer 和 FIRST 软件评估皮质厚度（Cortical Thickness，CTh）和深部 GM 体积。使用因子分析和分类分析来研究解释抑郁和认知障碍的 MRI 变量。多元回归模型将 GM 异常与症状严重程度相关联。
与对照组相比，MS 患者双侧大脑皮质广泛变薄，累及所有脑叶。抑郁型 MS 表现为额颞叶区域的选择性 CTh 减少，而认知障碍型 MS 表现为广泛的额顶叶皮质和皮质下 GM 萎缩。额叶皮质变薄是抑郁的最佳预测因子（C 统计量=0.7），而右侧楔前叶变薄和高 T2 病变体积是认知障碍的最佳预测因子（C 统计量=0.8）。MADRS 严重程度与右侧内嗅皮质变薄相关，而认知障碍严重程度与左侧内嗅皮质和丘脑萎缩相关。
MS 相关的抑郁与负责情感行为的区域的局灶性 CTh 变化有关，而认知障碍与参与认知的皮质和皮质下 GM 萎缩有关。
