title: No evidence of disease activity in multiple sclerosis: Implications on cognition and brain atrophy.
abstract: BACKGROUND
  The concept of no evidence of disease activity (NEDA) has emerged as an important outcome measure for multiple sclerosis (MS). However, it is not known if maintaining NEDA has a positive impact on cognition or brain atrophy.
  
  
  OBJECTIVE
  To evaluate NEDA status after two years, addressing its implications on cognition and brain atrophy.
  
  
  METHODS
  Forty-two relapsing-remitting MS patients and 30 controls underwent MRI (3T) and cognitive evaluation (BRB-N). Forty patients performed additional evaluations, after 12 and 24 months. NEDA was defined as the absence of clinical (relapses/disability progression) and MRI activity (new T2/gadolinium-enhancing lesions). Repeated measures and multivariate analyses were performed to assess the contribution of NEDA criteria to GM atrophy.
  
  
  RESULTS
  After two years, 30.8% of the cohort had NEDA. From these, 58.3% still had worsening in ⩾2 cognitive domains. Patients with MRI activity had more cortical thinning and slightly more thalamus volume decrease. Absence of new/enlarging T2 lesions was the only predictor of cortical thinning, subcortical GM and thalamic atrophy rates.
  
  
  CONCLUSIONS
  NEDA status was achieved in a small proportion of our cohort, and did not preclude cognitive deterioration. Absence of MRI activity and especially of new/enlarging T2 lesions was associated with less cortical and subcortical GM atrophy.
authors.affiliation: Departamento de Neurologia, Rua Tessália Vieira de Camargo, Universitária Zeferino Vaz, Brazil alfredodamasceno@hotmail.com.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Damasceno
authors.affiliation: Department of Neurology, University of Campinas (UNICAMP), Brazil.
authors.forename: Benito Pereira
authors.initials: BP
authors.lastname: Damasceno
authors.affiliation: Department of Neurology, University of Campinas (UNICAMP), Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cendes
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D066128:Gray Matter / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D013788:Thalamus / Q000473:pathology*
keywords: Atrophy; cognition; disease activity; magnetic resonance imaging; multiple sclerosis