Uher Tomas, Krasensky Jan, Sobisek Lukas, Blahova Dusankova Jana, Seidl Zdenek, Kubala Havrdova Eva, Sormani Maria Pia, Horakova Dana, Kalincik Tomas, Vaneckova Manuela
Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic.
Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic.
Ann Clin Transl Neurol. 2017 Dec 15;5(1):81-91. doi: 10.1002/acn3.512. eCollection 2018 Jan.
To investigate whether the strength of the association between magnetic resonance imaging (MRI) metrics and cognitive outcomes differs between various multiple sclerosis subpopulations.
A total of 1052 patients were included in this large cross-sectional study. Brain MRI (T1 and T2 lesion volume and brain parenchymal fraction) and neuropsychological assessment (Brief International Cognitive Assessment for Multiple Sclerosis and Paced Auditory Serial Addition Test) were performed.
Weak correlations between cognitive domains and MRI measures were observed in younger patients (age≤30 years; absolute Spearman's rho = 0.05-0.21), with short disease duration (<2 years; rho = 0.01-0.21), low Expanded Disability Status Scale [EDSS] (≤1.5; rho = 0.08-0.18), low T2 lesion volume (lowest quartile; <0.59 mL; rho = 0.01-0.20), and high brain parenchymal fraction (highest quartile; >86.66; rho = 0.01-0.16). Stronger correlations between cognitive domains and MRI measures were observed in older patients (age>50 years; rho = 0.24-0.50), with longer disease duration (>15 years; rho = 0.26-0.53), higher EDSS (≥5.0; rho = 0.23-0.39), greater T2 lesion volume (highest quartile; >5.33 mL; rho = 0.16-0.32), and lower brain parenchymal fraction (lowest quartile; <83.71; rho = 0.13-0.46). The majority of these observed results were confirmed by significant interactions (≤0.01) using continuous variables.
The association between structural brain damage and functional cognitive impairment is substantially weaker in multiple sclerosis patients with a low disease burden. Therefore, disease stage should be taken into consideration when interpreting associations between structural and cognitive measures in clinical trials, research studies, and clinical practice.
研究磁共振成像（MRI）指标与认知结果之间的关联强度在不同多发性硬化亚组中是否存在差异。
本项大型横断面研究共纳入1052例患者。进行了脑部MRI（T1和T2病变体积及脑实质分数）和神经心理学评估（多发性硬化简易国际认知评估和听觉连续加法测试）。
在年轻患者（年龄≤30岁；绝对斯皮尔曼等级相关系数ρ=0.05 - 0.21）、病程短（<2年；ρ=0.01 - 0.21）、扩展残疾状态量表[EDSS]低（≤1.5；ρ=0.08 - 0.18）、T2病变体积小（最低四分位数；<0.59 mL；ρ=0.01 - 0.20）以及脑实质分数高（最高四分位数；>86.66；ρ=0.01 - 0.16）的患者中，观察到认知领域与MRI测量值之间存在弱相关性。在老年患者（年龄>50岁；ρ=0.24 - 0.50）、病程长（>15年；ρ=0.26 - 0.53）、EDSS高（≥5.0；ρ=0.23 - 0.39）、T2病变体积大（最高四分位数；>5.33 mL；ρ=0.16 - 0.32）以及脑实质分数低（最低四分位数；<83.71；ρ=0.13 - 0.46）的患者中，观察到认知领域与MRI测量值之间存在更强的相关性。使用连续变量进行的显著交互作用（≤0.01）证实了这些观察结果中的大多数。
在疾病负担低的多发性硬化患者中，脑结构损伤与功能性认知障碍之间的关联明显较弱。因此，在临床试验、研究以及临床实践中解释结构与认知测量之间的关联时，应考虑疾病阶段。
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