White matter lesion load and location in relation to cognitive impairment in relapsing–remitting multiple sclerosis

Mohammed Y. Ezzeldin, Eman M. Khedr, Ahmed Nasreldein, Doaa M. Mahmoud
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Abstract

In relapsing–remitting multiple sclerosis (RRMS) the connection between cognitive impairment (CI) and white matter lesion load (WM-LL) and location is still unclear. This study aimed to identify the relationship between CI in RRMS patients and WM-LL and locations using a fully automated platform. CI and WM-LL were evaluated in 90 patients with RRMS using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and Automated MRI volumetric measures of WM-LL and lesion distribution. Regression analysis of BICAMS as a dependent variable with different clinical and radiological parameters was performed. Data were obtained from 90 patients with RRMS who had a mean age of 32.74 ± 8.43 years and a female-to-male ratio of 3:1. The mean (± SD) cognitive rating scores for the BICAMS subtests were 28.07 ± 11.78 for the Symbol Digit Modalities Test (SDMT), 42.32 ± 12.46 for the California Verbal Learning Test-II (CVLT-II), and 16.13 ± 8.17 for the Brief Visuospatial Memory Test-Revised (BVMT-R). According to the BICAMS criteria, 29 cases (32.2%) had CI. BICAMS scores were significantly correlated with age, education level, relapse frequency, disease duration, and time to start disease-modifying therapies. Whole WM-LL and periventricular lesion load were significantly associated with CI. After controlling for age, sex, and education, logistic regression analysis revealed that total WM-LL was the best predictor for CI together with duration of illness and years of education. The cut-off value of 12.85 cc for total WM-LL predicted CI. Whole WM-LL and periventricular lesion load are the best anatomical predictors for CI probably due to the effect on the anterior commissural fibers while years of education and duration of disease are the best demographic predictors for CI.
白质病变负荷和位置与复发性多发性硬化症认知障碍的关系
在复发缓解型多发性硬化症(RRMS)患者中,认知障碍(CI)与白质病变负荷(WM-LL)和位置之间的关系仍不清楚。本研究旨在利用全自动平台确定 RRMS 患者的 CI 与 WM-LL 和位置之间的关系。研究人员使用多发性硬化症简明国际认知评估(BICAMS)和自动磁共振成像对90名RRMS患者的CI和WM-LL以及病灶分布进行了评估。将 BICAMS 作为因变量与不同的临床和放射学参数进行回归分析。数据来自90名RRMS患者,他们的平均年龄为(32.74 ± 8.43)岁,男女比例为3:1。BICAMS子测试的认知评分平均值(± SD)为符号数字模型测试(SDMT)(28.07 ± 11.78)、加州言语学习测试-II(CVLT-II)(42.32 ± 12.46)和简明视觉空间记忆测试-修订版(BVMT-R)(16.13 ± 8.17)。根据 BICAMS 标准,29 例患者(32.2%)患有 CI。BICAMS评分与年龄、教育程度、复发频率、病程和开始接受疾病修饰疗法的时间有明显相关性。整个WM-LL和脑室周围病变负荷与CI显著相关。在控制了年龄、性别和受教育程度后,逻辑回归分析显示,总WM-LL与病程和受教育年限一起成为预测CI的最佳指标。总 WM-LL 的临界值为 12.85 cc,可预测 CI。整个WM-LL和脑室周围病变负荷是CI的最佳解剖学预测因子,这可能是由于对前神经纤维的影响,而受教育年限和病程则是CI的最佳人口学预测因子。
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CiteScore
1.90
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