Spain Rebecca I, Hildebrand Andrea, Waslo Carin S, Rooney William D, Emmons Joshua, Schwartz Daniel L, Freedman Mark S, Paz Soldan M Mateo, Repovic Pavle, Solomon Andrew J, Rinker John, Wallin Mitchell, Haselkorn Jodie K, Stuve Olaf, Gross Robert H, Turner Aaron P
Department of Veterans Affairs Portland Health Care System, Portland, OR, United States.
Neurology, Oregon Health & Science University, Portland, OR, United States.
Front Neurol. 2023 Jun 8;14:1188124. doi: 10.3389/fneur.2023.1188124. eCollection 2023.
Cognitive dysfunction and brain atrophy are both common in progressive multiple sclerosis (MS) but are seldom examined comprehensively in clinical trials. Antioxidant treatment may affect the neurodegeneration characteristic of progressive MS and slow its symptomatic and radiographic correlates.
This study aims to evaluate cross-sectional associations between cognitive battery components of the Brief International Cognitive Assessment for Multiple Sclerosis with whole and segmented brain volumes and to determine if associations differ between secondary progressive (SPMS) and primary progressive (PPMS) MS subtypes.
The study was based on a baseline analysis from a multi-site randomized controlled trial of the antioxidant lipoic acid in veterans and other people with progressive MS (NCT03161028).
Cognitive batteries were conducted by trained research personnel. MRIs were processed at a central processing site for maximum harmonization. Semi-partial Pearson's adjustments evaluated associations between cognitive tests and MRI volumes. Regression analyses evaluated differences in association patterns between SPMS and PPMS cohorts.
Of the 114 participants, 70% had SPMS. Veterans with MS made up 26% ( = 30) of the total sample and 73% had SPMS. Participants had a mean age of 59.2 and sd 8.5 years, and 54% of them were women, had a disease duration of 22.4 (sd 11.3) years, and had a median Expanded Disability Status Scale of 6.0 (with an interquartile range of 4.0-6.0, moderate disability). The Symbol Digit Modalities Test (processing speed) correlated with whole brain volume ( = 0.29, = 0.01) and total white matter volume ( = 0.33, < 0.01). Both the California Verbal Learning Test (verbal memory) and Brief Visuospatial Memory Test-Revised (visual memory) correlated with mean cortical thickness ( = 0.27, = 0.02 and = 0.35, < 0.01, respectively). Correlation patterns were similar in subgroup analyses.
Brain volumes showed differing patterns of correlation across cognitive tasks in progressive MS. Similar results between SPMS and PPMS cohorts suggest combining progressive MS subtypes in studies involving cognition and brain atrophy in these populations. Longitudinal assessment will determine the therapeutic effects of lipoic acid on cognitive tasks, brain atrophy, and their associations.
认知功能障碍和脑萎缩在进展性多发性硬化症（MS）中都很常见，但在临床试验中很少进行全面检查。抗氧化治疗可能会影响进展性MS的神经退行性变特征，并减缓其症状和影像学相关变化。
本研究旨在评估多发性硬化症简短国际认知评估的认知测试组件与全脑体积和分割脑体积之间的横断面关联，并确定继发进展型（SPMS）和原发进展型（PPMS）MS亚型之间的关联是否存在差异。
该研究基于一项针对退伍军人和其他进展性MS患者的抗氧化剂硫辛酸多中心随机对照试验（NCT03161028）的基线分析。
由训练有素的研究人员进行认知测试。MRI在中央处理站点进行处理，以实现最大程度的协调。半偏Pearson校正评估认知测试与MRI体积之间的关联。回归分析评估SPMS和PPMS队列之间关联模式的差异。
在114名参与者中，70%为SPMS。患有MS的退伍军人占总样本的26%（n = 30），其中73%为SPMS。参与者的平均年龄为59.2岁，标准差为8.5岁，54%为女性，疾病持续时间为22.4（标准差11.3）年，扩展残疾状态量表中位数为6.0（四分位间距为4.0 - 6.0，中度残疾）。符号数字模式测验（处理速度）与全脑体积（r = 0.29，p = 0.01）和总白质体积（r = 0.33，p < 0.01）相关。加利福尼亚言语学习测验（言语记忆）和修订版简短视觉空间记忆测验（视觉记忆）均与平均皮质厚度相关（分别为r = 0.27，p = 0.02和r = 0.35，p < 0.01）。亚组分析中的关联模式相似。
在进展性MS中，脑体积在不同认知任务中呈现出不同的关联模式。SPMS和PPMS队列之间的相似结果表明，在涉及这些人群认知和脑萎缩的研究中可将进展性MS亚型合并。纵向评估将确定硫辛酸对认知任务、脑萎缩及其关联的治疗效果。
