儿童多发性硬化症患者持续性注意系统和认知障碍的 MRI 底物。
MRI substrates of sustained attention system and cognitive impairment in pediatric MS patients.
机构信息
From the Neuroimaging Research Unit (E.D.M., E.P., M.F., M.A.R.) and Department of Neurology (E.D.M., L.M., A. Fiorino, G.C., M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, and Department of Neuroradiology (A. Falini), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Multiple Sclerosis Center (A.G., L.P.), Ospedale di Gallarate; Department of Child Neurology and Psychiatry (P.V., M.C.P.), C. Mondino National Neurological Institute, Brain and Behaviour Department, University of Pavia; Multiple Sclerosis Center (R.C.), Spedali Civili of Brescia; and Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy.
出版信息
Neurology. 2017 Sep 19;89(12):1265-1273. doi: 10.1212/WNL.0000000000004388. Epub 2017 Aug 18.
OBJECTIVE
To explore the structural and functional integrity of the sustained attention system in patients with pediatric multiple sclerosis (MS) and its effect on cognitive impairment.
METHODS
We enrolled 57 patients with pediatric MS and 14 age- and sex-matched healthy controls (HCs). Patients with >3 abnormal tests at neuropsychological evaluation were classified as cognitively impaired (CI). Sustained attention system activity was studied with fMRI during the Conners Continuous Performance Test (CCPT). Structural integrity of attention network connections was quantified with diffusion tensor (DT) MRI.
RESULTS
Within-group analysis showed similar patterns of recruitment of the attention network in HCs and patients with pediatric MS. Diffuse network DT MRI structural abnormalities were found in patients with MS. During CCPT, with increasing task demand, patients with pediatric MS showed increased activation of the left thalamus, anterior insula, and anterior cingulate cortex (ACC) and decreased recruitment of the right precuneus compared to HCs. Thirteen patients (23%) were classified as CI. Compared to cognitively preserved patients, CI patients with pediatric MS had decreased recruitment of several areas located mainly in parietal and occipital lobes and cerebellum and increased deactivation of the ACC, combined with more severe structural damage of white matter tracts connecting these regions.
CONCLUSIONS
Our results suggest that the age-expected level of sustained attention system functional competence is achieved in patients with pediatric MS. Inefficient regulation of the functional interaction between different areas of this system, due to abnormal white matter integrity, may result in global cognitive impairment in these patients.
目的
探讨儿童多发性硬化症（MS）患者持续性注意系统的结构和功能完整性及其对认知障碍的影响。
方法
我们纳入了 57 名儿童 MS 患者和 14 名年龄和性别匹配的健康对照者（HCs）。神经心理学评估中>3 项异常测试的患者被归类为认知障碍（CI）。在 Conners 持续表现测验（CCPT）期间，使用 fMRI 研究持续性注意系统的活动。使用弥散张量（DT）MRI 量化注意网络连接的结构完整性。
结果
组内分析显示 HCs 和儿童 MS 患者的注意网络募集模式相似。MS 患者存在弥散网络 DT MRI 结构异常。在 CCPT 中，随着任务需求的增加，与 HCs 相比，儿童 MS 患者表现出左丘脑、前岛叶和前扣带皮层（ACC）的激活增加，而右楔前叶的募集减少。13 名患者（23%）被归类为 CI。与认知正常的患者相比，CI 患者的儿童 MS 患者的几个主要位于顶叶和枕叶以及小脑的区域的募集减少，而 ACC 的去激活增加，同时这些区域之间的白质束的结构损伤更严重。
结论
我们的结果表明，儿童 MS 患者达到了预期年龄的持续性注意系统功能能力水平。由于白质完整性异常，该系统不同区域之间的功能相互作用的调节效率低下，可能导致这些患者出现整体认知障碍。
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