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Serial Neuropsychological Assessment and Magnetic Resonance Imaging Analysis in Multiple Sclerosis

Serial Neuropsychological Assessment and Magnetic Resonance Imaging Analysis in Multiple Sclerosis Abstract Objective: To assess the correlation between cognitive dysfunction and disease burden in multiple sclerosis (MS) during a 1-year period. Design: The Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis was performed at entrance and 1 year. Patients underwent at least 20 proton density (range, 20-24) and T2-weighted axial magnetic resonance imaging (MRI) brain scans except for stable patients who were scanned monthly. Magnetic resonance imaging was evaluated using computer-automated, 3-dimensional volumetric analysis. Setting: A research clinic of a university hospital. Patients: Forty-four patients with MS of the following disease categories: relapsing-remitting (14), relapsingremitting progressive (12), chronic progressive (13), and stable (5). Main Outcome Measures: The relationships between scores on the Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis and 2 MRI measures (total lesion volume and brain to intracranial cavity volume ratio) were assessed using linear regression. These MRI measures were also compared with cognitive status at 1 year using analysis of variance. Results: Overall, there was no decline in mean cognitive test performance during 1 year. Significant correlations were found between baseline neuropsychological test scores of nonverbal memory, informationprocessing speed, and attention and both MRI measures. Patients with chronic progressive MS demonstrated the strongest correlations. At 1 year, change in information-processing speed and attention correlated with change in total lesion volume. The mean increase in total lesion volume was 5.7 mL for 4 patients whose cognitive status worsened compared with 0.4 mL for 19 patients who improved and 0.5 mL for 21 patients who remained stable. Conclusions: During a 1-year period mean cognitive performance did not worsen. Automated volumetric MRI measures of total lesion volume and brain to intracranial cavity volume ratio correlated with neuropsychological performance, especially in patients with chronic progressive MS. Worsening MRI lesion burden correlated with cognitive decline. References 1. Rao SM, Leo GJ, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis, I: frequency, patterns and prediction . Neurology . 1991;41:685-691.Crossref 2. Rao SM. Neuropsychology of multiple sclerosis: a critical review . J Clin Exp Neuropsychol . 1986;8:503-542.Crossref 3. Rao SM, Leo GJ, Haughton VM, St Aubin-Faubert P, Bernardin L. Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis . Neurology . 1989;39:161-166.Crossref 4. Swirsky-Sacchetti T, Mitchell DR, Seward J, et al. Neuropsychological and structural brain lesions in multiple sclerosis: a regional analysis . Neurology . 1992; 42:1291-1295.Crossref 5. Clark CM, James G, Li D, Oger J, Paty D, Klonoff H. Ventricular size, cognitive function and depression in patients with multiple sclerosis . Can J Neurol Sci . 1992;19:352-356. 6. Huber SJ, Paulson GW, Shuttleworth EC, et al. Magnetic resonance imaging correlates of dementia in multiple sclerosis . Arch Neurol . 1987;44:732-736.Crossref 7. Comi G, Filippi M, Martinelli V, et al. Brain magnetic resonance imaging correlates of cognitive impairment in multiple sclerosis . J Neurol Sci . 1993;115( (suppl) ): S66-S73.Crossref 8. Medaer R, Nelissen E, Appel B, Swerts M, Geutjens J, Callaert H. Magnetic resonance imaging and cognitive functioning in multiple sclerosis . J Neurol . 1987; 235:86-89.Crossref 9. Pozzilli C, Passafiume D, Bernardi S, et al. SPECT, MRI and cognitive functions in multiple sclerosis . J Neurol Neurosurg Psychiatry . 1991;54:110-115.Crossref 10. Reischies FM, Baum K, Brau H, Hedde JP, Schwindt G. Cerebral magnetic resonance imaging findings in multiple sclerosis: relation to disturbance of affect, drive, and cognition . Arch Neurol . 