Rebranding MS a dementia (7): disease progression and brain atrophy

Progressive brain atrophy; should you accept it? #MSBlog #MSResearch

Epub: Hofstetter et al. Progression in disability and regional grey matter atrophy in relapsing-remitting multiple sclerosis. Mult Scler. 2013 Jun 26.

BACKGROUND: In multiple sclerosis (MS) regional grey matter (GM) atrophy has been associated with disability progression.

OBJECTIVE: The aim of this study was to compare regional GM volume changes in relapsing-remitting MS (RRMS) patients with progressive and stable disability, using voxel-based morphometry (VBM).

VBM = Voxel based morphometry (VBM) is a neuroimaging analysis technique that allows investigation of focal differences in brain anatomy, using a statistical approach. In traditional morphometry, volume of the whole brain or its subparts is measured by drawing regions of interest (ROIs) on images from brain scanning and calculating the volume enclosed. However, this is time consuming and can only provide measures of rather large areas. Smaller differences in volume may be overlooked. VBM registers every brain to a template, which gets rid of most of the large differences in brain anatomy among people. Then the brain images are smoothed so that each voxel represents the average of itself and its neighbors. Finally, the image volume is compared across brains at every voxel.

METHODS: They acquired baseline and 1-year follow-up 3-dimensional (3D) T1-weighted magnetic resonance imaging (MRI) data of RRMSers, using two 1.5-Tesla scanners. MSers were matched pair-wise with respect to age, gender, disease duration, medication, scanner and baseline Expanded Disability Status Scale (EDSS) into 13 pairs, with either progressive EDSS (≥ 1 point change y-1) or stable EDSS, as well as into 29 pairs with either progressive Multiple Sclerosis Functional Composite (MSFC) at ≥ 0.25% decrease in y-1 in any component, or stable MSFC. THey analysed longitudinal regional differences in GM volumes in the progressive and stable EDSS and MSFC groups, respectively, using VBM.

RESULTS: Significant GM volume reductions occurred in the right precuneus, in the progressive EDSS group. Differential between-group effects occurred in the right precuneus and in the postcentral gyrus. Further longitudinal GM volume reductions occurred in the right orbicular gyrus, in the progressive MSFC group, but no between-group differences were observed (non-stationary cluster-wise inference, all P-corrected < 0.05).

CONCLUSION: These results suggested a direct association of disability progression and regional GM atrophy in RRMS.

“It is clear that MS is a progressive neurodegenerative disease associated with neurological disability in multiple domains Unfortunately, the EDSS does not capture the cognitive aspects of MS. The MSFC does; it has a component called the paced-auditory serial addition test (PASAT) that tests multiple domains of cognition (short-term memory, calculations, recall, attention, etc.). It is clear from this that MSers with progressive focal brain atrophy progress using both the EDSS and MSFC. Can we halt or stop brain atrophy? Some drugs are better at doing it than others.”

“Would you consider choosing a drug that had an impact on brain atrophy? You may be interested in the results of the brain atrophy survey we did a few months back.”

Other posts of interest on rebranding MS a dementia:

03 Jul 2013
Rebranding MS a dementia (5): neuropsychological rehabilitation did not improve cognitive performance. MS-related cognitive impairment does not respond to rehabilitation. #MSBlog #MSResearch. “In general neurologists 
20 Jun 2013
Survey results on MS as a dementing illness. #MSBlog #MSResearch “Next to my posts on CCSVI the ‘Rebranding MS a Dementia’ post caused quite a stir in the blogosphere. It is clear from the comments in relation to this 
17 Jun 2013
Rebranding MS a dementia (3): Cognitive impairment in asymptomatic MS (or RIS). Cognitive impairment may begin before the first attack of MS. #MSBlog #MSResearch “This is an old post that needs more air time. It shows 
12 Jun 2013
“For me the best thing about going to conferences is that it allows you thinking time, and time to interact with like minded colleagues. After my platform presentation on early aggressive treatment several European neurologists 

14 Jun 2013
Rebranding MS as a Dementia: part 2. “What do you think of this of short animation? It tries to explain the impact of MS on the brain; in the other words the early phases of MS Dementia.” 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Prof G,

    Why the obsession with MS and dementia? I don't mind the warts and all approach, but my neuro didn't mention it six years ago when I was diagnosed. Now age 28, I have enough to contend with (part-time job and young baby). How does this all help me? I naively thought that MS research would year on year make breakthroughs in the understanding of the disease, but instead all we hear is it's much worse than we orginally thought! This doesn't happen in cancer research (thumbs up to oncology researchers).

    Any idea when we start to get on top of this disease rather than keep finding out it so much worse than we originally thought. it is 2013!

  • I hadn't heard of MSFC until this post – so I went and looked it up. It seems a good way (if a visual acuity test is added to the battery) to establish a baseline at diagnosis and then at periodic follow-up appointments. it gives a practical and holistic view of the MS'er and I presume there must be some norms to compare with.

    It doesn't need to be conducted by a doctor or nurse, so shouldn't be cost prohibitive. Why does it only appear to be used in trials / research rather than in regular MS appointments ?

  • Please stop trying to rebrand MS as a dementing disease. The cognitive decline associated with MS doesn't even meet the criteria of dementia as set down by the World Health Organisation, "Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation."

    The MS International Federation's latest issue of their magazine In Focus deals with the issue of MS cognitive difficulty and I quote from there, "…a severe decline of general cognitive functioning (dementia) is rare in MS."

    A copy of their magazine can be downloaded here:

    I totally agree with the view that MS should be treated early and aggressively but I fear that by going down this campaign path you are doing the cause a disservice by misnaming cognitive decline as dementia. MS has enough severe symptoms to fight for early treatment without inaccurately rebranding aspects of it.

  • For those of you who want to stay up to date on the latest MS research without having it filtered through the biases of this site I would suggest going here:

    You also won't be inundated with constant insistence that MS = dimentia.

    • Thanks for your support…..had a quick look and saw that the debate with Peter stys was with someone from CCSVI central.

      We met the people who have set this site up, they are very nice

      However where ever you get your info it will come with a bias but when you are up to speed you can cut through that and make you own mind up.

By Prof G



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