Gray matter trophism, cognitive impairment, and depression in patients with multiple sclerosis
Gray matter trophism, cognitive impairment, and depression in patients with multiple sclerosis
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DOI：
10.1177/1352458517692886
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发表时间：
2017-12-01
影响因子：
5.8
通讯作者：
Filippi, Massimo
中科院分区：
文献类型：
--
作者：
Pravata, Emanuele;Rocca, Maria A.;Filippi, Massimo
背景：认知障碍和抑郁常影响多发性硬化症（MS）患者。然而，抑郁症与认知功能障碍的发生及皮质萎缩的发展之间的关系尚未完全阐明。目的：探讨皮质和深部灰质（GM）体积与MS患者抑郁和认知功能障碍的关系。方法：对126例MS患者和59名匹配的健康对照者进行三维（3D） t1加权扫描。认知障碍的评估采用神经心理简易重复测试和抑郁的蒙哥马利-阿斯伯格抑郁评定量表（MADRS）。使用FreeSurfer和FIRST软件，我们评估了皮质厚度（CTh）和深部GM体积。采用因子分析和分类分析的方法，探讨了解释抑郁症和认知障碍的磁共振成像（MRI）变量。多变量回归模型将GM异常与症状严重程度联系起来。结果：与对照组相比，MS患者表现出广泛的双侧皮质变薄，包括所有脑叶。抑郁症多发性硬化症表现为额颞区选择性CTh减少，而认知障碍多发性硬化症表现为广泛的额顶叶皮质和皮层下GM萎缩。额叶皮质变薄是抑郁症的最佳预测指标（C-statistic=0.7），而右侧楔前叶变薄和高T2病变体积是认知障碍的最佳预测指标（C-statistic=0.8）。MADRS严重程度与右内嗅皮层变薄相关，而认知障碍严重程度与左内嗅和丘脑萎缩相关。结论：ms相关性抑郁与情绪行为相关区域的限制性CTh变化有关，而认知障碍与认知回路的皮层和皮层下GM萎缩有关。
Background: Cognitive impairment and depression frequently affects patients with multiple sclerosis (MS). However, the relationship between the occurrence of depression and cognitive impairment and the development of cortical atrophy has not been fully elucidated yet.Objectives: To investigate the association of cortical and deep gray matter (GM) volume with depression and cognitive impairment in MS.Methods: Three-dimensional (3D) T1-weighted scans were obtained from 126 MS patients and 59 matched healthy controls. Cognitive impairment was assessed using the Brief Repeatable Battery of Neuropsychological Tests and depression with the Montgomery-Asberg Depression Rating Scale (MADRS). Using FreeSurfer and FIRST software, we assessed cortical thickness (CTh) and deep GM volumetry. Magnetic resonance imaging (MRI) variables explaining depression and cognitive impairment were investigated using factorial and classification analysis. Multivariate regression models correlated GM abnormalities with symptoms severity.Results: Compared with controls, MS patients exhibited widespread bilateral cortical thinning involving all brain lobes. Depressed MS showed selective CTh decrease in fronto-temporal regions, whereas cognitive impairment MS exhibited widespread fronto-parietal cortical and subcortical GM atrophy. Frontal cortical thinning was the best predictor of depression (C-statistic=0.7), whereas thinning of the right precuneus and high T2 lesion volume best predicted cognitive impairment (C-statistic=0.8). MADRS severity correlated with right entorhinal cortex thinning, whereas cognitive impairment severity correlated with left entorhinal and thalamus atrophy.Conclusion: MS-related depression is linked to circumscribed CTh changes in areas deputed to emotional behavior, whereas cognitive impairment is correlated with cortical and subcortical GM atrophy of circuits involved in cognition.