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Brain Advance Access originally published online on July 27, 2005
Brain 2005 128(12):2891-2898; doi:10.1093/brain/awh602
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© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

A longitudinal study of cognition in primary progressive multiple sclerosis

S. J. Camp1, V. L. Stevenson1, A. J. Thompson1, G. T. Ingle1, D. H. Miller1, C. Borras2, B. Brochet3, V. Dousset3, M. Falautano4, M. Filippi4, N. F. Kalkers5, X. Montalban2, C. H. Polman5 and D. W. Langdon1,6

1 Department of Clinical Neurology, Institute of Neurology, London, UK, 2 Unitat de Neuroimmunologia Clinica, Hospitals Vall d'Hebron, Barcelona, Spain, 3 Fédération des Neurosciences Cliniques de CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France, 4 Department of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan, Italy, 5 University Hospital, Free University, Amsterdam, The Netherlands and 6 Department of Psychology, Royal Holloway, University of London, Egham, UK

Correspondence to: A. J. Thompson, Institute of Neurology, Queen Square, London WC1N 3BG, UK E-mail: a.thompson{at}ion.ucl.ac.uk

There are few longitudinal studies of cognition in patients with multiple sclerosis, and the results of these studies remain inconclusive. No serial neuropsychological data of an exclusively primary progressive series are available. Cross-sectional analyses have revealed significant correlations between cognition and magnetic resonance imaging (MRI) parameters in primary progressive multiple sclerosis (PPMS). This study investigated cognitive and MRI change in 99 PPMS patients from five European centres for 2 years. They were assessed at 12 month intervals using the Brief Repeatable Battery, a reasoning test, and a measure of depression. The MRI parameters of T1 hypointensity load, T2 lesion load, and partial brain volume were also calculated at each time point. There were no significant differences between the mean cognitive scores of the patients at year 0 and year 2. However, one-third of the patients demonstrated absolute cognitive decline on individual test scores. Results indicated that initial cognitive status on entry into the study was a good predictor of cognitive ability at 2 years. There was only a small number of significant correlations between changes in cognition and changes on MRI, notably T1 hypointensity load with the two attentional tasks (r = –0.266, P = 0.017; r = –0.303, P = 0.012). It is probable that multiple factors underlie this weak relation between the cognitive and MRI measures.

Key Words: cognitive function; longitudinal study; MRI; multiple sclerosis; primary progressive

Abbreviations: BRB = Brief Repeatable Battery; EDSS = Expanded Disability Status Scale; MADRS = Montgomery and Asberg Depression Rating Scale; MRI = magnetic resonance imaging; PPMS = primary progressive multiple sclerosis; SPMS = secondary progressive multiple sclerosis; RRMS = relapsing remitting multiple sclerosis; VESPAR = Verbal and Spatial Reasoning Test; SDMT = Symbol Digits Modalities Test; PASAT = Paced Auditory Serial Addition Task; WLG = Word List Generation Test

Received January 31, 2005. Revised May 17, 2005. Accepted June 27, 2005.


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