title: Contribution of cortical and white matter lesions to cognitive impairment in multiple sclerosis.
abstract: BACKGROUND
  Cortical lesions (CLs) have been reported to be a better predictor for cognitive impairment than white matter (WM) lesions in relapsing-remitting multiple sclerosis (RRMS).
  
  
  OBJECTIVE
  The objectives of this article are to investigate the contribution of CLs and WM lesions to cognitive impairment in 91 patients with MS and clinically isolated syndrome, and to test potential associations of CLs and WM lesions with fatigue and depression.
  
  
  METHODS
  Lesions were scored and segmented on 3D double inversion recovery sequences, according to their location (cortical, WM). Normalised grey matter volume was also determined. Cognitive performance was assessed with the SDMT and PASAT-3, fatigue with the FSMC and depression with the German version of the CES-D.
  
  
  RESULTS
  CL volume did not correlate with fatigue or depression, but correlated significantly with both neuropsychological outcome measures: PASAT-3 (r = -0.275, p = 0.009) and SDMT (r = -0.377, p < 0.001). Multiple regression analyses with age, WM lesions, CLs and GM volume as independent variables, however, did not reveal CL volume as a significant predictor of neuropsychological outcomes, whereas WM lesion volume significantly predicted SDMT and by trend PASAT performance.
  
  
  CONCLUSIONS
  These findings suggest a role of WM lesions in the development of cognitive deficits, especially information-processing speed, which may be higher than previously assumed.
  Center for Epidemiologic Studies Depression scale (ADS-L: Allgemeine Depressions Skala-L, German version of CES-D), CIS: clinically isolated syndrome, CL: cortical lesion, DIR: double inversion recovery, EDSS: Expanded Disability Status Scale, FSMC: fatigue scale for motor and cognitive functions, GM: grey matter, MRI: magnetic resonance imaging, MS: multiple sclerosis, PASAT-3: paced auditory serial addition test 3s, PPMS: primary progressive multiple sclerosis, RRMS: relapsing-remitting multiple sclerosis, SDMT: symbol digit modalities test, SPM: statistical parametric mapping, SPMS: secondary progressive multiple sclerosis, WM: white matter.
authors: Department of Neurology, University Hospital Basel, Switzerland.
authors: Athina
authors: A
authors: Papadopoulou
authors: Nicole
authors: N
authors: Müller-Lenke
authors: Yvonne
authors: Y
authors: Naegelin
authors: Gabriela
authors: G
authors: Kalt
authors: Kerstin
authors: K
authors: Bendfeldt
authors: Pascal
authors: P
authors: Kuster
authors: Markus
authors: M
authors: Stoecklin
authors: Achim
authors: A
authors: Gass
authors: Till
authors: T
authors: Sprenger
authors: Ernst Wilhelm
authors: EW
authors: Radue
authors: Ludwig
authors: L
authors: Kappos
authors: Iris-Katharina
authors: IK
authors: Penner
mesh_terms: D002540:Cerebral Cortex / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology*; D003711:Demyelinating Diseases / Q000150:complications / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009483:Neuropsychological Tests
keywords: Cortical lesions; cognition; multiple sclerosis; white matter lesions