fMRI may improve predictions of cognitive decline in MS patients

Using functional MRI (fMRI), researchers from VU University Medical Center in Amsterdam found a correlation between white matter brain damage and atrophy in multiple sclerosis (MS) patients—a primary factor of cognitive impairment in patients with the disease.

In the study, published online May 22 in Radiology, authors set out to determine why some MS patients with no atrophy developed cognitive impairment, while some with atrophy retained cognitive function.

Experts have hypothesized that cognitive reserve—which is related to an individual’s level of education and intellectual enrichment—is a key to this discovery. Many also believe it can postpone or reduce the rate of cognitive decline in MS and Alzheimer’s disease, according to corresponding author Anand J. C. E. Eijlers, MD, with VU University Medical Center, and colleagues.

To do determine this connection, the group retrospectively analyzed brain MRI of 332 patients with MS and 96 healthy control participants. All images were taken from 2008 to 2012.

Results showed, 132 of 328 patients with MS had no atrophy. Of that group, 42 (32 percent) had cognitive impairment. Of the 65 patients with MS and atrophy, 49 (75 percent) had cognitive impairment.

Authors noted “patients with multiple sclerosis and gray matter atrophy have cognitive impairment related to white matter damage; however, in patients without atrophy, cognitive impairment was primarily determined by cognitive reserve.” 

Additionally, Eijlers et al. found all patients with cognitive impairment demonstrated a similar change in brain function. They noted this may mean higher functional imaging could perhaps “bridge the gap” between the accumulation of structural damage and cognitive reserve mechanisms.

What does it mean?

Robert Zivadinov, MD, PhD, from the University of Buffalo’s Center for Biomedical Imaging at the Clinical Translational Science Institute, wrote a related editorial that praised the study for addressing an “under investigated” area of MS research.

“The findings from this study support assessing the cognitive reserve of patients with MS on a routine clinical basis. If incorporated into real-word patient monitoring, then clinicians can better estimate the timing of cognitive decline in patients with MS,” Zivadinov wrote, in the editorial published online May 22 in Radiology.