Cognitive impairment in multiple sclerosis can be predicted by imaging early in the disease.
BACKGROUND
Cognitive impairment is common in multiple sclerosis (MS) and adds significantly to the burden of the disease. The ability to predict future cognitive impairment from imaging obtained at disease onset has not been investigated.


METHODS
62 patients imaged within 3 months of a clinically isolated syndrome were assessed neuropsychologically 7 years later. Baseline and periodic MRI measures of lesions, atrophy and normal-appearing white and grey matter were regressed against neuropsychological scores to explore the best predictors of cognitive outcome.


RESULTS
28 patients had developed clinically definite MS at follow-up and a further nine met revised McDonald criteria for MS. Deficits in speed of information processing and executive function were the most common abnormalities. Poor performance correlated with high anxiety ratings. Baseline T(1) lesion metrics predicted executive deficits, and new T(2) lesions at the 3-month follow-up predicted slowed information processing. An increase in myo-inositol concentration in normal-appearing white matter over the first 3 years was associated with poor executive function.


CONCLUSIONS
MRI variables obtained at the onset of a clinically isolated syndrome can predict future development of cognitive abnormalities. Our findings may have implications in monitoring and treating patients.
Summers
M
M
Institute of Neurology, University College London, Queen Square, London, UK.
Swanton
J
J
Fernando
K
K
Dalton
C
C
Miller
D H
DH
Cipolotti
L
L
Ron
M A
MA
D000293:Adolescent; D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D002552:Cerebral Ventricles / Q000473:pathology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology; D015331:Cohort Studies; D004151:Dipeptides / Q000378:metabolism; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007294:Inositol / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis* / Q000523:psychology; D009460:Neurologic Examination; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies
D004151:Dipeptides; C027172:isospaglumic acid; D001224:Aspartic Acid; D007294:Inositol; C000179:N-acetylaspartate