Feinstein, Anthony; (1992) Psychiatric, psychometric and MRI abnormalities in multiple sclerosis. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Study 1. Forty two patients with acute optic neuritis were compared to matched, normal controls on tests of attention/information processing speed and anxiety/depression. Approximately half the sample had brain magnetic resonance imaging (MRI) abnormalities and were more impaired across a variety of psychometric tests compared to patients without brain lesions or controls. There were no psychometric differences between controls and optic neuritis patients without brain involvement. Total lesion area correlated significantly with some tests of attention. Psychiatric morbidity did not differ between optic neuritis patients, irrespective of the presence of brain lesions, and controls. Study 2. Forty eight patients with clinically isolated lesions (eg. optic neuritis) were followed up after 4 years with respect to MRI, psychometric and psychiatric abnormalities. Approximately half the sample had developed clinically definite multiple sclerosis (MS), with memory deficits becoming apparent. Attention deficits documented at initial assessment were present, but unchanged in those who remained with a clinically isolated lesion status. After dividing MS patients into a relapsing-remitting or chronic-progressive group, the latter were found to have significantly deteriorated on auditory attention tasks. Study 3. Over 6 months, 5 patients with early relapsing-remitting MS and 5 with long standing, "benign" MS underwent serial psychometric testing and contrast enhanced brain MRI at 2 weekly/monthly intervals respectively. All patients were individually matched with healthy controls who completed the same psychometric procedure. As a group, MS patients made more errors and/or performed slower on all tasks. In patients with stable brain lesion scores, no consistent deterioration occurred in any test and the overall pattern was one of improvement over time. However, patients with deteriorating lesion scores either showed a significant fall- off in performance on some psychomotor tasks or an impaired ability to improve performance with practice. Study 4. Ten psychotic MS patients were assessed retrospectively with the Present State Examination and matched according to demographic and disease characteristics with 10 MS patients without psychosis. Both groups underwent brain MRI. There was a trend for the psychotic group to have a higher periventricular and total lesion score. This reached statistically significance for temporal horn scores. Clinical and MRI data pointed to an aetiological association between MS and psychosis.

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