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Posterior brain damage and cognitive impairment in pediatric multiple sclerosis.
Neurology. 2014 Apr 15; 82(15):1314-21.Neur

Abstract

OBJECTIVE

We combined structural and functional MRI to better understand the mechanisms responsible for cognitive impairment in pediatric patients with multiple sclerosis (MS).

METHODS

Brain dual-echo, diffusion tensor, 3D T1-weighted, and resting-state (RS) fMRI scans were acquired from 35 consecutive pediatric patients with MS and 16 sex- and age-matched healthy controls. Patients with abnormalities in ≥2 neuropsychological tests were classified as cognitively impaired. The regional distribution of white matter (WM) and gray matter (GM) damage was assessed using voxel-wise analyses. Default mode network (DMN) RS functional connectivity (FC) was also measured.

RESULTS

Sixteen patients (45%) were classified as cognitively impaired. Compared to cognitively preserved (CP) patients, cognitively impaired patients with MS had higher occurrence of T2 lesions as well as more severe damage to the WM and GM, as measured by atrophy and diffusivity abnormalities, in the posterior regions of the parietal lobes close to the midline (precuneus, posterior cingulum, and corpus callosum). Compared to the other study groups, they also showed reduced RS FC of the precuneus, whereas CP patients experienced an increased RS FC of the anterior cingulate cortex. A multivariable model identified diffusivity abnormalities of the cingulum and corpus callosum and RS FC of the precuneus as the covariates more strongly associated with cognitive impairment (C-index = 0.99).

CONCLUSIONS

In pediatric patients with MS, cognitive dysfunction is associated with structural and functional abnormalities of the posterior core regions of the DMN. WM structural abnormalities co-occurring at this level are likely to be the substrate of such modifications.

Authors+Show Affiliations

From the Neuroimaging Research Unit (M.A.R., M.A., M.F.), Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience (M.A.R., M.A., L.M., A. Fiorino, G.C., M.F.), and Department of Neurology (M.P.A., E.P.), University of Florence; the Multiple Sclerosis Center (A.G., L.P.), Ospedale di Gallarate; Fondazione "Istituto Neurologico Casimiro Mondino" (P.V., M.C.P.), Pavia; Multiple Sclerosis Center (R.C.), Spedali Civili of Brescia, Italy; Department of Cardiovascular Sciences (M.A.H.), University of Leicester, UK; and the Department of Neuroradiology (A. Falini), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24647027

Citation

Rocca, Maria A., et al. "Posterior Brain Damage and Cognitive Impairment in Pediatric Multiple Sclerosis." Neurology, vol. 82, no. 15, 2014, pp. 1314-21.
Rocca MA, Absinta M, Amato MP, et al. Posterior brain damage and cognitive impairment in pediatric multiple sclerosis. Neurology. 2014;82(15):1314-21.
Rocca, M. A., Absinta, M., Amato, M. P., Moiola, L., Ghezzi, A., Veggiotti, P., Capra, R., Portaccio, E., Fiorino, A., Pippolo, L., Pera, M. C., Horsfield, M. A., Falini, A., Comi, G., & Filippi, M. (2014). Posterior brain damage and cognitive impairment in pediatric multiple sclerosis. Neurology, 82(15), 1314-21. https://doi.org/10.1212/WNL.0000000000000309
Rocca MA, et al. Posterior Brain Damage and Cognitive Impairment in Pediatric Multiple Sclerosis. Neurology. 2014 Apr 15;82(15):1314-21. PubMed PMID: 24647027.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior brain damage and cognitive impairment in pediatric multiple sclerosis. AU - Rocca,Maria A, AU - Absinta,Martina, AU - Amato,Maria Pia, AU - Moiola,Lucia, AU - Ghezzi,Angelo, AU - Veggiotti,Pierangelo, AU - Capra,Ruggero, AU - Portaccio,Emilio, AU - Fiorino,Agnese, AU - Pippolo,Lorena, AU - Pera,Maria Carmela, AU - Horsfield,Mark A, AU - Falini,Andrea, AU - Comi,Giancarlo, AU - Filippi,Massimo, Y1 - 2014/03/19/ PY - 2014/3/21/entrez PY - 2014/3/22/pubmed PY - 2014/6/10/medline SP - 1314 EP - 21 JF - Neurology JO - Neurology VL - 82 IS - 15 N2 - OBJECTIVE: We combined structural and functional MRI to better understand the mechanisms responsible for cognitive impairment in pediatric patients with multiple sclerosis (MS). METHODS: Brain dual-echo, diffusion tensor, 3D T1-weighted, and resting-state (RS) fMRI scans were acquired from 35 consecutive pediatric patients with MS and 16 sex- and age-matched healthy controls. Patients with abnormalities in ≥2 neuropsychological tests were classified as cognitively impaired. The regional distribution of white matter (WM) and gray matter (GM) damage was assessed using voxel-wise analyses. Default mode network (DMN) RS functional connectivity (FC) was also measured. RESULTS: Sixteen patients (45%) were classified as cognitively impaired. Compared to cognitively preserved (CP) patients, cognitively impaired patients with MS had higher occurrence of T2 lesions as well as more severe damage to the WM and GM, as measured by atrophy and diffusivity abnormalities, in the posterior regions of the parietal lobes close to the midline (precuneus, posterior cingulum, and corpus callosum). Compared to the other study groups, they also showed reduced RS FC of the precuneus, whereas CP patients experienced an increased RS FC of the anterior cingulate cortex. A multivariable model identified diffusivity abnormalities of the cingulum and corpus callosum and RS FC of the precuneus as the covariates more strongly associated with cognitive impairment (C-index = 0.99). CONCLUSIONS: In pediatric patients with MS, cognitive dysfunction is associated with structural and functional abnormalities of the posterior core regions of the DMN. WM structural abnormalities co-occurring at this level are likely to be the substrate of such modifications. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/24647027/Posterior_brain_damage_and_cognitive_impairment_in_pediatric_multiple_sclerosis_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=24647027 DB - PRIME DP - Unbound Medicine ER -