Magnetic resonance imaging markers reflect cognitive outcome after rehabilitation in children with acquired brain injury.

PURPOSE: To test markers from conventional and diffusion Magnetic Resonance Imaging (MRI) as possible predictors of cognitive outcome following rehabilitation therapy in children with acquired brain injury (ABI). METHODS: Twenty-one children (10 boys, mean age 11.6 years, range 7.1-19.4) with stroke or traumatic brain injury underwent MRI including Diffusion Tensor Imaging (DTI) before admission to the rehabilitation centre. The conventional images were scored according to a standardised injury scoring system, and mean Fractional Anisotropy (FA) was determined within the Corpus Callosum (CC), as this structure is hypothesised to play an important role in cognition. Both conventional MRI injury scores and mean FA of the CC and its sub-regions were compared with standard functional cognitive outcome scores. Relationships between MRI indices and cognitive outcome scores were assessed using multiple regression and receiver operating characteristic (ROC) analyses. RESULTS: A backwards regression analysis revealed that the mean FA of the CC body and genu and the supratentorial injury score appear to represent the best predictors of outcome, together with the age at rehabilitation and time in rehabilitation. In the ROC analysis, the mean FA values of the CC body and genu and the infratentorial injury score provided the highest sensitivity, while the mean FA of the CC splenium showed the highest specificity for outcome. CONCLUSIONS: The conventional MRI injury scores and DTI metrics from the CC reflect cognitive outcomes following rehabilitation. Neuroimaging methods such as MRI with DTI may therefore provide important markers for cognitive recovery after brain injury.

Altered functional adaptation to attention and working memory tasks with increasing complexity in relapsing-remitting multiple sclerosis patients.

As attention, processing speed, and working memory seem to be fundamental for a broad range of cognitive performance, the present study on patients with mild forms of relapsing-remitting multiple sclerosis (RR-MS) focused on these domains. To explore subtle neuropsychological changes in either the clinical or fMRI domain, we applied a multistep experimental design with increasing task complexity to investigate global brain activity, functional adaptation, and behavioral responses to typical cognitive processes related to attention and working memory. Fifteen patients with RR-MS (mean age 38 years, 22-49 years, 9 females, mean disease duration 5.9 years (SD = 3.6 years), mean Expanded Disability Status Scale score, 2.3 (SD = 1.3) but without reported cognitive impairment), and 15 age-matched healthy controls (HC; mean age, 34 years, 23-50 years, 6 women) participated. After a comprehensive neuropsychological assessment, participants performed different fMRI experiments testing attention and working memory. In the neuropsychological assessment, patients showed only subtle reduction in learning and memory abilities. In the fMRI experiments, both groups activated the brain areas typically involved in attention and working memory. HC showed a linear in- or decrease in activation paralleling the changing task complexity. Patients showed stronger activation change at the level of the simple tasks and a subsequent saturation effect of (de-)activation at the highest task load. These group/task interaction differences were found in the right parahippocampal cortex and in the middle and medial frontal regions. Our results indicate that, in MS, functional adaptation patterns can be found which precede clinical evidence of apparent cognitive decline.

The association of depression and neuroticism with pain reports: a comparison of momentary and recalled pain assessment.

OBJECTIVE: Pain assessment has been shown to be affected by depression, neuroticism, and recall bias. The purpose of this study was to determine whether momentary pain assessment, compared with recalled pain reports, would diminish the influence of neuroticism and depression on the measurement of pain. METHODS: Patients with chronic pain (n=66) completed depression (Beck Depression Inventory II) and neuroticism (NEO Personality Inventory) questionnaires, made weekly recall pain ratings, judged their change in pain from 1 week to the next over a 4-week period, and collected momentary reports of pain intensity and pain unpleasantness over a 2-week period. RESULTS: Analyses showed that neuroticism and depression correlated with pain intensity and pain unpleasantness at low levels for both momentary and recalled pain reports. Neuroticism and depression did not influence the accuracy of recalled pain (difference between momentary and recalled data). Both neuroticism and depression were systematically associated with ratings of judged change in pain even when actual changes in pain were controlled. Specifically, for increased levels of baseline depression and neuroticism, patients displayed a pattern of judging recent pain as more severe than pain in the previous week following several weeks of symptom monitoring. CONCLUSION: There was little evidence for neuroticism and depression affecting either recall or momentary pain ratings or influencing the accuracy of recall ratings. However, neuroticism and depression did influence pain assessment when the task involved rating change in pain-a measure widely used in clinical research.