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From the Department of Neurology (Drs. Amato, Zipoli, Portaccio, Mortilla, Siracusa, and Sorbi), University of Florence, Neurology Unit (Drs. Bartolozzi and Guidi), Hospital of Empoli, and Department of Neurological and Behavioral Sciences (Drs. Federico and De Stefano), University of Siena, Italy.
Address correspondence and reprint requests to Dr. M.P. Amato, Department of Neurology, University of Florence, Viale Morgagni, 85-50134 Florence, Italy; e-mail: mariapia.amato{at}unifi.it
Objective: To assess neocortical changes and their relevance to cognitive impairment in early relapsing–remitting (RR) multiple sclerosis (MS).
Methods: Conventional MR was acquired in 41 patients with RR MS and 16 demographically matched normal control subjects (NCs). An automated analysis tool was used with conventional T1-weighted MRI to obtain measures of cortical brain volumes normalized for head size. Neuropsychological performance of MS patients was assessed using the Rao Brief Repeatable Battery. Relationship between volumetric MR measures and neuropsychological scores was assessed.
Results: Neuropsychological assessment allowed for the identification of 18 cognitively preserved (MS-cp) and 23 cognitively impaired (MS-ci) MS patients. The whole MS sample showed lower values of normalized cortical volumes (NCVs) than did the NC group (p = 0.01). Upon grouping of MS patients according to cognitive performance, NCV values were lower (p = 0.02) in MS-ci patients than in both MS-cp patients and NCs. Moreover, there were positive correlations between NCV values and measures of verbal memory (r = 0.51, p = 0.02), verbal fluency (r = 0.51, p = 0.01), and attention/concentration (r = 0.65, p < 0.001) in MS-ci patients. Furthermore, NCV values were decreased in patients who scored lower on a greater number of tests (r = –0.58, p < 0.01) in the MS-ci group. None of the neuropsychological measures correlated to NCV values in the MS-cp patient group.
Conclusions: Cortical atrophy was found only in cognitively impaired patients and was significantly correlated with a poorer performance on tests of verbal memory, attention/concentration, and verbal fluency. Gray matter pathology may contribute to the development of cognitive impairment in MS from the earliest stages of the disease.
Received October 1, 2003. Accepted in final form February 27, 2004.
Presented at the 55th annual meeting of the American Academy of Neurology, Honolulu, HI, April 2003.
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