Disconnection as a Mechanism for Cognitive Dysfunction in Multiple Sclerosis

Autor/inn/en	Dineen, R. A.; Vilisaar, J.; Hlinka, J.; Bradshaw, C. M.; Morgan, P. S.; Constantinescu, C. S.; Auer, D. P.
Titel	Disconnection as a Mechanism for Cognitive Dysfunction in Multiple Sclerosis
Quelle	In: Brain, 132 (2009) 1, S.239-249 (11 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0006-8950
DOI	10.1093/brain/awn275
Schlagwörter	Age; Injuries; Testing; Verbal Learning; Adults; Patients; Short Term Memory; Statistical Analysis; Probability; Neurological Impairments; Brain; Diagnostic Tests; Scores; Cognitive Processes; Brain Hemisphere Functions; Diseases + Suchen Sie Ihr Suchwort? Alter; Lebensalter; Testdurchführung; Testen; Verbales Lernen; Patient; Kurzzeitgedächtnis; Statistische Analyse; Wahrscheinlichkeitsrechnung; Wahrscheinlichkeitstheorie; Neurodegenerative Erkrankung; Gehirn; Diagnostic test; Diagnostischer Test; Cognitive process; Kognitiver Prozess; Disease; Krankheit
Abstract	Disconnection of cognitively important processing regions by injury to the interconnecting white matter provides a potential mechanism for cognitive dysfunction in multiple sclerosis. The contribution of tract-specific white matter injury to dysfunction in different cognitive domains in patients with multiple sclerosis has not previously been studied. We apply tract-based spatial statistics (TBSS) to diffusion tensor imaging (DTI) in a cohort of multiple sclerosis patients to identify loci where reduced white matter tract fractional anisotropy (FA) predicts impaired performance in cognitive testing. Thirty-seven multiple sclerosis patients in remission (median age 43.5 years; Expanded Disability Status Scale range 1.5-6.5; 35 relapsing remitting, two secondary-progressive) underwent 3 T MRI including high-resolution DTI. Multiple sclerosis patients underwent formal testing of performance in multiple cognitive domains. Normalized cognitive scores were used for voxel-wise statistical analysis using TBSS, while treating age as a covariate of no interest. Permutation-based inference on cluster size (t greater than 2, P less than 0.05 corrected) was used to correct for multiple comparisons. Statistical mapping revealed differential patterns of FA reduction for tests of sustained attention, working memory and processing speed, visual working memory and verbal learning and recall. FA was not associated with frontal lobe function or visuospatial perception. Cognitively relevant tract localizations only partially overlapped with areas of high FLAIR lesion probability, confirming the contribution of normal-appearing white matter abnormality to cognitive dysfunction. Of note, tract localizations showing significant associations with cognitive impairment were found to interconnect cortical regions thought to be involved in processing in these cognitive domains, or involve possible compensatory processing pathways. This suggests that TBSS reveals functionally relevant tract injury underlying cognitive dysfunction in patients with multiple sclerosis. (As Provided).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10