title: Lesion load may predict long-term cognitive dysfunction in multiple sclerosis patients.
abstract: BACKGROUND
  Magnetic Resonance Imaging (MRI) techniques provided evidences into the understanding of cognitive impairment (CIm) in Multiple Sclerosis (MS).
  
  
  OBJECTIVE
  To investigate the role of white matter (WM) and gray matter (GM) in predicting long-term CIm in a cohort of MS patients.
  
  
  METHODS
  303 out of 597 patients participating in a previous multicenter clinical-MRI study were enrolled (49.4% were lost at follow-up). The following MRI parameters, expressed as fraction (f) of intracranial volume, were evaluated: cerebrospinal fluid (CSF-f), WM-f, GM-f and abnormal WM (AWM-f), a measure of lesion load. Nine years later, cognitive status was assessed in 241 patients using the Symbol Digit Modalities Test (SDMT), the Semantically Related Word List Test (SRWL), the Modified Card Sorting Test (MCST), and the Paced Auditory Serial Addition Test (PASAT). In particular, being SRWL a memory test, both immediate recall and delayed recall were evaluated. MCST scoring was calculated based on the number of categories, number of perseverative and non-perseverative errors.
  
  
  RESULTS
  AWM-f was predictive of an impaired performance 9 years ahead in SDMT (OR 1.49, CI 1.12-1.97 p = 0.006), PASAT (OR 1.43, CI 1.14-1.80 p = 0.002), SRWL-immediate recall (OR 1.72 CI 1.35-2.20 p<0.001), SRWL-delayed recall (OR 1.61 CI 1.28-2.03 p<0.001), MCST-category (OR 1.52, CI 1.2-1.9 p<0.001), MCST-perseverative error(OR 1.51 CI 1.2-1.9 p = 0.001), MCST-non perseverative error (OR 1.26 CI 1.02-1.55 p = 0.032).
  
  
  CONCLUSIONS
  In our large MS cohort, focal WM damage appeared to be the most relevant predictor of the long-term cognitive outcome.
authors: Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
authors: Francesco
authors: F
authors: Patti
authors: Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy.
authors: Manuela
authors: M
authors: De Stefano
authors: Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy.
authors: Luigi
authors: L
authors: Lavorgna
authors: Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
authors: Silvia
authors: S
authors: Messina
authors: Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
authors: Clara Grazia
authors: CG
authors: Chisari
authors: Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy.
authors: Domenico
authors: D
authors: Ippolito
authors: Department of Neurological Sciences, University 'Federico II,' Naples, Italy.
authors: Roberta
authors: R
authors: Lanzillo
authors: Department of Neurological Sciences, University 'Federico II,' Naples, Italy.
authors: Veria
authors: V
authors: Vacchiano
authors: Department of Experimental Biomedicine and Clinical Neurosciences-University of Palermo, Palermo, Italy.
authors: Sabrina
authors: S
authors: Realmuto
authors: Department of Medical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy.
authors: Paola
authors: P
authors: Valentino
authors: Department of Neurology, "Madonna delle Grazie" Hospital, Matera, Italy.
authors: Gabriella
authors: G
authors: Coniglio
authors: Department of Neurosciences, Psychiatry and Anaesthesiology, University of Messina, Messina, Italy.
authors: Maria
authors: M
authors: Buccafusca
authors: Department "Scienze Mediche di Base, Neuroscienze e Organi di Senso", University of Bari, Bari, Italy.
authors: Damiano
authors: D
authors: Paolicelli
authors: Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy.
authors: Alessandro
authors: A
authors: D'Ambrosio
authors: Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy.
authors: Patrizia
authors: P
authors: Montella
authors: Department of Neurological Sciences, University 'Federico II,' Naples, Italy.
authors: Vincenzo
authors: V
authors: Brescia Morra
authors: Department of Experimental Biomedicine and Clinical Neurosciences-University of Palermo, Palermo, Italy.
authors: Giovanni
authors: G
authors: Savettieri
authors: Biostructure and Bioimaging Institute, National Research Council, Naples, Italy.
authors: Bruno
authors: B
authors: Alfano
authors: Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy.
authors: Antonio
authors: A
authors: Gallo
authors: Department "Scienze Mediche di Base, Neuroscienze e Organi di Senso", University of Bari, Bari, Italy.
authors: Isabella
authors: I
authors: Simone
authors: Department "Scienze Mediche di Base, Neuroscienze e Organi di Senso", University of Bari, Bari, Italy.
authors: Rosa
authors: R
authors: Viterbo
authors: Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
authors: Mario
authors: M
authors: Zappia
authors: Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy; Neurological Institute for Diagnosis and Care "Hermitage Capodimonte", Naples, Italy.
authors: Simona
authors: S
authors: Bonavita
authors: Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy.
authors: Gioacchino
authors: G
authors: Tedeschi
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D066128:Gray Matter / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009483:Neuropsychological Tests; D011379:Prognosis