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Regional Magnetic Resonance Imaging Lesion Burden and Cognitive Function in Multiple Sclerosis
A Longitudinal Study
Reisa A. Sperling, MD;
Charles R. G. Guttmann, MD;
Marika J. Hohol, MD;
Simon K. Warfield, PhD;
Marianna Jakab, MS;
Marco Parente;
Eli L. Diamond;
Kirk R. Daffner, MD;
Michael J. Olek, DO;
E. John Orav, PhD;
Ron Kikinis, MD;
Ferenc A. Jolesz, MD;
Howard L. Weiner, MD
Arch Neurol. 2001;58:115-121.
Objective To investigate the relationship between magnetic resonance imaging regional
lesion burden and cognitive performance in multiple sclerosis (MS) over a
4-year follow-up period.
Design Twenty-eight patients with MS underwent magnetic resonance imaging and
took the Brief, Repeatable Battery of Neuropsychological Tests in Multiple
Sclerosis at baseline, 1-year, and 4-year follow-up. An automated 3-dimensional
lesion detection method was used to identify MS lesions within anatomical
regions on proton density T2-weighted images. The relationship between magnetic
resonance imaging regional lesion volumes and the Brief, Repeatable Battery
of Neuropsychological Tests in Multiple Sclerosis results was examined using
regression analyses.
Results At all time points, frontal lesion volume represented the greatest proportion
of total lesion volume, and the percentage of white matter classified as lesion
was also highest in frontal and parietal regions. On neuropsychological testing,
when compared with age- and educational level–matched control subjects,
patients with MS showed significant impairment on tests of sustained attention,
processing speed, and verbal memory (P<.001).
Performance on these measures was negatively correlated with MS lesion volume
in frontal and parietal regions at baseline, 1-year, and 4-year follow-up
(R = -0.55 to -0.73, P<.001).
Conclusions Multiple sclerosis lesions show a propensity for frontal and parietal
white matter. Lesion burden in these areas was strongly associated with performance
on tasks requiring sustained complex attention and working verbal memory.
This relationship was consistent over a 4-year period, suggesting that disruption
of frontoparietal subcortical networks may underlie the pattern of neuropsychological
impairment seen in many patients with MS.
From the Departments of Neurology (Drs Sperling, Daffner, Olek, and
Weiner and Messrs Parente and Diamond), Medicine (Dr Orav), and Radiology
(Drs Guttmann, Warfield, Kikinis, and Jolesz and Ms Jakab), Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass; and the Department of Neurology,
St Michael's Hospital, Toronto, Ontario (Dr Hohol).
Corresponding author: Reisa A. Sperling, MD, Memory Disorders Unit,
Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115 (e-mail: reisa{at}rics.bwh.harvard.edu).
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