1988;45:1114-1116.Crossref 11. Franklin GM, Heaton RK, Nelson LM, Filley CM, Seibert C. Correlation of neuropsychological and MRI findings in chronic/progressive multiple sclerosis . Neurology . 1988;38:1826-1829.Crossref 12. Feinstein A, Ron M, Thompson A. A serial study of psychometric and magnetic resonance imaging changes in multiple sclerosis . Brain . 1993;116:569-602.Crossref 13. Mariani C, Farina E, Cappa SF, et al. Neuropsychological assessment in multiple sclerosis: a follow-up study with magnetic resonance imaging . J Neurol . 1991; 238:395-400.Crossref 14. Mattioli F, Cappa SF, Cominelli C, Capra R, Marcianoc N, Gasparotti R. Serial study of neuropsychological performance and gadolinium-enhanced MRI in MS . Acta Neurol Scand . 1993;87:465-468.Crossref 15. Goodkin DE, Ross JS, Medendorp SV, Konecsni J, Rudick RA. Magnetic resonance imaging lesion enlargement in multiple sclerosis: disease-related activity, chance occurrence, or measurement artifact? Arch Neurol . 1992;49:261-263.Crossref 16. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols . Ann Neurol . 1983;13:227-231.Crossref 17. Kurtzke JF. Rating neurological impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS) . Neurology . 1983;33:1444-1452.Crossref 18. Hauser SL, Dawson DM, Lehrich JR, et al. Intensive immunosuppression in progressive multiple sclerosis: a randomized, three-arm study of high dose intravenous cyclophosphamide, plasma exchange, and ACTH . N Engl J Med . 1983; 308:173-180.Crossref 19. Rao SM, Cognitive Function Study Group, National Multiple Sclerosis Society. A Manual for the Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis . New York, NY: National Multiple Sclerosis Society; 1990. 20. Bever CT, Grattan L, Panitch HS, Johnson KP. The Brief, Repeatable Battery of Neuropsychological Tests for Multiple Sclerosis: a preliminary serial study . Mult Scler . 1995;1:165-169. 21. Kikinis R, Shenton ME, Gerig G, et al. Routine quantitative analysis of brain and cerebrospinal fluid spaces with MR imaging . J Magn Reson Imaging . 1992;2:619-629.Crossref 22. Ettinger GJ, Grimson WEL, Lozano-Perez T, Wells WM III, White SJ, Kikinis R. Automatic registration for multiple sclerosis change detection . In: Proceedings of the Institute of Electrical and Electronics Engineers Inc Workshop on Biomedical Image Analysis . Los Alamitos, Calif: IEEE Computer Society Press; 1994: 297-306. 23. Wells WM III, Grimson WEL, Kikinis R, Jolesz FA. Adaptive segmentation of MRI data . IEEE Trans Med Imag . 1996;15:429-442.Crossref 24. Metcalf D, Kikinis R, Guttmann CRG, Vaina L, Jolesz F. 4D connected component labeling applied to quantitative analysis of MS lesion temporal development . In: Proceeding of the 14th Annual International Conference of the IEEE-EMBS . Piscataway, NJ: IEEE Service Center; 1992;14:945-946. 25. Rao SM, Reingold SC, Ron MA, Lyon-Caen O, Comi G. Workshop on neurobehavioral disorders in multiple sclerosis . Arch Neurol . 1993;50:658-662.Crossref 26. Jennekens-Schinkel A, Laboyrie PM, Lanser JBK, van der Velde EA. Cognition in patients with multiple sclerosis after four years . J Neurol Sci . 1990;99:229-247.Crossref 27. Ivnik RJ. Neuropsychological stability in multiple sclerosis . J Consult Clin Psychol . 1978;46:913-923.Crossref 28. Canter AH. Direct and indirect measures of psychological deficit in multiple sclerosis . J Gen Psychol . 1951;44:3-50.Crossref 29. Fink SL, Houser HB. An investigation of physical and intellectual changes in multiple sclerosis . Arch Phys Med Rehabil . 1966;47:56-61. 30. Amato MP, Ponziani G, Pracucci G, Bracco L, Siracusa G, Amaducci L. Cognitive impairment in early-onset multiple sclerosis: pattern, predictors, and impact on everyday life in a 4-year follow-up . Arch Neurol . 1995;52:168-172.Crossref 31. Feinstein A, Kartsounis LD, Miller DH, Youl BD, Ron MA. Clinically isolated lesions of the type seen in multiple sclerosis: a cognitive, psychiatric, and MRI follow up study . J Neurol Neurosurg Psychiatry . 