Hostname: page-component-77c89778f8-sh8wx Total loading time: 0 Render date: 2024-07-21T22:53:16.980Z Has data issue: false hasContentIssue false
  • English
  • Français

Detecting Cognitive Dysfunction in Multiple Sclerosis with a Magnetic Resonance Imaging Rating Scale: A Pilot Study

Published online by Cambridge University Press:  07 November 2014

Laury Chamelian ,
Christian Bocti ,
Fu-Qiang Gao ,
Sandra E. Black  and
Anthony Feinstein
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: In multiple sclerosis (MS), magnetic resonance imaging (MRI) predictors of cognitive impairment are based on sophisticated computer-generated analyses that are difficult to apply in clinical settings. This study investigated the clinical usefulness of a new visual rating scale, the Cholinergic Pathways Hyperintensities Scale (CHIPS), in detecting cognitive dysfunction.

Methods: Forty clinically definite MS patients underwent a brain MRI. Based on the CHIPS, cholinergic pathway hyperintensities were rated in 10 regions on four axial slices. Computerized hyperintense lesion volumes were also obtained. For cognitive testing, The Neuropsychological Screening Battery for Multiple Sclerosis was used. “Low” and “High” lesion score groups were computed based on the mean of the total CHIPS score. Optimal sensitivity and specificity of the total CHIPS score in detecting cognitive impairment were determined using a receiver operator characteristic curve.

Results: Despite a similar demographic profile, subjects with a “High” lesion score performed significantly worse than the “Low” lesion score group on verbal (P=.007) and visuospatial (P=.02) memory, and on a global index of cognitive functioning (P=.001). Optimal sensitivity (82%) and specificity (83%) were reached with a threshold total CHIPS score of 18 points. Total CHIPS score and total hyperintense lesion load were correlated (σ=0.82, P<.0001).

Conclusion: CHIPS is helpful in clinically predicting cognitive impairment in MS.

