Foong, Jacqueline; (1996) Neuropsychological impairment in multiple sclerosis: MRI, MRS and clinical correlates. Masters thesis (M.Phil), UCL (University College London).

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Abstract

The aim of this thesis was to extend previous studies that have attempted to relate neuropsychological deficits and pathological abnormalities in multiple sclerosis (MS) by using standardised and sensitive neuropsychological tests and improved quantification techniques on MRI. Study 1 Deficits in executive function and the relationship to frontal lesion load as detected on MRI were investigated in 42 MS patients. A battery of neuropsychological tests examining executive skills including computerised tests of planning and spatial working memory was administered to all subjects. Performance on these tests was impaired in the patient group when compared to a group of matched controls but not all executive skills were affected to the same extent. Although a number of executive test scores correlated with the severity of frontal lesion load, it was difficult to disentangle the specific contribution of frontal lobe pathology to the impairment on executive tasks. This study highlights the difficulties in attempting to attribute specific cognitive abnormalities to focal brain pathology in the presence of widespread disease such as in MS. Study 2 Proton MRS was performed in the same group of MS patients and matched controls from Study 1 to examine the biochemical correlates of neuropsychological performance. There was a significant reduction of the NAA/Cr ratio in lesions and/or normal appearing white matter (NAWM) in the patient group compared to the control group. However, there was no association between the MRS abnormalities and neuropsychological deficits in the MS patients. Study 3 13 MS patients were examined with a battery of neuropsychological tests during acute relapse and six weeks later. Their performance was compared to the performance of 10 matched controls. Gd-enhanced MRI was also performed in patients on both occasions. There was evidence that the performance on tests of attention improved in patients whose Gd-enhanced lesion load decreased during the period of the study. This suggests that certain neuropsychological deficits detected during an acute relapse may be reversible. In addition, the improvement in some of the attentional test scores correlated significantly with the improvement in acute lesion load.

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