Contributions
Abstract: 97
Type: Scientific Session
Abstract Category: Clinical aspects of MS - MS symptoms
Background: There is an unmet need to identify robust prognostic markers that predict a worse long-term cognitive performance in people with multiple sclerosis (MS).
Objective: To investigate the relationship of early MRI abnormalities and long-term cognitive performance in relapse-onset MS.
Methods: We studied 104 clinically isolated syndrome patients (mean age 33.6 years, 74 female) who had brain/spinal cord MRI at onset and after 1 year, and were followed up after 15 years. MRI variables at baseline included supratentorial, infratentorial and spinal cord T2 lesion number, gadolinium-enhancing (GdE) lesion number, normalised brain volume (NBV) and upper cervical cord cross-sectional area (UCCA). The number of new T2 and GdE lesions plus percentage brain volume change (PBVC) and change in UCCA were measured at 1 year. Cognition was assessed after 15 years using the Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), tests of verbal and visual memory, and the Brixton and Hayling tests (executive function tests). Multivariate multiple linear regression models were used to identify early MRI predictors of performance in each of the three cognitive domains (information processing speed, memory, executive function) at 15 years, with adjustment for age, sex and estimated premorbid intelligence.
Results: At 15 years, 83 (80%) patients had MS and 35 (34%) were cognitively impaired (all MS). In the multivariate multiple regression models, baseline GdE lesions (1+) was independently associated with reduced performance on tests of information processing speed (p< 0.01), memory (p< 0.01) and executive function (p< 0.01) at 15 years. When the follow-up MRI variables at 1 year were included in the models, baseline GdE lesions (1+) remained significant for all three cognitive domains. New (1+) supratentorial lesions at 1 year was also associated with information processing speed (p=0.01) and memory (p< 0.01), and new (1+) supratentorial (p< 0.01) and spinal cord lesions (p=0.02) at 1 year with executive function. Baseline NBV and PBVC at 1 year were not associated with cognition at 15 years independent of lesion measures.
Conclusion: The extent of focal inflammatory activity in the brain in patients with early relapse-onset MS is associated with long-term cognitive performance. Conventional MRI measures may be helpful in identifying patients with early MS who are at high-risk for developing cognitive disability.
Disclosure: The study was supported by the UK Multiple Sclerosis Society, the Neurological Foundation of New Zealand and the NIHR University College London Hospitals Biomedical Research Centre.
Dr Brownlee has recieved speaker honoraria for educational activities for Merck and Roche.
Dr Altmann, Dr Miszkiel, Dr Prados, Dr Eshaghi, Dr Ourselin and Dr Gandini Wheeler-Kingshott have nothing to disclose.
Dr Barkhof is a consultant to Biogen-Idec, Janssen Alzheimer Immunotherapy, Bayer-Schering, Merck Serono, Roche, Novartis, Genzyme, and Sanofi-aventis. He has received sponsorship from EU-H2020, NWO, SMSR, EU-FP7, TEVA, Novartis, Toshiba. He is on the editorial board of Radiology, Brain, Neuroradiology, Multiple Sclerosis Journal and Neurology.
Dr Ciccarelli is a is a consultant for Novartis, Roche and Teva, and is an associate editor of Neurology.
Abstract: 97
Type: Scientific Session
Abstract Category: Clinical aspects of MS - MS symptoms
Background: There is an unmet need to identify robust prognostic markers that predict a worse long-term cognitive performance in people with multiple sclerosis (MS).
Objective: To investigate the relationship of early MRI abnormalities and long-term cognitive performance in relapse-onset MS.
Methods: We studied 104 clinically isolated syndrome patients (mean age 33.6 years, 74 female) who had brain/spinal cord MRI at onset and after 1 year, and were followed up after 15 years. MRI variables at baseline included supratentorial, infratentorial and spinal cord T2 lesion number, gadolinium-enhancing (GdE) lesion number, normalised brain volume (NBV) and upper cervical cord cross-sectional area (UCCA). The number of new T2 and GdE lesions plus percentage brain volume change (PBVC) and change in UCCA were measured at 1 year. Cognition was assessed after 15 years using the Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), tests of verbal and visual memory, and the Brixton and Hayling tests (executive function tests). Multivariate multiple linear regression models were used to identify early MRI predictors of performance in each of the three cognitive domains (information processing speed, memory, executive function) at 15 years, with adjustment for age, sex and estimated premorbid intelligence.
Results: At 15 years, 83 (80%) patients had MS and 35 (34%) were cognitively impaired (all MS). In the multivariate multiple regression models, baseline GdE lesions (1+) was independently associated with reduced performance on tests of information processing speed (p< 0.01), memory (p< 0.01) and executive function (p< 0.01) at 15 years. When the follow-up MRI variables at 1 year were included in the models, baseline GdE lesions (1+) remained significant for all three cognitive domains. New (1+) supratentorial lesions at 1 year was also associated with information processing speed (p=0.01) and memory (p< 0.01), and new (1+) supratentorial (p< 0.01) and spinal cord lesions (p=0.02) at 1 year with executive function. Baseline NBV and PBVC at 1 year were not associated with cognition at 15 years independent of lesion measures.
Conclusion: The extent of focal inflammatory activity in the brain in patients with early relapse-onset MS is associated with long-term cognitive performance. Conventional MRI measures may be helpful in identifying patients with early MS who are at high-risk for developing cognitive disability.
Disclosure: The study was supported by the UK Multiple Sclerosis Society, the Neurological Foundation of New Zealand and the NIHR University College London Hospitals Biomedical Research Centre.
Dr Brownlee has recieved speaker honoraria for educational activities for Merck and Roche.
Dr Altmann, Dr Miszkiel, Dr Prados, Dr Eshaghi, Dr Ourselin and Dr Gandini Wheeler-Kingshott have nothing to disclose.
Dr Barkhof is a consultant to Biogen-Idec, Janssen Alzheimer Immunotherapy, Bayer-Schering, Merck Serono, Roche, Novartis, Genzyme, and Sanofi-aventis. He has received sponsorship from EU-H2020, NWO, SMSR, EU-FP7, TEVA, Novartis, Toshiba. He is on the editorial board of Radiology, Brain, Neuroradiology, Multiple Sclerosis Journal and Neurology.
Dr Ciccarelli is a is a consultant for Novartis, Roche and Teva, and is an associate editor of Neurology.