Brain, Vol. 122, No. 7, 1341-1348,
July 1999
© 1999 Oxford University Press
Cognitive function in primary progressive and transitional progressive multiple sclerosis
A controlled study with MRI correlates
1 Department of Clinical Neurology, Institute of Neurology, London, UK, 2 Unitat de Neuroimmunologia Clinica, Hospitals Vall d'Hebron, Barcelona, Spain, 3 Service de Neurologie, Hôpital Pellegrin, Bordeaux, France, 4 Department of Neuroscience, Scientific Institute Ospedale San Raffaeke, Milan, Italy, 5 Servico de Neurologia, Hospital de Santa Maria, Lisbon, Portugal 6 University Hospital, Free University, Amsterdam, Netherlands
Correspondence to:
Dr D. W. Langdon, Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG, UK
The relative rarity of primary progressive (PP) and transitional progressive (TP) multiple sclerosis has meant that little documentation of cognitive function in such patients is currently available. The aim of this study was to investigate the cognitive skills of patients with PP and TP multiple sclerosis relative to matched healthy controls, and to examine the relationship of this impairment to MRI parameters. Sixty-three patients (43 PP, 20 TP) were individually matched with healthy controls, who undertook the same cognitive tasks as the patient group. The neuropsychological assessment comprised Rao's brief repeatable battery, a reasoning test, and a measure of depression. Patients also underwent T1- and T2-weighted brain MRI. These patients were taken from a larger cohort (158 PP, 33 TP) in whom it had been demonstrated that the re were no significant differences between the mean scores of the PP and TP groups on any of the cognitive variables. The 63 patients were therefore taken as one group for comparison with the healthy controls. These patients performed significantly worse than the controls in tests of verbal memory, attention, verbal fluency and spatial reasoning. An impairment index was constructed and applied to the patient data. This correlated modestly with T2-lesion load (r = 0.45, P = 0.01), T1-hypointensity load (r = 0.45, P = 0.01) and cerebral volume (r = –0.35, P = 0.01). Thus, PP and TP multiple sclerosis patients demonstrate significant cognitive dysfunction when compared with matched healthy controls. The relationship between this impairment and MRI parameters is moderate, suggesting that cognitive dysfunction in PP and TP multiple sclerosis has a complex and multifactorial aetiology, which is not adequately explained by pathology as demonstrated on conventional MRI.
multiple sclerosis; primary progressive; transitional progressive; cognitive function; MRI
BRB = Brief Repeatable Battery; EDSS = Expanded Disability Status Scale; MADRS = Montgomery and Asberg Depression Rating Scale; PP = primary progressive; SP = secondary progressive; TP = transitional progressive; VESPAR = Verbal and Spatial Reasoning Test
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