title: Cognitive impairment and its relation to imaging measures in multiple sclerosis: a study using a computerized battery.
abstract: OBJECTIVE
  Cognitive impairment (CI) is an important component of multiple sclerosis (MS) disability. A complex biological interplay between white matter (WM) and gray matter (GM) disease likely sustains CI. This study aims to address this issue by exploring the association between the extent of normal WM and GM disease and CI.
  
  
  METHODS
  Cognitive function of 24 MS patients and 24 healthy volunteers (HVs) was studied using the Automated Neuropsychological Assessment Metrics (ANAM) battery. WM focal lesions and normal appearing WM (NAWM) volume in patients, cortical thickness (CTh) and deep GM structure volumes in both patients and HVs were measured by high field strength (3.0-Tesla; 3T) imaging.
  
  
  RESULTS
  An analysis of covariance showed that patients performed worse than HVs on Code Substitution Delayed Memory (P = .04) and Procedural Reaction Time (P = .05) indicative of reduced performance in memory, cognitive flexibility, and processing speed. A summary score (Index of Cognitive Efficiency) indicating global test battery performance was also lower for the patient group (P = .04). Significant associations, as determined by the Spearman rank correlation tests, were noted between each of these 3 cognitive scores and measures of NAWM volume [CDD-TP1(r = .609; P = .0035), PRO-TP1 (r = .456; P = .029) and ICE (r = .489; P = .0129)], CTh (r = .5; P ≤ .05) and volume of subcortical normal appearing GM (NAGM) structures (r = .4; P≤ .04), but not WM lesions.
  
  
  CONCLUSIONS
  Both NAWM and NAGM volumes are related to CI in MS. The results highlight once again the urgent need to develop pharmacological strategies protecting patients from widespread neurodegeneration as possible preventive strategies of CI development.
authors.affiliation: Neuroimmunology Branch (NIB), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA.
authors.forename: Clelia
authors.initials: C
authors.lastname: Pellicano
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Antonio
authors.initials: A
authors.lastname: Gallo
authors.forename: Li
authors.initials: L
authors.lastname: Xiaobai
authors.forename: Susan K
authors.initials: SK
authors.lastname: Stern
authors.forename: Vasiliki N
authors.initials: VN
authors.lastname: Ikonomidou
authors.forename: Iordanis E
authors.initials: IE
authors.lastname: Evangelou
authors.forename: Joan M
authors.initials: JM
authors.lastname: Ohayon
authors.forename: Mary
authors.initials: M
authors.lastname: Ehrmantraut
authors.forename: Fredric K
authors.initials: FK
authors.lastname: Cantor
authors.forename: Francesca
authors.initials: F
authors.lastname: Bagnato
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D003627:Data Interpretation, Statistical; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D066128:Gray Matter / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis*; D009483:Neuropsychological Tests; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D066127:White Matter / Q000473:pathology*; D055815:Young Adult