title: Cognitive and White Matter Tract Differences in MS and Diffuse Neuropsychiatric Systemic Lupus Erythematosus.
abstract: OBJECTIVE
  Multiple sclerosis and neuropsychiatric systemic lupus erythematosus are autoimmune diseases with similar CNS inflammatory and neurodegenerative characteristics. Our aim was to investigate white matter tract changes and their association with cognitive function in patients with MS and those with neuropsychiatric systemic lupus erythematosus compared with healthy controls by using diffusion tensor imaging.
  
  
  METHODS
  Thirty patients with relapsing-remitting MS and 23 patients with neuropsychiatric systemic lupus erythematosus matched for disease severity and duration and 43 healthy controls were scanned with 3T MR imaging. The DTI was postprocessed, corrected for lesions, and analyzed with tract-based spatial statistics. Cognitive assessment included examination of processing speed; visual, auditory/verbal, and visual-spatial memory; and sustained attention and executive function. Differences were considered significant at P < .05.
  
  
  RESULTS
  Tract-based spatial statistics analysis revealed significantly decreased fractional anisotropy and increased mean diffusivity in patients with MS compared with healthy controls, decreased fractional anisotropy in patients with MS compared with those with neuropsychiatric systemic lupus erythematosus, and an increased mean diffusivity in patients with neuropsychiatric systemic lupus erythematosus compared with healthy controls. Patients with MS showed decreased fractional anisotropy throughout central WM pathways, including the corpus callosum and the inferior longitudinal and fronto-occipital fasciculi compared with those with neuropsychiatric systemic lupus erythematosus. Altered cognitive scores in patients with MS were significantly associated with decreased fractional anisotropy and increased mean diffusivity in all examined domains, while in patients with diffuse neuropsychiatric systemic lupus erythematosus, only decreased fractional anisotropy in the superior WM pathways showed significant association with executive function.
  
  
  CONCLUSIONS
  Patients with MS and neuropsychiatric systemic lupus erythematosus showed widespread WM tract alterations outside overt lesions, though more severe changes were identified in patients with MS. The WM tract changes were associated with cognitive dysfunction in all explored domains only in patients with MS.
authors.affiliation: From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.) Division of Cognitive and Behavioral Neurosciences (B.C., J.L.S., D.W.S.).
authors.forename: B
authors.initials: B
authors.lastname: Cesar
authors.affiliation: From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.) Department of Neurology (M.G.D., J.L.S., R.H.B.B., B.W.-G., D.W.S.).
authors.forename: M G
authors.initials: MG
authors.lastname: Dwyer
authors.affiliation: Department of Neurology (M.G.D., J.L.S., R.H.B.B., B.W.-G., D.W.S.) Division of Cognitive and Behavioral Neurosciences (B.C., J.L.S., D.W.S.) Neuroscience Program (J.L.S., D.W.S.).
authors.forename: J L
authors.initials: JL
authors.lastname: Shucard
authors.affiliation: From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.).
authors.forename: P
authors.initials: P
authors.lastname: Polak
authors.affiliation: From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.) Magnetic Resonance Laboratory (N.B.), IRCCS Don Gnocchi Foundation, Milan, Italy.
authors.forename: N
authors.identifier: http://orcid.org/0000-0002-7792-0433
authors.initials: N
authors.lastname: Bergsland
authors.affiliation: Department of Neurology (M.G.D., J.L.S., R.H.B.B., B.W.-G., D.W.S.).
authors.forename: R H B
authors.initials: RH
authors.lastname: Benedict
authors.affiliation: Department of Neurology (M.G.D., J.L.S., R.H.B.B., B.W.-G., D.W.S.).
authors.forename: B
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.affiliation: Department of Neurology (M.G.D., J.L.S., R.H.B.B., B.W.-G., D.W.S.) Division of Cognitive and Behavioral Neurosciences (B.C., J.L.S., D.W.S.) Neuroscience Program (J.L.S., D.W.S.).
authors.forename: D W
authors.initials: DW
authors.lastname: Shucard
authors.affiliation: From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.) MRI Clinical Translational Research Center (R.Z.), School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York rzivadinov@bnac.net.
authors.forename: R
authors.initials: R
authors.lastname: Zivadinov
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis* / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D020945:Lupus Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis* / Q000473:pathology*; D009434:Neural Pathways / Q000473:pathology*; D009483:Neuropsychological Tests; D012016:Reference Values; D066127:White Matter / Q000473:pathology*