Mirmosayyeb Omid, Yazdan Panah Mohammad, Vaheb Saeed, Ghoshouni Hamed, Mahmoudi Farhad, Kord Reza, Kord Ali, Zabeti Aram, Shaygannejad Vahid
Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States.
Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Mult Scler Relat Disord. 2025 Feb;94:106261. doi: 10.1016/j.msard.2025.106261. Epub 2025 Jan 6.
Alterations in structural connectivity of brain networks have been linked to complex cognitive functions in people with multiple sclerosis (PwMS). However, a definitive consensus on the optimal diffusion tensor imaging (DTI) markers as indicators of cognitive performance remains incomplete and inconclusive. This systematic review and meta-analysis aimed to explore the evidence on the correlation between DTI metrics and cognitive functions in PwMS.
A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, Scopus, and the Web of Science up to March 2024 to identify studies reporting the correlation between DTI metrics and cognitive functions. Cognitive function was assessed using the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test (CVLT), and Brief Visuospatial Memory Test-Revised (BVMT-R). The pooled correlation coefficients were estimated using R software version 4.4.0 with the random effect model.
Out of 1952 studies, 38 studies on 2055 PwMS fulfilled the inclusion criteria. The meta-analysis indicated that the SDMT exhibited the greatest correlation with corpus callosum fractional anisotropy (FA) (r = 0.54, 95 % CI: 0.4 to 0.66, p-value < 0.001, I = 34.1 %, p-heterogeneity = 0.19) and mean diffusivity (MD) (r = -0.48, 95 % CI: 0.61 to -0.33, p-value < 0.001, I = 0 %, p-heterogeneity = 0.77), white matter FA (r = 0.39, 95 % CI: 0.24 to 0.52, p-value < 0.001, I = 0 %, p-heterogeneity = 0.1), and fornix FA (r = 0.35, 95 % CI: 0.12 to 0.54, p-value = 0.003, I = 50.7 %, p-heterogeneity = 0.18) and MD (r = -0.35, 95 % CI: 0.49 to -0.19, p-value < 0.001, I = 0 %, p-heterogeneity = 0.5).
DTI measurements, including corpus callosum FA and MD, white matter FA, and fornix FA and MD, represent the indicators of cognitive performance in PwMS. Nonetheless, these findings warrant cautious interpretation due to the restricted kinds of cognitive tests and methodological variability across studies.
脑网络结构连接的改变与多发性硬化症患者（PwMS）的复杂认知功能有关。然而，关于作为认知表现指标的最佳扩散张量成像（DTI）标记物，尚未达成明确的共识，研究结果仍不完整且无定论。本系统评价和荟萃分析旨在探索DTI指标与PwMS认知功能之间相关性的证据。
截至2024年3月，在PubMed/MEDLINE、Embase、Scopus和科学网进行了全面的文献检索，以识别报告DTI指标与认知功能之间相关性的研究。使用符号数字模态测验（SDMT）、加利福尼亚言语学习测验（CVLT）和修订版简明视觉空间记忆测验（BVMT-R）评估认知功能。使用R软件4.4.0版的随机效应模型估计合并相关系数。
在1952项研究中，38项关于2055名PwMS的研究符合纳入标准。荟萃分析表明，SDMT与胼胝体各向异性分数（FA）（r = 0.54，95%CI：0.4至0.66，p值<0.001，I = 34.1%，p异质性 = 0.19）和平均扩散率（MD）（r = -0.48，95%CI：0.61至 -0.33，p值<0.001，I = 0%，p异质性 = 0.77）、白质FA（r = 0.39，95%CI：0.24至0.52，p值<0.001，I = 0%，p异质性 = 0.1）、穹窿FA（r = 0.35，95%CI：0.12至0.54，p值 = 0.003，I = 50.7%，p异质性 = 0.18）和MD（r = -0.35，95%CI：0.49至 -0.19，p值<0.001，I = 0%，p异质性 = 0.5）相关性最强。
DTI测量，包括胼胝体FA和MD、白质FA以及穹窿FA和MD，代表了PwMS认知表现的指标。尽管如此，由于认知测试种类有限以及各研究方法的变异性，这些发现仍需谨慎解读。
