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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1992 Oct;55(10):869–876. doi: 10.1136/jnnp.55.10.869

Clinically isolated lesions of the type seen in multiple sclerosis: a cognitive, psychiatric, and MRI follow up study.

A Feinstein 1, L D Kartsounis 1, D H Miller 1, B D Youl 1, M A Ron 1
PMCID: PMC1015179  PMID: 1431949

Abstract

There is a dearth of longitudinal studies on psychometric and psychiatric change in multiple sclerosis (MS) particularly on the evolution of these abnormalities early in the disease process. A 4 1/2 year follow up study documenting magnetic resonance imaging (MRI), psychometric, and psychiatric abnormalities was undertaken in a group of 48 patients with clinically isolated lesions--for example, optic neuritis--which are frequently the harbinger of MS. At follow up about half the subjects had developed clinically definite MS, with memory deficits becoming apparent. Deficits in attention documented at initial assessment were present but unchanged in those subjects who still had a clinically isolated lesion status. However, after MS was categorised into a relapsing-remitting or chronic progressive course, patients with a chronic progressive course were found to have significantly deteriorated with regard to auditory attention tasks. T1 relaxation times in apparently normal white matter correlated with certain indices of cognitive impairment. In developing a model to explain the pathogenesis of intellectual and emotional change in MS, the interaction of organic, psychological, and social factors needs to be emphasised.

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Selected References

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  1. Allen I. V., Glover G., Anderson R. Abnormalities in the macroscopically normal white matter in cases of mild or spinal multiple sclerosis (MS). Acta Neuropathol Suppl. 1981;7:176–178. doi: 10.1007/978-3-642-81553-9_53. [DOI] [PubMed] [Google Scholar]
  2. Anrews G., Schonell M., Tennant C. The relation between physical, psychological, and social morbidity in a suburban community. Am J Epidemiol. 1977 Apr;105(4):324–329. doi: 10.1093/oxfordjournals.aje.a112389. [DOI] [PubMed] [Google Scholar]
  3. Anzola G. P., Bevilacqua L., Cappa S. F., Capra R., Faglia L., Farina E., Frisoni G., Mariani C., Pasolini M. P., Vignolo L. A. Neuropsychological assessment in patients with relapsing-remitting multiple sclerosis and mild functional impairment: correlation with magnetic resonance imaging. J Neurol Neurosurg Psychiatry. 1990 Feb;53(2):142–145. doi: 10.1136/jnnp.53.2.142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Beatty W. W., Goodkin D. E., Monson N., Beatty P. A. Cognitive disturbances in patients with relapsing remitting multiple sclerosis. Arch Neurol. 1989 Oct;46(10):1113–1119. doi: 10.1001/archneur.1989.00520460103020. [DOI] [PubMed] [Google Scholar]
  5. Bradley W. G., Whitty C. W. Acute optic neuritis: prognosis for development of multiple sclerosis. J Neurol Neurosurg Psychiatry. 1968 Feb;31(1):10–18. doi: 10.1136/jnnp.31.1.10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Callanan M. M., Logsdail S. J., Ron M. A., Warrington E. K. Cognitive impairment in patients with clinically isolated lesions of the type seen in multiple sclerosis. A psychometric and MRI study. Brain. 1989 Apr;112(Pt 2):361–374. doi: 10.1093/brain/112.2.361. [DOI] [PubMed] [Google Scholar]
  7. Delbecq-Derouesné J., Beauvois M. F., Shallice T. Preserved recall versus impaired recognition. A case study. Brain. 1990 Aug;113(Pt 4):1045–1074. doi: 10.1093/brain/113.4.1045. [DOI] [PubMed] [Google Scholar]
  8. Fink S. L., Houser H. B. An investigation of physical and intellectual changes in multiple sclerosis. Arch Phys Med Rehabil. 1966 Feb;47(2):56–61. [PubMed] [Google Scholar]
  9. Francis D. A., Compston D. A., Batchelor J. R., McDonald W. I. A reassessment of the risk of multiple sclerosis developing in patients with optic neuritis after extended follow-up. J Neurol Neurosurg Psychiatry. 1987 Jun;50(6):758–765. doi: 10.1136/jnnp.50.6.758. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Franklin G. M., Heaton R. K., Nelson L. M., Filley C. M., Seibert C. Correlation of neuropsychological and MRI findings in chronic/progressive multiple sclerosis. Neurology. 1988 Dec;38(12):1826–1829. doi: 10.1212/wnl.38.12.1826. [DOI] [PubMed] [Google Scholar]
  11. Franklin G. M., Heaton R. K., Nelson L. M., Filley C. M., Seibert C. Correlation of neuropsychological and MRI findings in chronic/progressive multiple sclerosis. Neurology. 1988 Dec;38(12):1826–1829. doi: 10.1212/wnl.38.12.1826. [DOI] [PubMed] [Google Scholar]
  12. Goldberg D. P., Blackwell B. Psychiatric illness in general practice. A detailed study using a new method of case identification. Br Med J. 1970 May 23;1(5707):439–443. doi: 10.1136/bmj.2.5707.439. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Goldberg D. P., Cooper B., Eastwood M. R., Kedward H. B., Shepherd M. A standardized psychiatric interview for use in community surveys. Br J Prev Soc Med. 1970 Feb;24(1):18–23. doi: 10.1136/jech.24.1.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Grant I., McDonald W. I., Trimble M. R., Smith E., Reed R. Deficient learning and memory in early and middle phases of multiple sclerosis. J Neurol Neurosurg Psychiatry. 1984 Mar;47(3):250–255. doi: 10.1136/jnnp.47.3.250. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Halligan F. R., Reznikoff M., Friedman H. P., La Rocca N. G. Cognitive dysfunction and change in multiple sclerosis. J Clin Psychol. 1988 Jul;44(4):540–548. doi: 10.1002/1097-4679(198807)44:4<540::aid-jclp2270440410>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  16. Heaton R. K., Nelson L. M., Thompson D. S., Burks J. S., Franklin G. M. Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis. J Consult Clin Psychol. 1985 Feb;53(1):103–110. doi: 10.1037//0022-006x.53.1.103. [DOI] [PubMed] [Google Scholar]
  17. Huber S. J., Paulson G. W., Shuttleworth E. C., Chakeres D., Clapp L. E., Pakalnis A., Weiss K., Rammohan K. Magnetic resonance imaging correlates of dementia in multiple sclerosis. Arch Neurol. 1987 Jul;44(7):732–736. doi: 10.1001/archneur.1987.00520190040015. [DOI] [PubMed] [Google Scholar]
  18. Ivnik R. J. Neuropsychological test performance as a function of the duration of MS-related symptomatology. J Clin Psychiatry. 1978 Apr;39(4):304-7, 311-2. [PubMed] [Google Scholar]
  19. Jennekens-Schinkel A., Laboyrie P. M., Lanser J. B., van der Velde E. A. Cognition in patients with multiple sclerosis After four years. J Neurol Sci. 1990 Nov;99(2-3):229–247. doi: 10.1016/0022-510x(90)90158-j. [DOI] [PubMed] [Google Scholar]
  20. Kurtzke J. F. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983 Nov;33(11):1444–1452. doi: 10.1212/wnl.33.11.1444. [DOI] [PubMed] [Google Scholar]
  21. Litvan I., Grafman J., Vendrell P., Martinez J. M., Junqué C., Vendrell J. M., Barraquer-Bordas J. L. Multiple memory deficits in patients with multiple sclerosis. Exploring the working memory system. Arch Neurol. 1988 Jun;45(6):607–610. doi: 10.1001/archneur.1988.00520300025012. [DOI] [PubMed] [Google Scholar]
