Robust perfusion deficits in cognitively impaired patients with secondary-progressive multiple sclerosis.
OBJECTIVE
Cognitive impairment is a common, disabling symptom of MS. We investigated the impact of cerebral perfusion and brain and lesion volumetry on cognitive performance in 45 patients with SPMS by using MR imaging.


METHODS
Cognition was assessed by using a standard battery, the Minimal Assessment of Cognitive Function in Multiple Sclerosis. qCBF and qCBV maps were analyzed by using SPM and PLS. SPM was also used to conduct the GM, WM, and WML volumetric analyses.


RESULTS
Both SPM and PLS demonstrated significantly reduced qCBV in the superior medial frontal cortex of impaired patients. PLS also revealed significantly lower qCBV in the bilateral thalami and caudate nuclei of impaired patients and identified a pattern of significantly attenuated qCBF similar to that of qCBV. Performance on the Symbol Digit Modalities Test, which assesses information-processing speed, correlated most strongly overall with cerebral perfusion. Focal (ie, voxelwise) analyses of GM, WM, and WML volume revealed no significant differences between patients with and without cognitive impairment, though global GM volume was significantly decreased and global WML volume was significantly increased in impaired patients.


CONCLUSIONS
These results suggest that cognitively impaired patients with SPMS exhibit robust perfusion deficits in cortical and subcortical GM and impaired processing speed.
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. philip.francis@utoronto.ca
P L
PL
Francis
R
R
Jakubovic
P
P
O'Connor
L
L
Zhang
A
A
Eilaghi
L
L
Lee
T J
TJ
Carroll
J
J
Mouannes-Srour
A
A
Feinstein
R I
RI
Aviv
D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis*; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications / Q000175:diagnosis*; D009474:Neurons / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity