Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
J Neurol Neurosurg Psychiatry. 2024 Nov 18;95(12):1139-1149. doi: 10.1136/jnnp-2024-333460.
Research on cognitive rehabilitation (CR) and aerobic exercise (EX) to improve cognition in progressive multiple sclerosis (PMS) remains limited. CogEx trial investigated the effectiveness of CR and EX in PMS: here, we present MRI substudy volumetric and task-related functional MRI (fMRI) findings.
Participants were randomised to: 'CR plus EX', 'CR plus sham EX (EX-S)', 'EX plus sham CR (CR-S)' and 'CR-S plus EX-S' and attended 12-week intervention. All subjects performed physical/cognitive assessments at baseline, week 12 and 6 months post intervention (month 9). All MRI substudy participants underwent volumetric MRI and fMRI (Go-NoGo task).
104 PMS enrolled at four sites participated in the CogEx MRI substudy; 84 (81%) had valid volumetric MRI and valid fMRI. Week 12/month 9 cognitive performances did not differ among interventions; however, 25-62% of the patients showed Symbol Digit Modalities Test improvements. Normalised cortical grey matter volume (NcGMV) changes at week 12 versus baseline were heterogeneous among interventions (p=0.05); this was mainly driven by increased NcGMV in 'CR plus EX-S' (p=0.02). Groups performing CR (ie, 'CR plus EX' and 'CR plus EX-S') exhibited increased NcGMV over time, especially in the frontal (p=0.01), parietal (p=0.04) and temporal (p=0.04) lobes, while those performing CR-S exhibited NcGMV decrease (p=0.008). In CR groups, increased NcGMV (r=0.36, p=0.01) at week 12 versus baseline correlated with increased California Verbal Learning Test (CVLT)-II scores. 'CR plus EX-S' patients exhibited Go-NoGo activity increase (p<0.05, corrected) at week 12 versus baseline in bilateral insula.
In PMS, CR modulated grey matter (GM) volume and insular activity. The association of GM and CVLT-II changes suggests GM plasticity contributes to cognitive improvements.
NCT03679468.
关于认知康复（CR）和有氧运动（EX）改善进展性多发性硬化症（PMS）认知的研究仍然有限。CogEx 试验研究了 CR 和 EX 在 PMS 中的有效性：在这里，我们介绍 MRI 子研究的体积和任务相关功能磁共振成像（fMRI）结果。
参与者被随机分配到：“CR 加 EX”、“CR 加假 EX（EX-S）”、“EX 加假 CR（CR-S）”和“CR-S 加 EX-S”，并参加了 12 周的干预。所有受试者在基线、第 12 周和干预后 6 个月（第 9 个月）进行身体/认知评估。所有 MRI 子研究参与者都进行了体积 MRI 和 fMRI（Go-NoGo 任务）。
在四个地点有 104 名 PMS 患者参加了 CogEx MRI 子研究；84 名（81%）具有有效的体积 MRI 和有效的 fMRI。干预组之间第 12 周/第 9 个月的认知表现没有差异；然而，25-62%的患者符号数字模态测试（SDMT）有改善。与基线相比，第 12 周的皮质灰质体积（NcGMV）变化在干预之间存在异质性（p=0.05）；这主要是由于“CR 加 EX-S”中 NcGMV 的增加（p=0.02）。进行 CR（即“CR 加 EX”和“CR 加 EX-S”）的组随着时间的推移表现出 NcGMV 的增加，尤其是在额叶（p=0.01）、顶叶（p=0.04）和颞叶（p=0.04），而进行 CR-S 的组表现出 NcGMV 的减少（p=0.008）。在 CR 组中，与基线相比，第 12 周的 NcGMV 增加（r=0.36，p=0.01）与加利福尼亚语言学习测试（CVLT）-II 分数的增加相关。“CR 加 EX-S”患者在第 12 周与基线相比，双侧岛叶的 Go-NoGo 活动增加（p<0.05，校正）。
在 PMS 中，CR 调节了灰质（GM）体积和岛叶活动。GM 和 CVLT-II 变化的相关性表明 GM 可塑性有助于认知的改善。
NCT03679468。