  22. Logsdail S. J., Callanan M. M., Ron M. A. Psychiatric morbidity in patients with clinically isolated lesions of the type seen in multiple sclerosis: a clinical and MRI study. Psychol Med. 1988 May;18(2):355–364. doi: 10.1017/s003329170000790x. [DOI] [PubMed] [Google Scholar]
  23. Marsh G. G. Disability and intellectual function in multiple sclerosis patients. J Nerv Ment Dis. 1980 Dec;168(12):758–762. doi: 10.1097/00005053-198012000-00009. [DOI] [PubMed] [Google Scholar]
  24. Miller D. H., Ormerod I. E., Rudge P., Kendall B. E., Moseley I. F., McDonald W. I. The early risk of multiple sclerosis following isolated acute syndromes of the brainstem and spinal cord. Ann Neurol. 1989 Nov;26(5):635–639. doi: 10.1002/ana.410260508. [DOI] [PubMed] [Google Scholar]
  25. Minden S. L., Orav J., Reich P. Depression in multiple sclerosis. Gen Hosp Psychiatry. 1987 Nov;9(6):426–434. doi: 10.1016/0163-8343(87)90052-1. [DOI] [PubMed] [Google Scholar]
  26. Minden S. L., Schiffer R. B. Affective disorders in multiple sclerosis. Review and recommendations for clinical research. Arch Neurol. 1990 Jan;47(1):98–104. doi: 10.1001/archneur.1990.00530010124031. [DOI] [PubMed] [Google Scholar]
  27. Nelson H. E. A modified card sorting test sensitive to frontal lobe defects. Cortex. 1976 Dec;12(4):313–324. doi: 10.1016/s0010-9452(76)80035-4. [DOI] [PubMed] [Google Scholar]
  28. Nelson H. E., O'Connell A. Dementia: the estimation of premorbid intelligence levels using the New Adult Reading Test. Cortex. 1978 Jun;14(2):234–244. doi: 10.1016/s0010-9452(78)80049-5. [DOI] [PubMed] [Google Scholar]
  29. Ormerod I. E., Miller D. H., McDonald W. I., du Boulay E. P., Rudge P., Kendall B. E., Moseley I. F., Johnson G., Tofts P. S., Halliday A. M. The role of NMR imaging in the assessment of multiple sclerosis and isolated neurological lesions. A quantitative study. Brain. 1987 Dec;110(Pt 6):1579–1616. doi: 10.1093/brain/110.6.1579. [DOI] [PubMed] [Google Scholar]
  30. Peyser J. M., Rao S. M., LaRocca N. G., Kaplan E. Guidelines for neuropsychological research in multiple sclerosis. Arch Neurol. 1990 Jan;47(1):94–97. doi: 10.1001/archneur.1990.00530010120030. [DOI] [PubMed] [Google Scholar]
  31. Poser C. M., Paty D. W., Scheinberg L., McDonald W. I., Davis F. A., Ebers G. C., Johnson K. P., Sibley W. A., Silberberg D. H., Tourtellotte W. W. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983 Mar;13(3):227–231. doi: 10.1002/ana.410130302. [DOI] [PubMed] [Google Scholar]
  32. Rabins P. V., Brooks B. R., O'Donnell P., Pearlson G. D., Moberg P., Jubelt B., Coyle P., Dalos N., Folstein M. F. Structural brain correlates of emotional disorder in multiple sclerosis. Brain. 1986 Aug;109(Pt 4):585–597. doi: 10.1093/brain/109.4.585. [DOI] [PubMed] [Google Scholar]
  33. Rao S. M., Hammeke T. A., McQuillen M. P., Khatri B. O., Lloyd D. Memory disturbance in chronic progressive multiple sclerosis. Arch Neurol. 1984 Jun;41(6):625–631. doi: 10.1001/archneur.1984.04210080033010. [DOI] [PubMed] [Google Scholar]
  34. Rao S. M., Hammeke T. A., Speech T. J. Wisconsin Card Sorting Test performance in relapsing-remitting and chronic-progressive multiple sclerosis. J Consult Clin Psychol. 1987 Apr;55(2):263–265. doi: 10.1037//0022-006x.55.2.263. [DOI] [PubMed] [Google Scholar]
  35. Rao S. M., Leo G. J., Haughton V. M., St Aubin-Faubert P., Bernardin L. Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis. Neurology. 1989 Feb;39(2 Pt 1):161–166. doi: 10.1212/wnl.39.2.161. [DOI] [PubMed] [Google Scholar]
  36. Ron M. A., Callanan M. M., Warrington E. K. Cognitive abnormalities in multiple sclerosis: a psychometric and MRI study. Psychol Med. 1991 Feb;21(1):59–68. doi: 10.1017/s0033291700014653. [DOI] [PubMed] [Google Scholar]
  37. Ron M. A., Logsdail S. J. Psychiatric morbidity in multiple sclerosis: a clinical and MRI study. Psychol Med. 1989 Nov;19(4):887–895. doi: 10.1017/s0033291700005602. [DOI] [PubMed] [Google Scholar]
  38. Thompson A. J., Kermode A. G., Wicks D., MacManus D. G., Kendall B. E., Kingsley D. P., McDonald W. I. Major differences in the dynamics of primary and secondary progressive multiple sclerosis. Ann Neurol. 1991 Jan;29(1):53–62. doi: 10.1002/ana.410290111. [DOI] [PubMed] [Google Scholar]
  39. Warrington E. K., Weiskrantz L. Amnesia: a disconnection syndrome? Neuropsychologia. 1982;20(3):233–248. doi: 10.1016/0028-3932(82)90099-9. [DOI] [PubMed] [Google Scholar]
  40. Willison J. R., Thomas D. J., du Boulay G. H., Marshall J., Paul E. A., Pearson T. C., Russell R. W., Symon L., Wetherley-Mein G. Effect of high haematocrit on alertness. Lancet. 1980 Apr 19;1(8173):846–848. doi: 10.1016/s0140-6736(80)91353-7. [DOI] [PubMed] [Google Scholar]
  41. Young A. C., Saunders J., Ponsford J. R. Mental change as an early feature of multiple sclerosis. J Neurol Neurosurg Psychiatry. 1976 Oct;39(10):1008–1013. doi: 10.1136/jnnp.39.10.1008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]
  43. van den Burg W., van Zomeren A. H., Minderhoud J. M., Prange A. J., Meijer N. S. Cognitive impairment in patients with multiple sclerosis and mild physical disability. Arch Neurol. 1987 May;44(5):494–501. doi: 10.1001/archneur.1987.00520170024017. [DOI] [PubMed] [Google Scholar]

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