Photo Credit: Md Babul Hosen

The following is a summary of “Atrophy Patterns in Patients With Multiple Sclerosis With Cognitive Impairment, Fatigue, and Mood Disorders,” published in the November 2024 issue of Neurology by Rimkus et al.    

Researchers conducted a retrospective study to identify brain atrophy patterns in people with multiple sclerosis (PwMS) experiencing cognitive impairment, fatigue, anxiety, and depression.  

They enrolled 102 PwMS (mean age 37 ± 10 years; 67 women) who met the 2017 McDonald criteria and 98 HCs (mean age 36 ± 12 years; 63 women). Participants underwent cognitive testing across 5 domains and completed inventories for fatigue, anxiety, and depression. Disability was assessed using the Expanded Disability Status Scale (EDSS). Patients were grouped using K-means clustering based on cognitive performance, fatigue, anxiety, and depression. FreeSurfer group surface analysis (P<0.05) and Bayesian multinomial logistic regression (95% CI) were used to evaluate cortical and deep gray matter atrophy, defined as a regional volumetric z-score <−1.5.  

The results showed 4 patient clusters: K1 (n = 26), cognitively preserved without fatigue, anxiety, or depression; K2 (n = 31), cognitively preserved with fatigue, anxiety, and depression, K3 (n = 18), impaired without fatigue, anxiety, or depression, and K4 (n = 27), cognitively impaired with fatigue, anxiety, and depression. Cognitive tests explained 34.7% of variability, while fatigue, anxiety, and depression explained 18.7%, EDSS scores correlated more strongly with fatigue, anxiety, and depression (loading = 0.32) and were higher in K2 and K4 (P<0.05), K3 showed more hippocampus (log odds = 2.47, P=0.023) and amygdala (log odds = 1.79, P=0.003) atrophy than K1. The K4 exhibited widespread bilateral cortical atrophy, with more bilateral thalamus (log odds = 1.28, P=0.023), amygdala (log odds = 2.57, P=0.003), and basal ganglia (log odds = 1.44, P=0.01) abntrophy. Cerebellar atrophy was notable in K2 (log odds = 17.68, P<0.001) and K4 (log odds = 18.05, P<0.001) compared to K1.  

They concluded that cognitive impairment was more strongly linked to deep gray matter atrophy, while cerebellar atrophy was more closely associated with fatigue, anxiety, and depression, co-occurrence of these symptoms was related to widespread brain atrophy. 

Source: neurology.org/doi/10.1212/WNL.0000000000210080