187.Determinants of Cognitive Impairment in Patients with MS

每天朗读一段医学影像学英语文章

Determinants of Cognitive Impairment in Patients with MS with and without Atrophy

多发性硬化患者伴/不伴脑萎缩对认知功能损伤的决定性作用

Multiple sclerosis (MS) is characterized by focal and diffuse damage in both the white matter (WM) and gray matter (GM). The relationship between structural damage and cognitive impairment is well established, with WM lesion volume, WM integrity damage and GM atrophy correlating with cognitive impairment. The large heterogeneity in cognitive symptoms, however, cannot be fully explained by GM atrophy alone.

In an article published online in Radiology (RSNA.org/Radiology), Anand J.C. Eijlers, MD, VU University Medical Center, Amsterdam, and colleagues investigated why some MS patients with no atrophy may still develop severe cognitive impairment, whereas other patients are able to maintain preserved cognitive function in the presence of widespread atrophy.

The retrospective imaging study included MRI data from 2008–2012, including 332 patients with MS who then underwent extensive neuropsychologic evaluation and additional MRI. Cognitive impairment was present in 42 of 132 patients without atrophy and in 49 of 65 patients with atrophy.

In patients without atrophy, cognitive impairment was primarily determined by cognitive reserve (i.e., low level of education), but not by the amount of WM damage. An opposite pattern was visible in patients with GM atrophy, where patients with cognitive impairment showed a higher amount of concomitant WM damage than did patients with preserved cognitive function, with no effect of cognitive reserve. Regardless of these disparate effects of WM damage and cognitive reserve, all patients with cognitive impairment demonstrated a similar change in brain functioning: a more central position of the posterior cingulate cortex within the global functional brain network.

“Patients with MS and GM atrophy have cognitive impairment related to WM damage; however, in patients without atrophy, cognitive impairment was primarily determined by cognitive reserve (i.e., low level of education). Abnormalities detected by functional MRI could serve as a marker of cognitive impairment, independent of atrophy,” the authors write.

Images show differences in white matter (WM) integrity between patient groups, measured with diffusion imaging–derived fractional anisotrophy.

A. Comparison between patients with preserved cognitive function with and without atrophy. B. Comparison between patients with cognitive impairment with and without atrophy.

Eijlers, et al, Radiology 2018;InPress © RSNA 2018.

From:

https://www.rsna.org/News.aspx?id=24809

Notes:

1. sclerosis [skləˈroʊsɪs] n. 硬化

2. atrophy [ˈætrəfi] n. 萎缩，衰退

3. heterogeneity [ˌhetərə'dʒə'ni:ətɪ] n. 异质性，不均匀性

4. cingulate ['sɪŋgjəleɪt] adj. 扣带回

5. cortex [ˈkɔ:rteks] n. 皮质

6. fractional [ˈfrækʃənəl] adj. 小数的; 微小的

来源：每天朗读一段医学影像学英语文章

圈主

深圳市人民医院放射科副主任医师杨敏洁

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