Type
Research Article
Information
CNS Spectrums , Volume 10 , Issue 5 , May 2005 , pp. 394 - 402
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Rao, SM, Leo, GJ, Bernardin, L, et al. Cognitive dysfunction in multiple sclerosis. I. frequency, patterns, prediction. Neurology. 1991;41:685–691.Google Scholar
2.McIntosh-Michaelis, SA, Wilkinson, SM, Diamond, ID, et al. The prevalence of cognitive impairment in a community survey of multiple sclerosis. Br J Clin Psychol. 1991;30(pt 4):333–348.Google Scholar
3.Peyser, JM, Rao, SM, LaRocca, NG, Kaplan, E. Guidelines for neuropsychological research in multiple sclerosis. Arch Neurol. 1990;47:94–97.Google Scholar
4.Feinstein, A. The Clinical Neuropsychiatry of Multiple Sclerosis. Cambridge, England: Cambridge University Press; 1999.Google Scholar
5.Bagert, B, Camplair, P, Bourdette, D. Cognitive dysfunction in multiple sclerosis: natural history, pathophysiology and management. CNS Drugs. 2002;16:445–455.Google Scholar
6.Bobholz, JA, Rao, SM. Cognitive dysfunction in multiple sclerosis: a review of recent developments. Curr Opin Neurol. 2003;16:283–288.Google Scholar
7.Rao, SM, Leo, GJ, Ellington, L, et al. Cognitive dysfunction in multiple sclerosis. II. impact on employment and social function. Neurology. 1991;41:692–696.Google Scholar
8.Amato, MP, Giuseppina, P, Pracucci, G, et al. Cognitive impairment in early-onset multiple sclerosis. Patterns, predictors, and impact on everyday life in a 4-year follow-up. Arch Neurol. 1995;52:168–172.Google Scholar
9.Ivnik, RJ. Neuropsychological test performance as a function of the duration of MS-related symptomatology. J Clin Psychiatry. 1978;39:304–312.Google Scholar
10.Beatty, WW, Goodkin, DE, Hertsgaard, D, Monson, N. Clinical and demographic predictors of cognitive performance in multiple sclerosis. Do diagnostic type, disease duration, and disability matter? Arch Neurol. 1990;47:305–308.Google Scholar
11.Jennekens-Schinkel, A, Laboyrie, PM, Lanser, JB, van der Velde, EA. Cognition in patients with multiple sclerosis after four years. J Neurol Sci. 1990;99:229–247.Google Scholar
12.Hohol, MJ, Guttmann, CRG, Orav, J, et al. Serial neuropsychological assessment and magnetic resonance imaging analysis in multiple sclerosis. Arch Neurol. 1997;54:1018–1025.Google Scholar
13.Sperling, RA, Guttmann, CRG, Hohol, MJ, et al. Regional magnetic resonance imaging lesion burden and cognitive function in multiple sclerosis: a longitudinal study. Arch Neurol. 2001;58:115–121.Google Scholar
14.Filley, CM, Heaton, RK, Thompson, LL, Nelson, LM, Franklin, GM. Effects of disease course on neuropsychological functioning. In: Rao, SM, ed. Neurobehavioural Aspects of Multiple Sclerosis. New York, NY: Oxford University Press; 1990:136–148.Google Scholar
15.Marsh, GG. Disability and intellectual function in multiple sclerosis patients. J Nerv Ment Dis. 1980;168:758–762.Google Scholar
16.van den Burg, W, van Zomeren, AH, Minderhoud, JM, Prange, AJ, Meijer, NS. Cognitive impairment in patients with multiple sclerosis and mild physical disability. Arch Neurol. 1987;44:494–501.Google Scholar
17.Rao, SM, Leo, GJ, Haughton, VM, St Aubin-Faubert, P, Bernardin, L. Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis. Neurology. 1989;39:161–166.Google Scholar
18.Huber, SJ, Bornstein, RA, Rammohan, KW, Christy, JA, Chakeres, DW, McGhee, RB. Magnetic resonance imaging correlates of neuropsychological impairment in multiple sclerosis. J Neuropsychiatry Clin Neurosci. 1992;4:152–158.Google Scholar
19.Rovaris, M, Filippi, M, Falautano, M, et al. Relation between MR abnormalities and patters of cognitive impairment in multiple sclerosis. Neurology. 1998;50:1601–1608.Google Scholar
20.Camp, SJ, Stevenson, VL, Thompson, AJ, et al. Cognitive function in primary progressive and transitional progressive multiple sclerosis: a controlled study with MRI correlates. Brain. 1999;122:1341–1348.Google Scholar
21.Comi, G, Filippi, M, Martinelli, V, et al. Brain magnetic resonance imaging correlates in primary and secondary progressive multiple sclerosis. J Neurol Sci. 1993;115(suppl):S66–S73.Google Scholar
22.Swirsky-Sacchetti, T, Mitchell, DR, Seward, J, et al. Neuropsychological and structural brain lesions in multiple sclerosis: a regional analysis. Neurology. 1992;42:1291–1295.Google Scholar
23.Arnett, PA, Rao, SM, Bernardin, L, et al. Relationship between frontal lobe lesions and Wisconsin Card Sorting Test performance in patients with multiple sclerosis. Neurology. 1994;44(3 pt 1):420–425.Google Scholar
24.Foong, J, Rozewicz, L, Quaghebeur, G, et al. Executive function in multiple sclerosis. The role of frontal lobe pathology. Brain. 1997;120(pt 1):15–26.Google Scholar
25.Huber, SJ, Paulson, GW, Shuttleworth, EC, et al. Magnetic resonance imaging correlates of dementia in multiple sclerosis. Arch Neurol. 1987;44:732–736.Google Scholar
26.Franklin, GM, Heaton, RK, Nelson, LM, et al. Correlation of neuropsychological and MRI findings in chronic/progressive multiple sclerosis. Neurology. 1988;38:1826–1829.Google Scholar
27.Callanan, MM, Logsdail, SJ, Ron, MA, Warrington, EK. Cognitive impairment in patients with clinically isolated lesions of the type seen in multiple sclerosis. A psychometric and MRI study. Brain. 1989;112:361–374.Google Scholar
28.Ron, MA, Callanan, MM, Warrington, EK. Cognitive abnormalities in multiple sclerosis: a psychometric and MRI study. Psychol Med. 1991;21:59–68.Google Scholar
29.Bocti, C, Gao, FQ, Swartz, RH, et al. Strategic localization of white matter hyperintensities on MRI: a new rating scale to measure involvement of cholinergic pathways [abstract]. J Neurol Sci. 2004;226:139.Google Scholar
30.Bocti, C, Swartz, RH, Gao, FQ, et al. Alzheimer‘s disease with cerebrovascular disease: possible additional cholinergic system injury by strategic white matter hyperintensities [abstract]. Neurobiol Aging. 2004;25:267.Google Scholar
31.D'intino, G, Paradisi, M, Fernandez, M, et al. Cognitive deficit associated with cholinergic and nerve growth factor down-regulation in experimental allergic encephalomyelitis in rats. Proc Nad Acad Sci U S A. 2005;102:3070–3075.Google Scholar
32.Ruberg, M, Villageois, A, Bonnet, AM, et al. Acetylcholinesterase and butyrylcholinesterase activity in the cerebrospinal fluid of patients with neurodegenerative diseases involving cholinergic systems. J Neurol Neurosurg Psych. 1987;50:538–543.Google Scholar
33.Greene, Y, Tariot, P, Wishart, H, et al. A 12-week, open trial of donepezil hydrochloride in patients with multiple sclerosis and associated cognitive impairments. J Clin Psychopharmacol. 2000;20;350–356.Google Scholar
34.Parry, AM, Scott, RB, Palace, J, Smith, S, Matthews, PM. Potentially adaptive functional changes in cognitive processing for patients with multiple sclerosis and their acute modulation by rivastigmine. Brain. 2003;126:2750–2760.Google Scholar
35.Krupp, LB, Christodoulou, C, Melville, P, et al. Donepezil improved memory in multiple sclerosis in a randomized clinical trial. Neurology. 2004;63:1579–1585.Google Scholar
36.Poser, CM, Paty, DW, Scheinberg, L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983;13:227–231.Google Scholar
37.Feinstein, A, Roy, P, Lobough, N, Feinstein, K, O'Connor, P, Black, S. Structural brain abnormalities in multiple sclerosis patients with major depression. Neurology. 2004;62:586–590.Google Scholar
38.Interferon beta-lb is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology. 1993;43:655–661.Google Scholar
39.Jacobs, LD, Cookfair, DL, Rudick, RA, et al. Intramuscular interferon beta-la for disease for disease progression in relapsing multiple sclerosis: the Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol. 1996;39:285–294.Google Scholar
40.Edan, G, Miller, D, Clanet, M, et al. Therapeutic effect of mitoxantrone combined with methylprednisonolone in multiple sclerosis: a randomised multicentre study of active disease using MRI and clinical criteria, J Neurol Neurosurg Psychiatry. 1997;2:112–118.Google Scholar
41.Comi, G, Filippi, M, Wolinsky, JS. European/Canadian multicenter, double-blind, randomized, placebo-controlled study of the effects of glatiramer acetate on magnetic resonance imaging--measured disease activity and burden in patients with relapsing multiple sclerosis. European/Canadian Glatiramer Acetate Study Group. Ann Neurol. 2001;49:290–297.Google Scholar
42.Pliskin, NH, Hamer, DP, Goldstein, DS, et al. Improved delayed visual reproduction test performance in multiple sclerosis patients receiving interferon beta-1b. Neurology. 1996;47:1463–1468.Google Scholar
43.Fischer, JS, Priore, RL, Jacobs, LD, et al. Neuropsychological effects of interferon beta-1a in relapsing multiple sclerosis: Multiple Sclerosis Collaborative Research Group. Ann Neurol. 2000;48:885–892.Google Scholar
44.Kurtzke, JE. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33:1444–1452.Google Scholar
45.Grober, E, Sliwinski, M. Development and validation of a model for estimating premorbid verbal intelligence in the elderly. J Clin Exp Neuropsychol. 1991;13:933–949.Google Scholar
46.Rao, SM. The Neuropsychological Screening Battery for Multiple Sclerosis. Milwaukee, Wise: Medical College of Wisconsin; 1992.Google Scholar
47.Kraemer, HC, Peabody, CA, Tinklenberg, JR, et al. Mathematical and empirical development of a test of memory for clinical and research use. Psychol Bull. 1983;94:367–380.Google Scholar
48.Buschke, H, Fuld, PA. Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology. 1974;24:1019–1025.Google Scholar
49.Barbizet, J, Cany, E. Clinical and psychometrical study of a patient with memory disturbances. Int J Neurol. 1968;7:44–54.Google Scholar
50.Rao, SM, Hammeke, TA, McQuillen, MP, et al. Memory disturbance in chronic progressive multiple sclerosis. Arch Neurol. 1984;41:625–631.Google Scholar
51.Gronwall, DM. Paced auditory serial-addition task: a measure of recovery from concussion. Percept Mot Skills. 1977;44:367–373.Google Scholar
52.Lezak, MD. Neuropsychological Assessment. 2nd ed. New York, NY: Oxford University Press; 1983.Google Scholar
53.First, MB, Spitzer, RL, Gibbon, M, et al. Structured Clinical Interview for Axis 1 DSM-IV Disorders-Patient Edition (SCID-I/P, version 2.0). New York, NY: Biometrics Research Department, New York State Psychiatric Institute; 1994.Google Scholar
54.Arnett, PA, Higginson, CL, Randolph, JJ. Depression in multiple sclerosis: relationship to planning ability. J Int Neuropsychol Soc. 2001;7:665–674.Google Scholar
55.Selden, NR, Gitelman, DR, Salamon-Murayama, N, et al. Trajectories of cholinergic pathways within the cerebral hemispheres of the human brain. Brain. 1998;121:2249–2257.Google Scholar
56.Fisher, J. Using the Wechsler Memory Scale-revised to detect and characterize memory deficits in multiple sclerosis. Clin Neuropsychol. 1988;2:149–172.Google Scholar
57.Grant, I, McDonald, WI, Trimble, MR, Smith, E, Reed, R. Deficient learning and memory in early and middle phases of multiple sclerosis. J Neurol Neurosurg Psychiatry. 1984;47:250–255.Google Scholar
58.Beatty, WW, Goodkin, DE, Monson, N, et al. Anterograde and retrograde memory amnesia in patients with chronic-progressive multiple sclerosis. Arch Neurol. 1988;45:611–619.Google Scholar
59.Wishart, H, Sharpe, D. Neuropsychological aspects of multiple sclerosis. J Clin Exp Neuropsychol. 1997;19:810–824.Google Scholar
60.Goldstein, FC, McKendall, RR, Haut, MC. Gist recall in multiple sclerosis. Arch Neurol. 1992;49:1060–1064.Google Scholar
61.Beatty, WW, Monson, N. Semantic priming in multiple sclerosis. Bull Psychon Soc. 1990;28:397–400.Google Scholar
62.Grafman, J, Rao, S, Bernardin, L, et al. Automatic memory process in patients with multiple sclerosis. Arch Neurol. 1991;48:1072–1075.Google Scholar
63.Freo, U, Pizzolato, G, Dam, M, et al. A short review of cognitive and functional neuroimaging studies of cholinergic drugs: implications for therapeutic potentials. J Neural Transm. 2002;109:857–870.Google Scholar
64.Rao, SM. Neuroimaging correlates of cognitive dysfunction. In: Rao, SM, ed. Neurobehavioural Aspects of Multiple Sclerosis. New York, NY: Oxford University Press; 1990:118–135.Google Scholar