What role does brain shrinkage play in someone dx with M.S.?

Our brains naturally shrink as we age, but does it occur at an accelerated rate with M.S patients?

How does it accelerate with the different forms of M.S.?
RR
SP
PP

Just curious on what others' thoughts are regarding this issue with it's implications with M.S. patients.

Katherine in Oregon

On my last MRI the radiologist wrote "Some moderate brain shrinkage is noted but appropriate for medical condition and age."

You be the Judge.....

jackD
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jackD, thanks for the chuckle. I needed that!

LOL, Jack!!

To answer your question...I don't know

I've had some brain atrophy...not sure what's "normal" for MS patients...I do know it's due to nerve cell death...

I don't know but it sounds like a good excuse for some of the cog fog I have!

The normal brain shrinkage that occurs with everyone is accelerated with MS. It has nothing with nerve cell death. Jack, you da man.

I must say that I do think that the nerve death is related to the increased loss in volume of the brain because the area of the brain that shows up in a MRI as "enhancing" is REAL inflammation (dying tissue) after which comes the formation of scar tissue which occupies a smaller volume.

Given the number of "enhancing lesions" I had I am very lucky that my brain does not look like a "raisin" in size and shape. I am very glad I have at least a prune size brain.


jackD

The main problem associated with Brain atrophy is cognitive impairment.

jackD


Arch Neurol. 2009 Sep;66(9):1144-50.

Cortical lesions and atrophy associated with cognitive impairment in relapsing-remitting multiple sclerosis.

Calabrese M, Agosta F, Rinaldi F, Mattisi I, Grossi P, Favaretto A, Atzori M, Bernardi V, Barachino L, Rinaldi L, Perini P, Gallo P, Filippi M.

Multiple Sclerosis Centre of Veneto Region, First Neurology Clinic, Department of Neurosciences, University Hospital of Padua.

Abstract
BACKGROUND: Neuropsychological deficits in patients with multiple sclerosis (MS) have been shown to be associated with the major pathological substrates of the disease, ie, inflammatory demyelination and neurodegeneration. Double inversion recovery sequences allow cortical lesions (CLs) to be detected in the brain of patients with MS. Modern postprocessing techniques allow cortical atrophy to be assessed reliably.

OBJECTIVE: To investigate the contribution of cortical gray matter lesions and tissue loss to cognitive impairment in patients with relapsing-remitting MS. DESIGN: Cross-sectional survey.

SETTING: Referral, hospital-based MS clinic. Patients Seventy patients with relapsing-remitting MS. MAIN OUTCOME MEASURES: Neuropsychological performance was tested using the Rao Brief Repeatable Battery of Neuropsychological Tests, version A. Patients who scored 2 SDs below the mean normative values on at least 1 test of the Rao Brief Repeatable Battery of Neuropsychological Tests, version A, were considered to be cognitively impaired.

A composite cognitive score (the cognitive impairment index) was computed. T2 hyperintense white matter lesion volume, contrast-enhancing lesion number, CL number and volume, normalized brain volume, and normalized neocortical gray matter volume were also assessed.

RESULTS: Twenty-four patients with relapsing-remitting MS (34.3%) were classified as cognitively impaired. T2 hyperintense white matter lesion volume and contrast-enhancing lesion number were not different between cognitively impaired and cognitively unimpaired patients.

Cognitively impaired patients had a higher CL number (P = .01) and volume (P < .001) and decreased normalized brain volume (P = .02) and normalized neocortical gray matter volume (P = .002) when compared with cognitively unimpaired patients.

Multivariate analysis revealed that age (beta = 0.228; P = .02), CL volume (beta = 0.452; P < .001), and normalized neocortical gray matter volume (beta = 0.349; P < .001) were independent predictors of the cognitive impairment index (r(2) = 0.55; F = 23.903; P < .001).

CONCLUSION: The burden of CLs and tissue loss are among the major structural changes associated with cognitive impairment in relapsing-remitting MS.

PMID: 19752305 [PubMed - indexed for MEDLINE]
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Neurology. 2004 Jul 13;63(1):89-93.

Neocortical volume decrease in relapsing-remitting MS patients with mild cognitive impairment.

Amato MP, Bartolozzi ML, Zipoli V, Portaccio E, Mortilla M, Guidi L, Siracusa G, Sorbi S, Federico A, De Stefano N.

Department of Neurology, University of Florence, Viale Morgagni, 85-50134 Florence, Italy. mariapia.amato@unifi.it

Abstract
OBJECTIVE: To assess neocortical changes and their relevance to cognitive impairment in early relapsing-remitting (RR) multiple sclerosis (MS).

METHODS: Conventional MR was acquired in 41 patients with RR MS and 16 demographically matched normal control subjects (NCs). An automated analysis tool was used with conventional T1-weighted MRI to obtain measures of cortical brain volumes normalized for head size. Neuropsychological performance of MS patients was assessed using the Rao Brief Repeatable Battery. Relationship between volumetric MR measures and neuropsychological scores was assessed.

RESULTS: Neuropsychological assessment allowed for the identification of 18 cognitively preserved (MS-cp) and 23 cognitively impaired (MS-ci) MS patients. The whole MS sample showed lower values of normalized cortical volumes (NCVs) than did the NC group (p = 0.01). Upon grouping of MS patients according to cognitive performance, NCV values were lower (p = 0.02) in MS-ci patients than in both MS-cp patients and NCs. Moreover, there were positive correlations between NCV values and measures of verbal memory (r = 0.51, p = 0.02), verbal fluency (r = 0.51, p = 0.01), and attention/concentration (r = 0.65, p < 0.001) in MS-ci patients. Furthermore, NCV values were decreased in patients who scored lower on a greater number of tests (r = -0.58, p < 0.01) in the MS-ci group. None of the neuropsychological measures correlated to NCV values in the MS-cp patient group.

CONCLUSIONS: Cortical atrophy was found only in cognitively impaired patients and was significantly correlated with a poorer performance on tests of verbal memory, attention/concentration, and verbal fluency. Gray matter pathology may contribute to the development of cognitive impairment in MS from the earliest stages of the disease.
PMID: 15249616 [PubMed - indexed for MEDLINE]

I know that when my neuro first looked at the MRI that the former neuro had dxd me based on what he saw, he pointed out some atrophy, said to his assistant, "This is very typical in a brain with MS". Called it some high-falooting thingie and went on...but my heart kind of sank inside...