Regional gray matter atrophy and neuropsychologcal problems in relapsing-remitting multiple sclerosis

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Abstract

In multiple sclerosis, gray matter atrophy is extensive, and cognitive deficits and mood disorders are frequently encountered. It has been conjectured that focal atrophy is associated with emotional decline. However, conventional MRI has revealed that the pathological characteristics cannot fully account for the mood disorders. Moreover, there is no correlation between cognitive disorders and MRI results in clinically isolated syndromes or in cases of definite multiple sclerosis. In this case-control study, voxel-based morphometric analysis was performed on 11 subjects with relapsing-remitting multiple sclerosis, and the results show that these patients exhibit gray matter atrophy. Moreover, the gray matter atrophy in the superior and middle gyri of the right frontal lobe in patients with multiple sclerosis was correlated with scores from the Hamilton Anxiety Rating Scale. The scores obtained with the Repeatable Battery for the Assessment of Neuropsychological Status were associated with gray matter atrophy in the middle gyrus of the left frontal lobe, the superior and middle gyrus of the right frontal lobe, the middle gyrus of the left cingulate, the superior and middle gyri of the left frontal lobe, and the triangular area of the left frontal lobe. However, there was no statistical significance. These findings suggest that the cingulate and frontal cortices of the nant hemisphere are the most severely atrophic regions of the brain, and this atrophy is correlated with cognitive decline and emotional abnormalities.

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Cognitive and emotional influences in anterior cingulate cortex.

Bush, Luu, Posner (2000)

Anterior cingulate cortex (ACC) is a part of the brain's limbic system. Classically, this region has been related to affect, on the basis of lesion studies in humans and in animals. In the late 1980s, neuroimaging research indicated that ACC was active in many studies of cognition. The findings from EEG studies of a focal area of negativity in scalp electrodes following an error response led to the idea that ACC might be the brain's error detection and correction device. In this article, these various findings are reviewed in relation to the idea that ACC is a part of a circuit involved in a form of attention that serves to regulate both cognitive and emotional processing. Neuroimaging studies showing that separate areas of ACC are involved in cognition and emotion are discussed and related to results showing that the error negativity is influenced by affect and motivation. In addition, the development of the emotional and cognitive roles of ACC are discussed, and how the success of this regulation in controlling responses might be correlated with cingulate size. Finally, some theories are considered about how the different subdivisions of ACC might interact with other cortical structures as a part of the circuits involved in the regulation of mental and emotional activity.

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Thalamic atrophy and cognition in multiple sclerosis.

Ralph Benedict, R Killiany, Z Jaisani … (2007)

Recent studies have indicated that brain atrophy is more closely associated with cognitive impairment in multiple sclerosis (MS) than are conventional MRI lesion measures. Enlargement of the third ventricle shows a particularly strong correlation with cognitive impairment, suggesting clinical relevance of damage to surrounding structures, such as the thalamus. Previous imaging and pathology studies have demonstrated thalamic involvement in MS. In this study, we tested the hypothesis that thalamic volume is lower in MS than in normal subjects, and that thalamic atrophy in MS correlates with cognitive function. We studied 79 patients with MS and 16 normal subjects. A subgroup of 31 MS subjects underwent cognitive testing. The thalamus was segmented in whole from three-dimensional MRI scans. We also determined whole brain atrophy (brain parenchymal fraction), third ventricular width, and whole brain T2-weighted (fluid-attenuated inversion recovery) hyperintense, T1 hypointense, and gadolinium-enhanced lesion volumes. Normalized thalamic volume was 16.8% lower in the MS group (p < 0.0001) vs controls. Cognitive performance in all domains was moderately to strongly related to thalamic volume in the MS group (r = 0.506 to 0.724, p < 0.005), and thalamic volume entered and remained in all regression models predicting cognitive performance. Thalamic volume showed a weak relationship to physical disability score (r = -0.316, p = 0.005). These findings suggest that thalamic atrophy is a clinically relevant biomarker of the neurodegenerative disease process in multiple sclerosis.

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Rating depressive patients.

Clare M Hamilton (1980)

Various methods can be used for assessing symptoms of depression. These include check lists, scales for patient self-rating and rating scales completed by trained professional observers. Each technique has its special place in psychiatric research and each technique has its own strengths and weaknesses. A common concern on the part of psychiatrists is the fear that numerical assessment is dehumanizing. This is not the case as this method is intended only to make statistical analysis convenient and in no way reduces the concern for the subject's individuality. A commonly used depression rating scale, the Hamilton, has been extensively used in clinical trials of antidepressant drugs and for other purposes in clinical research. The various items of that scale are discussed and the system of rating explored from a clinician's point of view.

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Author and article information

Journal

Journal ID (nlm-ta): Neural Regen Res

Journal ID (iso-abbrev): Neural Regen Res

Journal ID (publisher-id): NRR

Title: Neural Regeneration Research

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 1673-5374

ISSN (Electronic): 1876-7958

Publication date (Print): 25 July 2013

Volume: 8

Issue: 21

Pages: 1958-1965

Affiliations

[1 ] Department of Neurology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China

[2 ] Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China

[3 ] Department of Hyperbaric Oxygen Treatment, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China

[4 ] Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China

Author notes

Aiyu Lin and Fuyong Chen contributed equally to this work.

Corresponding author: Aiyu Lin, Associate chief physician, Department of Neurology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China, aiyulina@ 123456yahoo.cn . (N201303005)

Author contributions: Yu T and Lin AY was responsible for study design, writing and validation. Chen FY and Liu F took part in study design. Li ZW provided research guidance. Liu Y was responsible for MR technical support. Lin SF, Wang XY and Zhu JT conducted the Repeatable Battery for the Assessment of Neuropsychological Status scale, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale tests. All authors approved the final version of the paper.

Author statements: The manuscript is original, has not been submitted to or is not under consideration by another publication, has not been previously published in any language or any form, including electronic, and contains no disclosure of confidential information or authorship/patent application disputations.

Article

Publisher ID: NRR-8-1958

DOI: 10.3969/j.issn.1673-5374.2013.21.004

PMC ID: 4145907

PubMed ID: 25206504

SO-VID: f23e9c82-e72c-46a0-9eb6-cb1acc7552a1

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Regional gray matter atrophy and neuropsychologcal problems in relapsing-remitting multiple sclerosis

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Claudins

Most cited references 32

Cognitive and emotional influences in anterior cingulate cortex.

Thalamic atrophy and cognition in multiple sclerosis.

Rating depressive patients.

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