title: Cognitive impairment and structural brain changes in patients with clinically isolated syndrome at high risk for multiple sclerosis.
abstract: Patients with clinically isolated syndrome (CIS), unlike those with multiple sclerosis (MS), have a selective cognitive impairment which is not consistently related to structural brain changes. Our objective was to characterize a profile of cognitive impairment and its association with structural brain changes in patients with CIS who are at high risk of developing MS. Patients with CIS at high risk for MS on interferon-beta (n = 51) and age-, gender-, and education-matched controls (n = 44) underwent comprehensive neuropsychological testing and MRI brain scan with voxel-based morphometry. The CIS group had lower cognitive performance in verbal and nonverbal memory, information processing speed/attention/working memory, and executive and visuo-spatial functions compared to controls (p ≤ 0.040). Lower cognitive performance was present in 18-37 and 14-26% of patients with CIS at high risk for MS depending on the criteria used. Brain volume was reduced predominantly in fronto-temporal regions and the thalamus in the CIS group (p ≤ 0.019). Cognitive performance was not associated with structural brain changes except for the association between worse visuo-spatial performance and lower white matter volume in the CIS group (β = 0.29; p = 0.042). Our results indicated that patients with CIS at high risk for MS may have a pattern of lower cognitive performance and regional brain atrophy similar to that found in patients with MS. Lower cognitive performance may be present in up to one-third of patients with CIS at high risk for MS, but, unlike patients with MS, variability in their cognitive performance may lead to a lack of consistent associations with structural brain changes.
authors.affiliation: Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Hynčicová
authors.affiliation: Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Vyhnálek
authors.affiliation: Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.
authors.forename: Adam
authors.initials: A
authors.lastname: Kalina
authors.affiliation: Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.
authors.forename: Lukáš
authors.initials: L
authors.lastname: Martinkovič
authors.affiliation: Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Nikolai
authors.affiliation: Department of Radiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Lisý
authors.affiliation: Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic.
authors.forename: Jakub
authors.initials: J
authors.lastname: Hort
authors.affiliation: Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Meluzínová
authors.affiliation: Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06, Prague 5, Czech Republic. jan.laczo@lfmotol.cuni.cz.|International Clinical Research Center, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic. jan.laczo@lfmotol.cuni.cz.
authors.forename: Jan
authors.initials: J
authors.lastname: Laczó
mesh_terms: D000328:Adult; D001284:Atrophy; D001921:Brain / Q000000981:diagnostic imaging*; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging* / Q000209:etiology; D003711:Demyelinating Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000523:psychology*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D009929:Organ Size; D011379:Prognosis; D012307:Risk Factors
keywords: Clinically isolated syndrome; Cognition; MRI; Multiple sclerosis; Neuropsychology; Voxel-based morphometry