title: Independent contributions of cortical gray matter atrophy and ventricle enlargement for predicting neuropsychological impairment in multiple sclerosis.
abstract: The primary goal of this study was to investigate associations between regional gray matter (GM) atrophy and neuropsychological function in multiple sclerosis (MS), while accounting for the influence of central brain atrophy (i.e. third ventricle enlargement). Using a cross-sectional design, we studied 59 MS patients with brain MRI and neuropsychological testing. Regional gray matter fractions (rGMFs) were calculated from MRI images for 11 homologous brain areas using the semiautomatic brain region extraction (SABRE) technique. Neuropsychological testing followed consensus panel guidelines and included tests emphasizing episodic memory, working memory and processing speed. The analytic approach was stepwise linear regression, with forward selection and p<0.05 threshold for significance. Consistent with previous research, there were significant correlations between third ventricle width and neuropsychological tests. Stepwise linear regression analyses controlling for third ventricle width retained rGMFs obtained from specific regions within the prefrontal cortex. Left frontal atrophy was associated with tests emphasizing auditory/verbal memory. Right frontal atrophy was associated with impairment in visual episodic and working memory. For the first time, we show an independent relationship between cortical atrophy and cognitive impairment after accounting for the effects of central atrophy.
authors.affiliation: Department of Neurology, University at Buffalo, State University of New York, USA.
authors.forename: Ayda
authors.initials: A
authors.lastname: Tekok-Kilic
authors.forename: Ralph H B
authors.initials: RH
authors.lastname: Benedict
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: Michael G
authors.initials: MG
authors.lastname: Dwyer
authors.forename: Dominic
authors.initials: D
authors.lastname: Carone
authors.forename: Bhooma
authors.initials: B
authors.lastname: Srinivasaraghavan
authors.forename: Viritha
authors.initials: V
authors.lastname: Yella
authors.forename: Nadir
authors.initials: N
authors.lastname: Abdelrahman
authors.forename: Frederick
authors.initials: F
authors.lastname: Munschauer
authors.forename: Rohit
authors.initials: R
authors.lastname: Bakshi
authors.forename: Robert
authors.initials: R
authors.lastname: Zivadinov
mesh_terms: D000328:Adult; D001284:Atrophy; D002540:Cerebral Cortex / Q000473:pathology*; D002552:Cerebral Ventricles / Q000473:pathology*; D003704:Dementia / Q000175:diagnosis*; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis*; D009483:Neuropsychological Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D013223:Statistics as Topic; D020542:Third Ventricle / Q000473:pathology