title: Multiple sclerosis, cannabis, and cognition: A structural MRI study.
abstract: OBJECTIVE
  A subset of patients with multiple sclerosis (MS) smoke cannabis to relieve symptoms including spasticity and pain. Recent evidence suggests that smoking cannabis further impairs cognition in people with MS and is linked to impaired functional brain changes. No such association, however, has been reported between cannabis use and structural brain changes, hence the focus of the present study.
  
  
  METHODS
  Twenty patients with MS who smoke cannabis for symptom relief, and 19 matched non-cannabis-smoking MS patients were given the Brief Repeatable Neuropsychological Battery and structural MRI scans. Images were segmented into gray matter and white matter, and subsequently analysed with Partial Least Squares, a data-driven multivariate technique that explores brain-behaviour associations.
  
  
  RESULTS
  In both groups, the Partial Least Squares analysis yielded significant correlations between cognitive scores and both gray matter (33% variance, p < .0001) and white matter (17% variance, p < .05) volume. Gray matter volume in the thalamus, basal ganglia, medial temporal, and medial prefrontal regions, and white matter volume in the fornix correlated with cognitive deficits. Crucially, the analysis indicated that brain volume reductions were associated with more extensive cognitive impairment in the cannabis versus the non-cannabis MS group.
  
  
  CONCLUSIONS
  These results suggest that cannabis use in MS results in more widespread cognitive deficits, which correlate with tissue volume in subcortical, medial temporal, and prefrontal regions. These are the first findings demonstrating an association between cannabis use, cognitive impairment and structural brain changes in MS patients.
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Romero
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Bennis
authors.initials: B
authors.lastname: Pavisian
authors.affiliation: Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
authors.forename: William R
authors.initials: WR
authors.lastname: Staines
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Feinstein
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000139:chemically induced / Q000209:etiology / Q000503:physiopathology*; D066128:Gray Matter / Q000187:drug effects / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D064086:Medical Marijuana / Q000009:adverse effects*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D066127:White Matter / Q000187:drug effects / Q000473:pathology*
chemical_list: D064086:Medical Marijuana