Attention and processing speed performance in multiple sclerosis is mostly related to thalamic volume
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Cognitive impairment (CI), mainly involving attention and processing speed (A-PS), is a common and disabling symptom in multiple sclerosis (MS). Symbol Digit Modalities Test (SDMT) is one of the more sensitive and reliable tests to assess A-PS deficits in MS. Structural MRI correlates of A-PS in MS still need to be clarified. This study aimed to investigate, in a large group of MS patients, the relationship between regional gray matter (GM) atrophy and SDMT performance. 125 relapsing remitting MS patients and 52 healthy controls (HC) underwent a 3 T–MRI protocol including high-resolution 3D–T1 imaging. All subjects underwent a neurological evaluation and SDMT. A Voxel Based Morphometry analysis was performed to assess: 1) correlations between regional GM volume and SDMT performance in MS patients; 2) regional differences in GM volume between MS patients and HC. Thalamic, putamen and cerebellar volumes were also calculated using FIRST tool from the FMRIB Software Library. A linear regression analysis was performed to assess the contribution of each one of these structures to A-PS performance. A significant negative correlation was found between regional GM volume and SDMT score at the level of the thalamus, cerebellum, putamen, and occipital cortex in MS patients. Thalamus, cerebellum and putamen also showed significant GM atrophy in MS patients compared to HC. Thalamic atrophy is also an independent and additional contributor to A-PS deficits in MS patients. These findings support the role of thalamus as the most relevant GM structure subtending A-PS performance in MS, as measured by SDMT.
KeywordsMultiple sclerosis Attention Processing speed Gray matter Magnetic resonance imaging Thalamus
The authors thank all subjects, especially the patients with MS for the time and effort devoted to this study; Antonella Paccone, MRI Center “SUN-FISM,” University of Campania “Luigi Vanvitelli” and Institute of Diagnosis and Care “Hermitage-Capodimonte,” Naples, Italy for technical support; Mattia Siciliano, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Italy for contributing to statistical analysis.
Compliance with ethical standards
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
Alvino Bisecco, Svetlana Stamenova, Giuseppina Caiazzo, Alessandro d’Ambrosio, Rosaria Sacco, Renato Docimo, Sabrina Esposito, Mario Cirillo and Fabrizio Esposito have no disclosures. Simona Bonavita received speakers’ honoraria from Biogen Idec, Novartis, and Merck-Serono. Gioacchino Tedeschi has received compensation for consulting services and/or speaking activities from Bayer Schering Pharma, Biogen Idec, Merck Serono, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck Serono, and Fondazione Italiana Sclerosi Multipla. Antonio Gallo received honoraria for speaking and travel grants from Biogen, Sanofi-Aventis, Merck Serono, Genzyme, Teva, Bayer-Schering and Novartis.
This study was approved by the by the local Ethic Committee. All procedures performed in this study involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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