Predicting cognitive decline in multiple sclerosis: a 5-year follow-up study

Cognitive dysfunction is common in multiple sclerosis, but predicting cognitive decline remains challenging. Eijlers and van Geest et al. show that MRI-measured cortical atrophy predicts subsequent cognitive decline during five-year follow-up. Assessment of cortical atrophy may provide an outcome marker in clinical trials and prove useful in individual patient management. Abstract Cognitive decline is common in multiple sclerosis and strongly affects overall quality of life. Despite the identification of cross-sectional MRI correlates of cognitive impairment, predictors of future cognitive decline remain unclear. The objective of this study was to identify which MRI measures of structural damage, demographic and/or clinical measures at baseline best predict cognitive decline, during a 5-year follow-up period. A total of 234 patients with clinically definite multiple sclerosis and 60 healthy control subjects were examined twice, with a 5-year interval (mean = 4.9 years, standard deviation = 0.9). An extensive neuropsychological evaluation was performed at both time points and the reliable change index was computed to evaluate cognitive decline. Both whole-brain and regional MRI (3 T) measures were assessed at baseline, including white matter lesion volume, diffusion-based white matter integrity, cortical and deep grey matter volume. Logistic regression analyses were performed to determine which baseline measures best predicted cognitive decline in the entire sample as well as in early relapsing-remitting (symptom duration