Pathological background

Each MS lesion may have an impact on cognition through various mechanisms including:

• Chronic inflammation

• Disruption of the neuronal/axonal compartments

• Oxidative stress

• Alterations in the cerebral metabolism

Changes in Cortico-Cortical and Cortico-Subcortical connectivity

Cognition in MS: a marker of silent progression

Unraveling the substrates of cognitive impairment in multiple sclerosis: A multiparametric structural and functional magnetic resonance imaging study by using random forest analysis evaluating regional white matter (WM) lesions, WM fractional anisotropy (FA) abnormalities, gray matter (GM) atrophy and RS functional connectivity (FC)

The best MRI predictors of cognitive impairment

White matter lesions

(a) r. superior longitudinal fasciculus (100%),

(b) l.anterior thalamic radiation (93.4%),

(c) l.posterior corona radiata (78.5%), d) l.medial lemniscus (74.2%), e) l.inferior longitudinal fasciculus (70.4%), f) l.optic radiation (68.7%), g)ri.middle cerebellar peduncle (60.6%) h) r.optic radiation (53.5%);

Structural

Decreased FAI

a) splenium of the corpus callosum (64.3%), b) l. optic radiation (61.0%), c) body of the corpus callosum (51.9%) d) fornix (50.9%);

Brain Atrophy

a) l. precuneus (91.4%), b) r. cerebellum crus I (84.4%), c) r. caudate nucleus (78.6%), d) l.thalamus (76.2%) e) l.supplementary motor area (59.8%). damage in strategic WM and GM regions explains cognitive impairment in MS

Cognition in MS: a marker of silent progression