Loitfelder M, Fazekas F, Koschutnig K, Fuchs S, Petrovic K, Ropele S, Pichler A, Jehna M, Langkammer C, Schmidt R, Neuper C, Enzinger C. Brain activity changes in cognitive networks in relapsing-remitting multiple sclerosis – insights from a longitudinal FMRI study. PLoS One. 2014; 9(4):e93715
BACKGROUND: Extrapolations from previous cross-sectional fMRI studies suggest cerebral functional changes with progression of Multiple Sclerosis (MS), but longitudinal studies are scarce. We assessed brain activation changes over time in MS patients using a cognitive fMRI paradigm and examined correlations with clinical and cognitive status and brain morphology.
METHODS: 13 MS patients and 15 healthy controls (HC) underwent MRI including fMRI (go/no-go task), neurological and neuropsychological exams at baseline (BL) and follow-up (FU; minimum 12, median 20 months). We assessed estimates of and changes in fMRI activation, total brain and subcortical grey matter volumes, cortical thickness, and T2-lesion load. Bland-Altman (BA) plots served to assess fMRI signal variability.
RESULTS: Cognitive and disability levels remained largely stable in the patients. With the fMRI task, both at BL and FU, patients compared to HC showed increased activation in the insular cortex, precuneus, cerebellum, posterior cingulate cortex, and occipital cortex. At BL, patients vs. HC also had lower caudate nucleus, thalamus and putamen volumes. Over time, patients (but not HC) demonstrated fMRI activity increments in the left inferior parietal lobule. These correlated with worse single-digit-modality test (SDMT) performance. BA-plots attested to reproducibility of the fMRI task. In the patients, the right caudate nucleus decreased in volume which again correlated with worsening SDMT performance.
CONCLUSIONS: Given preserved cognitive performance, the increased activation at BL in the patients may be viewed as largely adaptive. In contrast, the negative correlation with SDMT performance suggests increasing parietal activation over time to be maladaptive. Several areas with purported relevance for cognition showed decreased volumes at BL and right caudate nucleus volume decline correlated with decreasing SDMT performance. This highlights the dynamics of functional changes and the strategic importance of specific brain areas for cognitive processes in MS.
When you do any action your brain uses more oxygen in areas that are active and this can be seen with a combination of a MRI and an oxygen dye this is called functional MRI. What happened to the cognitive abilities of MSers in this paper was nothing but when you look at MSers verses non-MSers the MSers were using more brain bits, because they were compensating for probable damage due to MS. This is called “plasticity” and whilst it can give compensatory capacity for awhile so you don’t notice much, this is the “iceberg effect” and things are going on.