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Cognitive impairment and memory disorders in relapsing–remitting multiple sclerosis: the role of white matter, gray matter and hippocampus

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Abstract

Cognitive disorders occur in up to 65 % of multiple sclerosis (MS) patients; they have been correlated with different MRI measures of brain tissue damage, whole and regional brain atrophy. The hippocampal involvement has been poorly investigated in cognitively impaired (CI) MS patients. The objective of this study is to analyze and compare brain tissue abnormalities, including hippocampal atrophy, in relapsing–remitting MS (RRMS) patients with and without cognitive deficits, and to investigate their role in determining cognitive impairment in MS. Forty-six RRMS patients [20 CI and 26 cognitively preserved (CP)] and 25 age, sex and education-matched healthy controls (HCs) underwent neuropsychological evaluation and 3-Tesla anatomical MRI. T2 lesion load (T2-LL) was computed with a semiautomatic method, gray matter volume and white matter volume were estimated using SIENAX. Hippocampal volume (HV) was obtained by manual segmentation. Brain tissues volumes were compared among groups and correlated with cognitive performances. Compared to HCs, RRMS patients had significant atrophy of WM, GM, left and right Hippocampus (p < 0.001). Compared to CP, CI RRMS patients showed higher T2-LL (p = 0.02) and WM atrophy (p = 0.01). In the whole RRMS group, several cognitive tests correlated with brain tissue abnormalities (T2-LL, WM and GM atrophy); only verbal memory performances correlated with left hippocampal atrophy. Our results emphasize the role of T2-LL and WM atrophy in determining clinically evident cognitive impairment in MS patients and provide evidence that GM and hippocampal atrophy occur in MS patients regardless of cognitive status.

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Acknowledgments

We gratefully acknowledge the patients and controls who took part in this study. We thank Dr. Valentina Panetta for providing statistical advice and the radiographer who acquired MRI images: Antonella Paccone (Neurological Institute for Diagnosis and Care “Hermitage Capodimonte”, Naples).

Conflict of interest

R. Sacco, M. Della Corte, S. Esposito, A. d’Ambrosio, R. Docimo, A. Bisecco, L. Lavorgna, D. Corbo, F. Esposito, M. Cirillo report no disclosures. A. Gallo and S. Bonavita received speakers honoraria from Biogen Idec, Novartis, and Merck-Serono. G. Tedeschi has received compensation for consulting services and/or speaking activities from Bayer Schering Pharma, Biogen Idec, Merck Serono, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck Serono, and Fondazione Italiana Sclerosi Multipla.

Ethical standard

This study was approved by the Local Ethical Committees on human studies and written informed consent from each subject was obtained prior to their enrolment.

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    Authors and Affiliations

    1. Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy

      R. Sacco, A. Bisecco, M. Della Corte, A. d’Ambrosio, R. Docimo, A. Gallo, S. Esposito, L. Lavorgna, G. Tedeschi & S. Bonavita

    2. Neurological Institute for Diagnosis and Care “Hermitage Capodimonte”, MRI Center SUN-FISM, Naples, Italy

      R. Sacco, D. Corbo, M. Della Corte, A. Gallo, M. Cirillo, G. Tedeschi & S. Bonavita

    3. Department of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy

      F. Esposito

    4. Neuroradiology Service, Department of Radiology, Second University of Naples, Naples, Italy

      M. Cirillo

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    1. R. Sacco
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    2. A. Bisecco
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    Correspondence to S. Bonavita.

    Additional information

    R. Sacco and A. Bisecco contributed equally to this study.

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    Sacco, R., Bisecco, A., Corbo, D. et al. Cognitive impairment and memory disorders in relapsing–remitting multiple sclerosis: the role of white matter, gray matter and hippocampus. J Neurol 262, 1691–1697 (2015). https://doi.org/10.1007/s00415-015-7763-y

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    • DOI: https://doi.org/10.1007/s00415-015-7763-y

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