title: Longitudinal associations between MRI and cognitive changes in very early MS.
abstract: OBJECTIVE
  Cognitive dysfunction in multiple sclerosis (MS) has been primarily examined in patients with advanced disease. Our objective was to study the longitudinal associations between brain magnetic resonance imaging (MRI) metrics and neuropsychological outcomes in patients with early MS.
  
  
  METHODS
  Relapsing MS patients within 12 months of onset were enrolled in a neuroprotection trial of riluzole versus placebo with up to 36 months of follow-up. MRI metrics included percent brain volume changes measured by SIENAX normalized measurements [normalized brain parenchymal volume (nBPV), normalized normal-appearing white and gray matter volume (nNAWMV and nGMV)] and T2 lesion volume (T2LV). A neuropsychological battery was performed annually. Mixed model regression measured time trends and associations between imaging and neuropsychological outcomes, adjusting for sex, age and education level.
  
  
  RESULTS
  Forty-three patients (mean age 36 years; 31 females) were enrolled within 7.5 ± 4.9 months of disease onset. 11.6% of patients with baseline cognitive assessment met conservative criteria for cognitive impairment. Compared to placebo, riluzole had no significant effect on neuropsychological performance; thus, both groups were combined for the association analyses. Baseline T2LV predicted subsequent changes in PASAT (p=0.006) and SDMT (p=0.002) scores. Longitudinal changes of T2LV were associated with changes in CVLT-II (p<0.001).
  
  
  CONCLUSIONS
  These findings suggest that cognitive impairment is relatively common in patients with very early MS. Baseline and longitudinal changes in the lesion load may be associated with some of the most frequently identified changes in cognitive function in MS.
authors: Department of Neurology, University of California San Francisco, San Francisco, USA. Electronic address: bardia.nourbakhsh@ucsf.edu.
authors: Bardia
authors: B
authors: Nourbakhsh
authors: Palo Alto University, Palo Alto, CA, USA.
authors: Julia
authors: J
authors: Nunan-Saah
authors: Department of Neurology, University of California San Francisco, San Francisco, USA.
authors: Amir-Hadi
authors: AH
authors: Maghzi
authors: Department of Internal Medicine, University of California San Francisco, San Francisco, CA, USA.
authors: Laura J
authors: LJ
authors: Julian
authors: Department of Neurology, Oregon Health and Science University, OR, USA.
authors: Rebecca
authors: R
authors: Spain
authors: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors: Chengshi
authors: C
authors: Jin
authors: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors: Ann
authors: A
authors: Lazar
authors: Department of Neurology, University of Southern California, Los Angeles, CA, USA.
authors: Daniel
authors: D
authors: Pelletier
authors: Department of Neurology, University of California San Francisco, San Francisco, USA; Department of Pediatrics, University of California San Francisco, San Francisco, USA.
authors: Emmanuelle
authors: E
authors: Waubant
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy / Q000473:pathology* / Q000523:psychology*; D018696:Neuroprotective Agents / Q000627:therapeutic use; D009483:Neuropsychological Tests; D019782:Riluzole / Q000627:therapeutic use
chemical_list: D018696:Neuroprotective Agents; D019782:Riluzole
keywords: Atrophy; MRI scans; Multiple sclerosis; Neuropsychological tests