1992;55:869-876.Crossref 32. Filley CM, Heaton RK, Thompson LL, Nelson LM, Franklin GM. Effects of disease course on neuropsychological functioning . In: Rao SM, ed. Neurobehavioral Aspects of Multiple Sclerosis . New York, NY: Oxford University Press Inc; 1990:136-148. 33. Goodkin DE, Rudick RA, Ross JS. The use of brain magnetic resonance imaging in multiple sclerosis . Arch Neurol . 1994;51:505-516.Crossref 34. Callanan MM, Logsdail SJ, Ron MA, Warrington EK. Cognitive impairment in patients with clinically isolated lesions of the type seen in multiple sclerosis: a psychometric and MRI study . Brain . 1989;112:361-374.Crossref 35. Filley CM, Heaton RK, Nelson LM, Burks JS, Franklin GM. A comparison of dementia in Alzheimer's disease and multiple sclerosis . Arch Neurol . 1989;46:157-161.Crossref 36. Heaton RK, Nelson LM, Thompson DS, Burks JS, Franklin GM. Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis . J Consult Clin Psychol . 1985;53:103-110.Crossref 37. Möller A, Wiedemann G, Rohde U, Backmund H, Sonntag A. Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis . Acta Psychiatr Scand . 1994;89:117-121.Crossref 38. Rao SM, Hammeke TA, Speech TJ. Wisconsin Card Sorting Test performance in relapsing-remitting and chronic-progressive multiple sclerosis . J Consult Clin Psychol . 1987;55:263-265.Crossref 39. Gonzalez CF, Swirsky-Sacchetti T, Mitchell D, Lublin FD, Knobler RL, Ehrlich SM. Distributional patterns of multiple sclerosis brain lesions: magnetic resonance imaging-clinical correlation . J Neuroimag . 1994;4:188-195. 40. Koopmans RA, Li DKB, Grochowski EW, Cutler PJ, Paty DW. Benign versus chronic progressive multiple sclerosis: magnetic resonance imaging features . Ann Neurol . 1989;25:74-81.Crossref 41. The IFNB Multiple Sclerosis Study Group. Interferon beta-1 b is effective in relapsingremitting multiple sclerosis, I: clinical results of a multicenter, randomized, doubleblind, placebo-controlled trial . Neurology . 1993;43:655-661.Crossref 42. Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis . Ann Neurol . 1996;39:285-294.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Serial Neuropsychological Assessment and Magnetic Resonance Imaging Analysis in Multiple Sclerosis

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1997.00550200074013
Publisher site
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Abstract

Abstract Objective: To assess the correlation between cognitive dysfunction and disease burden in multiple sclerosis (MS) during a 1-year period. Design: The Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis was performed at entrance and 1 year. Patients underwent at least 20 proton density (range, 20-24) and T2-weighted axial magnetic resonance imaging (MRI) brain scans except for stable patients who were scanned monthly. Magnetic resonance imaging was evaluated using computer-automated, 3-dimensional volumetric analysis. Setting: A research clinic of a university hospital. Patients: Forty-four patients with MS of the following disease categories: relapsing-remitting (14), relapsingremitting progressive (12), chronic progressive (13), and stable (5). Main Outcome Measures: The relationships between scores on the Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis and 2 MRI measures (total lesion volume and brain to intracranial cavity volume ratio) were assessed using linear regression. These MRI measures were also compared with cognitive status at 1 year using analysis of variance. Results: Overall, there was no decline in mean cognitive test performance during 1 year. Significant correlations were found between baseline neuropsychological test scores of nonverbal memory, informationprocessing speed, and attention and both MRI measures. Patients with chronic progressive MS demonstrated the strongest correlations. At 1 year, change in information-processing speed and attention correlated with change in total lesion volume. The mean increase in total lesion volume was 5.7 mL for 4 patients whose cognitive status worsened compared with 0.4 mL for 19 patients who improved and 0.5 mL for 21 patients who remained stable. Conclusions: During a 1-year period mean cognitive performance did not worsen. Automated volumetric MRI measures of total lesion volume and brain to intracranial cavity volume ratio correlated with neuropsychological performance, especially in patients with chronic progressive MS. Worsening MRI lesion burden correlated with cognitive decline. References 1. Rao SM, Leo GJ, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis, I: frequency, patterns and prediction . Neurology . 