Gajewski Bartosz, Siger Małgorzata, Karlińska Iwona, Bednarski Igor A, Świderek-Matysiak Mariola, Stasiołek Mariusz
Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153 Lodz, Poland.
Int J Mol Sci. 2025 Sep 2;26(17):8523. doi: 10.3390/ijms26178523.
The diagnosis and monitoring of progressive multiple sclerosis (PMS) require further development of fast and effective clinical tools. Relations between MRI-based brain atrophy measures and cognitive impairment in people with primary progressive and secondary progressive MS (PwPPMS, n = 20 and PwSPMS, n = 19, respectively) were investigated in a prospective study with follow-up after a mean 14.97 ± 4.67 months. MRI analysis showed that at baseline and follow-up in PwSPMS, the left thalamic fraction and corpus callosum fraction were significantly lower than in PwPPMS (baseline: 0.39 ± 0.04 vs. 0.44 ± 0.06, = 0.0203 and 0.26 ± 0.05 vs. 0.30 ± 0.05, = 0.0097; respectively and follow-up: 0.40 ± 0.04 vs. 0.44 ± 0.07, = 0.0443 and 0.25 ± 0.06 vs. 0.30 ± 0.05, = 0.0103, respectively). In contrast, only at baseline, PwPPMS had a significantly lower cerebellar white matter fraction (CWMF) than PwSPMS (1.83 ± 0.20 vs. 2.01 ± 0.24, = 0.0132). No other significant differences were observed in the MRI fractions at either study time point or in the changes of the MRI fractions between the PwPPMS and PwSPMS. However, a significant decline in the right putaminal fraction was found during observation in PwSPMS (0.332% ± 0.05% vs. 0.328% ± 0.05%, = 0.0479). Cognitive test scores and their changes did not differ significantly between the subgroups. Declines in the Brief Visuospatial Memory Test Revised in the whole PMS group (18.74 ± 7.43 vs. 17.03 ± 7.61, = 0.0209) and in PwPPMS (19.50 ± 8.29 vs. 17.20 ± 7.72, = 0.0338), as well as in the Brief International Cognitive Assessment for Multiple Sclerosis in PwPPMS (1.05 ± 0.89 vs. 1.25 ± 1.02, = 0.0421), were observed. In both PwPMS and PwPPMS, a worsening on the Symbol Digit Modalities Test (SDMT) was associated with the reduction of fractions of white matter, cerebellum and right thalamus. SDMT performance also correlated with both gray matter fraction (GMF) and CWMF in the whole group, and with cerebellar gray matter fraction (CGMF) in PwPPMS. In PwSPMS, only Stroop Color and Word Test scores correlated with GMF and CGMF. In conclusion, subtle differences between PwPPMS and PwSPMS were detected both in MRI and neuropsychological parameters. Thus, our results indicate the need for a multicomponent attempt in characterizing progression in different clinical courses of MS.
进行性多发性硬化症（PMS）的诊断和监测需要进一步开发快速有效的临床工具。在一项前瞻性研究中，对原发性进行性和继发性进行性多发性硬化症患者（分别为n = 20的原发性进行性多发性硬化症患者和n = 19的继发性进行性多发性硬化症患者）进行了平均14.97±4.67个月的随访，研究了基于MRI的脑萎缩测量与认知障碍之间的关系。MRI分析显示，在继发性进行性多发性硬化症患者的基线和随访时，左侧丘脑分数和胼胝体分数显著低于原发性进行性多发性硬化症患者（基线：0.39±0.04对0.44±0.06，P = 0.0203；0.26±0.05对0.30±0.05，P = 0.0097；随访：0.40±0.04对0.44±0.07，P = 0.0443；0.25±0.06对0.30±0.05，P = 0.0103）。相比之下，仅在基线时，原发性进行性多发性硬化症患者的小脑白质分数（CWMF）显著低于继发性进行性多发性硬化症患者（1.83±0.20对2.01±0.24，P = 0.0132）。在两个研究时间点的MRI分数或原发性进行性多发性硬化症患者和继发性进行性多发性硬化症患者之间的MRI分数变化中均未观察到其他显著差异。然而，在继发性进行性多发性硬化症患者的观察期间发现右侧壳核分数显著下降（0.332%±0.05%对0.328%±0.05%，P = 0.0479）。亚组之间的认知测试分数及其变化没有显著差异。整个PMS组（18.74±7.43对17.03±7.61，P = 0.0209）、原发性进行性多发性硬化症患者（19.50±8.29对17.20±7.72，P = 0.0338）以及原发性进行性多发性硬化症患者的简短国际多发性硬化症认知评估（1.05±0.89对1.25±1.02，P = 0.0421）中的简短视觉空间记忆测试修订版分数均有所下降。在原发性进行性多发性硬化症患者和继发性进行性多发性硬化症患者中，符号数字模式测试（SDMT）的恶化与白质、小脑和右侧丘脑分数的降低有关。SDMT表现还与整个组中的灰质分数（GMF）和CWMF相关，以及与原发性进行性多发性硬化症患者中的小脑灰质分数（CGMF）相关。在继发性进行性多发性硬化症患者中，只有Stroop颜色和文字测试分数与GMF和CGMF相关。总之，在MRI和神经心理学参数方面均检测到原发性进行性多发性硬化症患者和继发性进行性多发性硬化症患者之间的细微差异。因此，我们的结果表明需要进行多方面的尝试来表征多发性硬化症不同临床病程中的进展情况。
