Contributions
Abstract: P523
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Background: The definition of benign MS is based on the limited accumulation of locomotor disability over long periods of time, without considering cognitive impairment. We applied a multiparametric MRI approach to investigate whether cognitive impairment in BMS patients is associated with specific patterns of structural and functional abnormalities.
Methods: Dual-echo, high-resolution 3D T1-weighted, diffusion tensor (DT) and resting state (RS) functional MRI sequences were acquired from 38 BMS patients (EDSS score < 3.0 and disease duration >15 years) and 50 age- and gender-matched healthy controls (HC). All patients underwent neuropsychological assessment, using the BRB-N, and a cognitive impairment index (CII) was calculated. Regional gray matter (GM) atrophy was estimated using a voxel-based-morphometry analysis, white matter (WM) fractional anisotropy (FA) and mean diffusivity (MD) abnormalities were investigated with tract-based-spatial-statistical analysis, while RS functional connectivity (FC) was assessed using independent component analysis. A linear regression analysis was performed to investigate the correlations between CII and regional structural and functional MRI abnormalities.
Results: In BMS patients, the median CII was 9 (IQR:4-16). Compared to HC, BMS patients showed: a significant GM atrophy of several deep GM nuclei, fronto-temporal regions and cingulate cortex; decreased FA of supratentorial/infratentorial WM tracts, and increased MD in supratentorial WM tracts only; a widespread increase of RS FC in fronto-temporo-parietal regions involved in attention and executive function networks. At correlation analyses, higher CII, indicating cognitive dysfunction, was correlated with right (R) thalamic atrophy and more severe microstructural abnormalities (decreased FA and increased MD) in cognitive-relevant WM tracts, including bilateral posterior thalamic radiation, corona radiata, splenium of corpus callosum, inferior fronto-occipital fasciculus, forceps major, inferior, superior longitudinal fasciculus and R fornix. Positive associations between higher CII and increased RS FC of the R precuneus in the default mode network and R middle frontal gyrus in the executive control network were also found.
Conclusions: These findings support the need for a new clinical definition of BMS, which should include including cognitive features.
Acknowledgments: Partially supported by Fondazione Italiana Sclerosi Multipla (FISM2018/S/3).
Disclosure: M.A. Rocca received speakers honoraria from Biogen Idec, Novartis, Genzyme, Sanofi-Aventis, Teva, Merck Serono, and Roche and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla.
G.C. Riccitelli and A. Meani have nothing to disclose.
P. Preziosa received speakers honoraria from Biogen Idec, Novartis and ExceMED.
G. Comi has received consulting fees for participating on advisory boards from Novartis, Teva Pharmaceutical Ind. Ltd, Sanofi, Genzyme, Merck Serono, Bayer, Actelion and honorarium for speaking activities for Novartis, Teva Pharmaceutical Ind. Ltd, Sanofi, Genzyme, Merck Serono, Bayer, Biogen, ExceMED.
M.Filippi is Editor-in-Chief of the Journal of Neurology; received compensation for consulting services and/or speaking activities from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA).
Abstract: P523
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Background: The definition of benign MS is based on the limited accumulation of locomotor disability over long periods of time, without considering cognitive impairment. We applied a multiparametric MRI approach to investigate whether cognitive impairment in BMS patients is associated with specific patterns of structural and functional abnormalities.
Methods: Dual-echo, high-resolution 3D T1-weighted, diffusion tensor (DT) and resting state (RS) functional MRI sequences were acquired from 38 BMS patients (EDSS score < 3.0 and disease duration >15 years) and 50 age- and gender-matched healthy controls (HC). All patients underwent neuropsychological assessment, using the BRB-N, and a cognitive impairment index (CII) was calculated. Regional gray matter (GM) atrophy was estimated using a voxel-based-morphometry analysis, white matter (WM) fractional anisotropy (FA) and mean diffusivity (MD) abnormalities were investigated with tract-based-spatial-statistical analysis, while RS functional connectivity (FC) was assessed using independent component analysis. A linear regression analysis was performed to investigate the correlations between CII and regional structural and functional MRI abnormalities.
Results: In BMS patients, the median CII was 9 (IQR:4-16). Compared to HC, BMS patients showed: a significant GM atrophy of several deep GM nuclei, fronto-temporal regions and cingulate cortex; decreased FA of supratentorial/infratentorial WM tracts, and increased MD in supratentorial WM tracts only; a widespread increase of RS FC in fronto-temporo-parietal regions involved in attention and executive function networks. At correlation analyses, higher CII, indicating cognitive dysfunction, was correlated with right (R) thalamic atrophy and more severe microstructural abnormalities (decreased FA and increased MD) in cognitive-relevant WM tracts, including bilateral posterior thalamic radiation, corona radiata, splenium of corpus callosum, inferior fronto-occipital fasciculus, forceps major, inferior, superior longitudinal fasciculus and R fornix. Positive associations between higher CII and increased RS FC of the R precuneus in the default mode network and R middle frontal gyrus in the executive control network were also found.
Conclusions: These findings support the need for a new clinical definition of BMS, which should include including cognitive features.
Acknowledgments: Partially supported by Fondazione Italiana Sclerosi Multipla (FISM2018/S/3).
Disclosure: M.A. Rocca received speakers honoraria from Biogen Idec, Novartis, Genzyme, Sanofi-Aventis, Teva, Merck Serono, and Roche and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla.
G.C. Riccitelli and A. Meani have nothing to disclose.
P. Preziosa received speakers honoraria from Biogen Idec, Novartis and ExceMED.
G. Comi has received consulting fees for participating on advisory boards from Novartis, Teva Pharmaceutical Ind. Ltd, Sanofi, Genzyme, Merck Serono, Bayer, Actelion and honorarium for speaking activities for Novartis, Teva Pharmaceutical Ind. Ltd, Sanofi, Genzyme, Merck Serono, Bayer, Biogen, ExceMED.
M.Filippi is Editor-in-Chief of the Journal of Neurology; received compensation for consulting services and/or speaking activities from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA).