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Tuesday, March 19, 2013

Brain Imaging Pinpoints Cognitive Impairment in MS Patients

An MRI imaging technique could be used to track the progression of cognitive impairment in MS patients and may provide insight into the effectiveness of MS medications.

By Mollie Bloudoff-Indelicato, Everyday Health Staff Writer

HURSDAY, March 7, 2013 — MRI scans can map the destruction of cranial white matter, providing a new way to track cognitive impairment in patients with multiple sclerosis (MS), according to a study published in the journal Neurology.
Up to 65 percent of patients with multiple sclerosis will experience some cognitive impairment such as memory lapses and the inability to multitask, but doctors previously had no way of precisely measuring the biological cause. Now, an MRI scan called “diffusion tensor imaging” (DTI) shows that the destruction of white matter in the brain could be behind such cognitive issues. The technology looks at the flow of fluid within the brain and uses it to detect abnormalities in white matter. DTI also provides an easy way for physicians to follow the progression of the disease, which affects about 2.5 million worldwide.
“We are looking for the biological basis for memory and cognitive problems in MS,” says Hanneke Hulst, MSc, a neuroscientist at VU Medical Center in the Netherlands and lead author on the study. “Diffusion tensor imaging is a method that has been used in the clinic as a diagnostic tool for stroke and white matter disease. It has never been used to investigate such stringently defined cognitively impaired MS patients.”
Hulst and her team performed DTI scans on 55 multiple sclerosis patients, 20 of whom previously tested positive for cognitive impairment during mental examinations. Researchers compared these brain scans with those of the non-impaired MS patients as well as 30 healthy controls who were matched to the patients accounting for gender and age. Hulst found that brain damage within the white matter was a significant predictor of cognitive impairment – a discovery that would have been difficult to uncover with a regular doctor’s visit.
“One of the problems with patients with MS is it’s very hard to tell that someone is having difficulties with their cognitive function,” says Lily Jung Henson, MD, a neurologist at the Swedish Neuroscience Institute who was not involved in the study. “This gives us some markers to identify some patients that are impaired.”
Multiple sclerosis patients with cognitive impairment can become sluggish and experience personality shifts as the disease attacks their white matter. They may perform poorly at work and strain personal relationships at home. This could explain why cognitively impaired MS patients have higher rates of depression and divorce when compared with healthy individuals, says Peter Joseph Jongen, MD, a neurologist at the MS4 Research Institute in the Netherlands who was not involved in the study but has done extensive research on the topic.
“Memory impairment is also a problem, forgetting things,” Dr. Jongen says. "Bosses don’t like that at all.”

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