早期区域性大脑灰质损伤可预测多发性硬化症的长期认知障碍表型:一项为期 20 年的研究。

IF 4.1 Q1 CLINICAL NEUROLOGY
Brain communications Pub Date : 2024-10-12 eCollection Date: 2024-01-01 DOI:10.1093/braincomms/fcae355
Stefano Ziccardi, Francesco Crescenzo, Maddalena Guandalini, Gulser Caliskan, Luigi Martinelli, Agnese Tamanti, Gian Marco Schiavi, Albulena Bajrami, Damiano Marastoni, Massimiliano Calabrese
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引用次数: 0

摘要

尽管皮质和皮质下区域的灰质萎缩与多发性硬化症的认知障碍有关,但只有少数研究评估了其对长期改变的预测价值。我们旨在确定多发性硬化症患者 20 年后认知状况的早期预测因素。在这项纵向回顾性研究中,参与者在确诊时(T0)和两年后(T2)接受了 1.5 T MRI 扫描,其中包括对区域灰质体积损失模式的评估。研究结束时,所有多发性硬化症患者都接受了全面的神经心理学评估,并根据他们的整体和特定认知领域状况(记忆力、注意力/信息处理速度、执行功能)进行了分类。临床和磁共振成像特征被评估为长期认知障碍的预测因素。研究人员进行了协方差分析、t 检验、未调整和调整(年龄、性别、病程、白质病变体积、皮质病变体积)逻辑回归。对 175 名多发性硬化症患者(118 名女性;研究结束时的平均(±SD)年龄 = 47.7 ± 9.4 岁)自发病起 20 年的临床随访情况(平均(±SD)= 19.9 ± 5.1)进行了评估。研究结束时,81 人(47%)被归类为认知功能受损:其中轻度受损者 38 人(22%),重度受损者 43 人(25%)。其中,46 人记忆力受损(27%),66 人注意力/信息处理速度受损(38%),71 人执行功能受损(41%)。回归模型发现,楔前回(调整后的几率比=3.37;P < 0.001)、脑岛(调整后的几率比=2.33;P = 0.036)、海马旁回(调整后的几率比=2.07;P < 0.001)和扣带回(调整后的几率比=1.81;P = 0.在对人口统计学和临床变量以及局灶性白质和灰质损伤进行调整后,多发性硬化症患者在平均 20 年后出现的整体认知功能障碍和特定领域认知功能改变与这些区域的相关性最大。特定皮质和深灰质区域的早期灰质体积损失可预测多发性硬化确诊20年后的整体和特定领域认知改变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early regional cerebral grey matter damage predicts long-term cognitive impairment phenotypes in multiple sclerosis: a 20-year study.

Despite grey matter atrophy in cortical and subcortical regions has been related to cognitive impairment in multiple sclerosis, only a few studies evaluated its predictive value for alterations in the long-term. We aimed to determine early predictors of cognitive status after 20 years of multiple sclerosis. In this longitudinal retrospective study, participants underwent a 1.5 T MRI scanning at diagnosis (T0) and after two years (T2), which included the evaluation of regional grey matter volume loss patterns. All individuals with multiple sclerosis underwent a comprehensive neuropsychological assessment at the end of the study and were classified considering their global and specific cognitive domains status (memory, attention/information processing speed, executive functioning). Clinical and MRI characteristics were assessed as predictors of long-term cognitive impairment. Analysis of covariance, t-test, unadjusted and adjusted (for age, sex, disease duration, volume of white matter lesions, volume of cortical lesions) logistic regression were conducted. One hundred seventy-five people with multiple sclerosis (118 females; mean ± SD age at the end of study = 47.7 ± 9.4 years) clinically followed for 20 years from onset (mean ± SD = 19.9 ± 5.1) were evaluated. At the end of the study, 81 (47%) were classified as cognitively impaired: 38 as mildly impaired (22%), and 43 as severely impaired (25%). In particular, 46 were impaired in memory (27%), 66 were impaired in attention/information processing speed (38%), and 71 were impaired in executive functioning (41%). Regression models identified precuneus (adjusted odds ratio = 3.37; P < 0.001), insula (adjusted odds ratio = 2.33; P = 0.036), parahippocampal gyrus (adjusted odds ratio = 2.07; P < 0.001) and cingulate (adjusted odds ratio = 1.81; P = 0.009) as the most associated regions with global cognitive impairment and domains-specific cognitive alterations after a mean of 20 years of multiple sclerosis, after adjusting for demographic and clinical variables as well as for focal white matter and grey matter damage. Early grey matter volume loss of specific cortical and deep grey matter regions predicts global and domain cognitive alterations after 20 years from multiple sclerosis diagnosis.

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