1991;41:685-691.Crossref 2. Rao SM. Neuropsychology of multiple sclerosis: a critical review . J Clin Exp Neuropsychol . 1986;8:503-542.Crossref 3. Rao SM, Leo GJ, Haughton VM, St Aubin-Faubert P, Bernardin L. Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis . Neurology . 1989;39:161-166.Crossref 4. Swirsky-Sacchetti T, Mitchell DR, Seward J, et al. Neuropsychological and structural brain lesions in multiple sclerosis: a regional analysis . Neurology . 1992; 42:1291-1295.Crossref 5. Clark CM, James G, Li D, Oger J, Paty D, Klonoff H. Ventricular size, cognitive function and depression in patients with multiple sclerosis . Can J Neurol Sci . 1992;19:352-356. 6. Huber SJ, Paulson GW, Shuttleworth EC, et al. Magnetic resonance imaging correlates of dementia in multiple sclerosis . Arch Neurol . 1987;44:732-736.Crossref 7. Comi G, Filippi M, Martinelli V, et al. Brain magnetic resonance imaging correlates of cognitive impairment in multiple sclerosis . J Neurol Sci . 1993;115( (suppl) ): S66-S73.Crossref 8. Medaer R, Nelissen E, Appel B, Swerts M, Geutjens J, Callaert H. Magnetic resonance imaging and cognitive functioning in multiple sclerosis . J Neurol . 1987; 235:86-89.Crossref 9. Pozzilli C, Passafiume D, Bernardi S, et al. SPECT, MRI and cognitive functions in multiple sclerosis . J Neurol Neurosurg Psychiatry . 1991;54:110-115.Crossref 10. Reischies FM, Baum K, Brau H, Hedde JP, Schwindt G. Cerebral magnetic resonance imaging findings in multiple sclerosis: relation to disturbance of affect, drive, and cognition . Arch Neurol . 1988;45:1114-1116.Crossref 11. Franklin GM, Heaton RK, Nelson LM, Filley CM, Seibert C. Correlation of neuropsychological and MRI findings in chronic/progressive multiple sclerosis . Neurology . 1988;38:1826-1829.Crossref 12. Feinstein A, Ron M, Thompson A. A serial study of psychometric and magnetic resonance imaging changes in multiple sclerosis . Brain . 1993;116:569-602.Crossref 13. Mariani C, Farina E, Cappa SF, et al. Neuropsychological assessment in multiple sclerosis: a follow-up study with magnetic resonance imaging . J Neurol . 1991; 238:395-400.Crossref 14. Mattioli F, Cappa SF, Cominelli C, Capra R, Marcianoc N, Gasparotti R. Serial study of neuropsychological performance and gadolinium-enhanced MRI in MS . Acta Neurol Scand . 1993;87:465-468.Crossref 15. Goodkin DE, Ross JS, Medendorp SV, Konecsni J, Rudick RA. Magnetic resonance imaging lesion enlargement in multiple sclerosis: disease-related activity, chance occurrence, or measurement artifact? Arch Neurol . 1992;49:261-263.Crossref 16. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols . Ann Neurol . 1983;13:227-231.Crossref 17. Kurtzke JF. Rating neurological impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS) . Neurology . 1983;33:1444-1452.Crossref 18. Hauser SL, Dawson DM, Lehrich JR, et al. Intensive immunosuppression in progressive multiple sclerosis: a randomized, three-arm study of high dose intravenous cyclophosphamide, plasma exchange, and ACTH . N Engl J Med . 1983; 308:173-180.Crossref 19. Rao SM, Cognitive Function Study Group, National Multiple Sclerosis Society. A Manual for the Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis . New York, NY: National Multiple Sclerosis Society; 1990. 20. Bever CT, Grattan L, Panitch HS, Johnson KP. The Brief, Repeatable Battery of Neuropsychological Tests for Multiple Sclerosis: a preliminary serial study . Mult Scler . 1995;1:165-169. 21. Kikinis R, Shenton ME, Gerig G, et al. Routine quantitative analysis of brain and cerebrospinal fluid spaces with MR imaging . J Magn Reson Imaging . 