SERIAL NEUROPSYCHOLOGICAL ASSESSMENT AND MAGNETIC-RESONANCE-IMAGING ANALYSIS IN MULTIPLE-SCLEROSIS

Objective: To assess the correlation between cognitive dysfunction and disease burden in multiple sclerosis (MS) during a 1-year period. Des ign: The Brief, Repeatable Battery of Neuropsychological Tests in Mult iple Sclerosis was performed at entrance and 1 year. Patients underwen t at least 20 proton density (range, 20-24) and T-2-weighted axial mag netic resonance imaging (MRI) brain scans except for stable patients w ho were scanned monthly. Magnetic resonance imaging was evaluated usin g computer-automated, 3-dimensional volumetric analysis. Setting: A re search clinic of a university hospital. Patients: Forty-four patients with MS of the following disease categories: relapsing-remitting (14), relapsing-remitting progressive (12), chronic progressive (13), and s table (5). Main Outcome Measures: The relationships between scores on the Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis and 2 MRI measures (total lesion volume and brain to intracr anial cavity volume ratio) were assessed using linear regression. Thes e MRT measures were also compared with cognitive status at 1 year usin g analysis of variance. Results: Overall, there was no decline in mean cognitive test performance during 1 year. Significant correlations we re found between baseline neuropsychological test scores of nonverbal memory, information-processing speed, and attention and both MRI measu res. Patients with chronic progressive MS demonstrated the strongest c orrelations. At 1 year, change in information-processing speed and att ention correlated with change in total lesion volume. The mean increas e in total lesion volume was 5.7 mL for 4 patients whose cognitive sta tus worsened compared with 0.4 mL for 19 patients who improved and 0.5 mL for 21 patients who remained stable. Conclusions: During a 1-year period mean cognitive performance did not worsen. Automated volumetric MRI measures of total lesion volume and brain to intracranial cavity volume ratio correlated with neuropsychological performance, especiall y in patients with chronic progressive MS. Worsening MRI lesion burden correlated with cognitive decline.