Detecting cognitive dysfunction in multiple sclerosis with a magnetic resonance imaging rating scale: a pilot study.
OBJECTIVE
In multiple sclerosis (MS), magnetic resonance imaging (MRI) predictors of cognitive impairment are based on sophisticated computer-generated analyses that are difficult to apply in clinical settings. This study investigated the clinical usefulness of a new visual rating scale, the Cholinergic Pathways Hyperintensities Scale (CHIPS), in detecting cognitive dysfunction.


METHODS
Forty clinically definite MS patients underwent a brain MRI. Based on the CHIPS, cholinergic pathway hyperintensities were rated in 10 regions on four axial slices. Computerized hyperintense lesion volumes were also obtained. For cognitive testing, The Neuropsychological Screening Battery for Multiple Sclerosis was used. "Low" and "High" lesion score groups were computed based on the mean of the total CHIPS score. Optimal sensitivity and specificity of the total CHIPS score in detecting cognitive impairment were determined using a receiver operator characteristic curve.


RESULTS
Despite a similar demographic profile, subjects with a "High" lesion score performed significantly worse than the "Low" lesion score group on verbal (P = .007) and visuospatial (P = .02) memory, and on a global index of cognitive functioning (P = .001). Optimal sensitivity (82%) and specificity (83%) were reached with a threshold total CHIPS score of 18 points. Total CHIPS score and total hyperintense lesion load were correlated (sigma = 0.82, P < .0001).


CONCLUSIONS
CHIPS is helpful in clinically predicting cognitive impairment in MS.
Chamelian
Laury
L
Department of Psychiatry, University of Toronto, Toronto, Canada.
Bocti
Christian
C
Gao
Fu-Qiang
FQ
Black
Sandra E
SE
Feinstein
Anthony
A
D001921:Brain / Q000473:pathology*; D002799:Cholinergic Fibers / Q000378:metabolism; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology*; D009483:Neuropsychological Tests; D010865:Pilot Projects; D012720:Severity of Illness Index; D014795:Visual Pathways / Q000033:anatomy & histology / Q000378:metabolism