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The report by Enzinger et al¹ confirms the earlier study by Chapman et al² regarding the predictive value of the apolipoprotein E 4 allele (APOE 4) for severity in multiple sclerosis. Reduced N-acetylaspartate levels have been shown to be valuable markers for cognitive decline in several diseases, including Alzheimer disease^3-4 and multiple sclerosis⁵ (C. Christodoulou, PhD, L. B. Krupp, MD, Z. Liang, PhD, et al, written communication, 2003). Were any data collected by Enzinger and colleagues on cognitive function in their various patient subgroups, with attempts to correlate cognitive decline to APOE 4 allele and N-acetylaspartate levels?

Alan A. Mazurek, MD
Rockville Centre, NY

1. Enzinger C, Ropele S, Strasser-Fuchs S, et al. Lower levels of N-acetylaspartate in multiple sclerosis patients with the apolipoprotein E e4 allele. Arch Neurol. 2003;60:65-70. FREE FULL TEXT 2. Chapman J, Vinokurov S, Achiron A, et al. APOE genotype is a major predictor of long-term progression of disability in MS. Neurology. 2001;56:312-316. FREE FULL TEXT 3. Jessen F, Block W, Traber F, et al. Decrease of N-acetylaspartate in the MTL correlates with cognitive decline of AD patients. Neurology. 2001;57:930-932. FREE FULL TEXT 4. Block W, Jessen F, Traber F, et al. Regional N-acetylaspartate reduction in the hippocampus detected with fast proton magnetic resonance spectroscopic imaging in patients with Alzheimer disease. Arch Neurol. 2002;59:828-834. FREE FULL TEXT 5. Pan JW, Krupp LB, Elkins LE, Coyle PK. Cognitive dysfunction lateralizes with NAA in multiple sclerosis. Appl Neuropsychol. 2001;8:155-160. FULL TEXT | PUBMED

Arch Neurol. 2004;61:296.

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Reduced N-acetylaspartate Levels and Cognitive Decline—Reply
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Arch Neurol. 2004;61(2):296.
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