Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea.
Biometric Research Branch, Research Institute and Hospital of National Cancer Center, Goyang, Korea.
Sci Rep. 2017 Aug 23;7(1):9180. doi: 10.1038/s41598-017-08889-9.
Cognitive impairment (CI) is reported in 29-57% of patients with neuromyelitis optica spectrum disorder (NMOSD). However, the pathophysiology underlying CI in NMOSD is poorly understood. The present study aims to investigate the predictive values of various conventional and quantitative MRI parameters for cognitive performance in patients with NMOSD. Neurological assessment and conventional, diffusion tensor, and volumetric MRI sequences were collected form 73 patients with NMOSD and 44 healthy controls (HCs). Patients with ≥3 failed tests were considered to have CI. Brain lesion load, gray matter (GM) and white matter (WM) atrophy, deep GM (DGM) atrophy, cortical thickness, and diffuse microstructural WM damage were assessed. Twenty-three (32%) patients with NMOSD had CI. Compared to cognitively preserved (CP) individuals, patients with CI had atrophy in the WM, thalamus, and caudate, decreased fractional anisotropy (FA) and increased mean diffusivity in their WM. A multivariate model indicated that mean FA values in the WM and volume in the nucleus accumbens (NAc) were associated with overall cognition (p = 0.002 and p = 0.008, respectively). Diffuse microstructural damage in the WM and DGM atrophy in the NAc are the strongest predictors of cognitive impairment in patients with NMOSD.
认知障碍（CI）在视神经脊髓炎谱系疾病（NMOSD）患者中的报道率为 29-57%。然而，NMOSD 中 CI 的病理生理学机制仍知之甚少。本研究旨在探讨各种常规和定量 MRI 参数对 NMOSD 患者认知表现的预测价值。对 73 例 NMOSD 患者和 44 例健康对照者（HCs）进行了神经学评估以及常规、弥散张量和容积 MRI 序列采集。将≥3 项测试失败的患者视为认知障碍（CI）。评估脑病变负荷、灰质（GM）和白质（WM）萎缩、深部 GM（DGM）萎缩、皮质厚度和弥散性 WM 微观结构损伤。23 例（32%）NMOSD 患者存在 CI。与认知正常（CP）个体相比，CI 患者 WM、丘脑和尾状核存在萎缩，WM 中的各向异性分数（FA）降低，平均弥散度增加。多变量模型表明 WM 中的平均 FA 值和伏隔核（NAc）的体积与整体认知相关（分别为 p=0.002 和 p=0.008）。WM 中的弥散性微观结构损伤和 NAc 的 DGM 萎缩是 NMOSD 患者认知障碍的最强预测因子。
