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Patterns of cognitive impairment in multiple sclerosis and their relationship to neuropathology on magnetic resonance imaging Ryan, Lee


Recent reviews (Peyser & Poser, 1986; Rao, 1986) suggest that Multiple Sclerosis results in cognitive impairments in the areas of learning and memory, abstract reasoning, information processing efficiency, and, often, visual-spatial ability. Whether this pattern applies to the individual with MS is unclear. Due to the disseminated distribution of MS neuropathology, patients may undergo idiosyncratic cognitive changes dependent upon the site of white matter lesions. The present study explored this question using cluster analysis on the neuropsychological data from a group of mildly disabled MS patients (n = 177) and a well-matched control group (n=89). In a group of MS patients who were identified with unequivocal cognitive impairment, the resultant clusters indicated that MS does not result in a characteristic pattern of impairment. Two clusters were obtained that resembled the pattern described in the literature, while the majority of patients clustered into groups with specific deficits in one or two areas, with normal performance in others. In order to identify associations between cluster groups and lesion sites, frequency tables were constructed for the presence of a lesion on Magnetic Resonance Imaging in 24 brain sites. An association was obtained between two lesion sites and two cognitive tests. Visual-spatial impairment, as assessed by the Benton Visual Retention test, was associated with lesions in the genu of the corpus callosum and with more lesions throughout the corpus callosum. Impaired performance on Paired Associates, a test of learning and memory for novel verbal associations, was associated with a lesion in the deep white matter of the left parietal lobe. The results support the hypothesis that MS results in multiple patterns of cognitive impairment depending on the individual placement of white matter lesions. Identifying and characterizing the heterogeneity of the impairment may greatly increase our understanding of the role of myelin in cognition and the functions of white matter tracts in the brain.

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