1992;2:619-629.Crossref 22. Ettinger GJ, Grimson WEL, Lozano-Perez T, Wells WM III, White SJ, Kikinis R. Automatic registration for multiple sclerosis change detection . In: Proceedings of the Institute of Electrical and Electronics Engineers Inc Workshop on Biomedical Image Analysis . Los Alamitos, Calif: IEEE Computer Society Press; 1994: 297-306. 23. Wells WM III, Grimson WEL, Kikinis R, Jolesz FA. Adaptive segmentation of MRI data . IEEE Trans Med Imag . 1996;15:429-442.Crossref 24. Metcalf D, Kikinis R, Guttmann CRG, Vaina L, Jolesz F. 4D connected component labeling applied to quantitative analysis of MS lesion temporal development . In: Proceeding of the 14th Annual International Conference of the IEEE-EMBS . Piscataway, NJ: IEEE Service Center; 1992;14:945-946. 25. Rao SM, Reingold SC, Ron MA, Lyon-Caen O, Comi G. Workshop on neurobehavioral disorders in multiple sclerosis . Arch Neurol . 1993;50:658-662.Crossref 26. Jennekens-Schinkel A, Laboyrie PM, Lanser JBK, van der Velde EA. Cognition in patients with multiple sclerosis after four years . J Neurol Sci . 1990;99:229-247.Crossref 27. Ivnik RJ. Neuropsychological stability in multiple sclerosis . J Consult Clin Psychol . 1978;46:913-923.Crossref 28. Canter AH. Direct and indirect measures of psychological deficit in multiple sclerosis . J Gen Psychol . 1951;44:3-50.Crossref 29. Fink SL, Houser HB. An investigation of physical and intellectual changes in multiple sclerosis . Arch Phys Med Rehabil . 1966;47:56-61. 30. Amato MP, Ponziani G, Pracucci G, Bracco L, Siracusa G, Amaducci L. Cognitive impairment in early-onset multiple sclerosis: pattern, predictors, and impact on everyday life in a 4-year follow-up . Arch Neurol . 1995;52:168-172.Crossref 31. Feinstein A, Kartsounis LD, Miller DH, Youl BD, Ron MA. Clinically isolated lesions of the type seen in multiple sclerosis: a cognitive, psychiatric, and MRI follow up study . J Neurol Neurosurg Psychiatry . 1992;55:869-876.Crossref 32. Filley CM, Heaton RK, Thompson LL, Nelson LM, Franklin GM. Effects of disease course on neuropsychological functioning . In: Rao SM, ed. Neurobehavioral Aspects of Multiple Sclerosis . New York, NY: Oxford University Press Inc; 1990:136-148. 33. Goodkin DE, Rudick RA, Ross JS. The use of brain magnetic resonance imaging in multiple sclerosis . Arch Neurol . 1994;51:505-516.Crossref 34. Callanan MM, Logsdail SJ, Ron MA, Warrington EK. Cognitive impairment in patients with clinically isolated lesions of the type seen in multiple sclerosis: a psychometric and MRI study . Brain . 1989;112:361-374.Crossref 35. Filley CM, Heaton RK, Nelson LM, Burks JS, Franklin GM. A comparison of dementia in Alzheimer's disease and multiple sclerosis . Arch Neurol . 1989;46:157-161.Crossref 36. Heaton RK, Nelson LM, Thompson DS, Burks JS, Franklin GM. Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis . J Consult Clin Psychol . 1985;53:103-110.Crossref 37. Möller A, Wiedemann G, Rohde U, Backmund H, Sonntag A. Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis . Acta Psychiatr Scand . 1994;89:117-121.Crossref 38. Rao SM, Hammeke TA, Speech TJ. Wisconsin Card Sorting Test performance in relapsing-remitting and chronic-progressive multiple sclerosis . J Consult Clin Psychol . 1987;55:263-265.Crossref 39. Gonzalez CF, Swirsky-Sacchetti T, Mitchell D, Lublin FD, Knobler RL, Ehrlich SM. Distributional patterns of multiple sclerosis brain lesions: magnetic resonance imaging-clinical correlation . J Neuroimag . 1994;4:188-195. 40. Koopmans RA, Li DKB, Grochowski EW, Cutler PJ, Paty DW. Benign versus chronic progressive multiple sclerosis: magnetic resonance imaging features . Ann Neurol . 1989;25:74-81.Crossref 41. The IFNB Multiple Sclerosis Study Group. Interferon beta-1 b is effective in relapsingremitting multiple sclerosis, I: clinical results of a multicenter, randomized, doubleblind, placebo-controlled trial . Neurology . 1993;43:655-661.Crossref 42. Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis . Ann Neurol . 1996;39:285-294.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Aug 1, 1997

References

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