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Regional white matter and gray matter damage and cognitive performances in multiple sclerosis according to sex

Molecular Psychiatry volume 28, pages 1783–1792 (2023)Cite this article

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Abstract

In this study, we investigated whether regional distribution of white matter (WM) lesions, normal-appearing [NA] WM microstructural abnormalities and gray matter (GM) atrophy may differently contribute to cognitive performance in multiple sclerosis (MS) patients according to sex. Using the same scanner, brain 3.0T MRI was acquired for 287 MS patients (females = 173; mean age = 42.1 [standard deviation, SD = 12.7] years; relapsing-remitting = 196, progressive = 91; median Expanded Disability Status Scale = 2.5 [interquartile range, IQR = 1.5–5.0]; median disease duration = 12.1 [IQR = 6.3–19.0] years; treatment: none = 70, first-line = 130, second-line = 87) and 172 healthy controls (HC) (females = 92; mean age = 39.3 [SD = 14.8] years). MS patients underwent also Rao’s neuropsychological battery. Using voxel-wise analyses, we investigated in patients sex-related differences in the association of cognitive performances with WM lesions, NAWM fractional anisotropy (FA) and GM volumes (p < 0.01, family-wise error [FWE]). Sixty-six female (38%) and 48 male (42%) MS patients were cognitively impaired, with no significant between-group difference (p = 0.704). However, verbal memory performance was worse in males (p = 0.001), whereas verbal fluency performance was worse in females (p = 0.004). In both sexes, a higher T2-hyperintense lesion prevalence in cognitively-relevant WM tracts was significantly associated with worse cognitive performance (p ≤ 0.006), with stronger associations in females than males in global cognition (p ≤ 0.004). Compared to sex-matched HC, male and female MS patients had widespread lower NAWM FA and GM volume (p < 0.01). In both sexes, worse cognitive performance was associated with widespread reduced NAWM FA (p < 0.01), with stronger associations in females than males in global cognition and verbal memory (p ≤ 0.009). Worse cognitive performance was significantly associated with clusters of cortical GM atrophy in males (p ≤ 0.007) and mainly with deep GM atrophy in females (p ≤ 0.006). In this study, only limited differences in cognitive performances were found between male and female MS patients. A disconnection syndrome due to focal WM lesions and diffuse NAWM microstructural abnormalities seems to be more relevant in female MS patients to explain cognitive impairment.

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Fig. 1: T2-hyperintense WM lesion probability maps.
Fig. 2: WM microstructural abnormalities.
Fig. 3: GM atrophy.

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Data availability

The anonymized dataset used and analyzed during the current study is available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Nicolò Tedone, Paolo Preziosa, Alessandro Meani, Elisabetta Pagani, Carmen Vizzino, Massimo Filippi & Maria A. Rocca

  2. Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Paolo Preziosa, Massimo Filippi & Maria A. Rocca

  3. Vita-Salute San Raffaele University, Milan, Italy

    Paolo Preziosa, Massimo Filippi & Maria A. Rocca

  4. Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

  5. Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

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  1. Nicolò Tedone
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Contributions

NT contributed to drafting/revising the manuscript and preparing the figures, and analysis and interpretation of the data. PP contributed to drafting/revising the manuscript and preparing the figures, study concept, and acquisition, analysis, and interpretation of the data. AM, EP, and CV contributed to drafting/revising the manuscript, analysis, and interpretation of the data. MF and MA Rocca contributed to drafting/revising the manuscript, study concept, interpretation of the data, and study supervisor. All the authors gave their approval to the current version of the manuscript.

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Correspondence to Maria A. Rocca.

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Competing interests

The authors declare that they have no competing interests in relation to this work. Potential conflicts of interest outside the submitted work are as follows: N. Tedone, A. Meani, E. Pagani, and C. Vizzino have nothing to disclose. P. Preziosa received speaker honoraria from Roche, Biogen, Novartis, Merck Serono, Bristol Myers Squibb and Genzyme. He has received research support from Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla. M. Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology; received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi; speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme; he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). M.A. Rocca received consulting fees from Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche; and speaker honoraria from AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. She receives research support from the MS Society of Canada, the Italian Ministry of Health, and Fondazione Italiana Sclerosi Multipla. She is Associate Editor for Multiple Sclerosis and Related Disorders.

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Tedone, N., Preziosa, P., Meani, A. et al. Regional white matter and gray matter damage and cognitive performances in multiple sclerosis according to sex. Mol Psychiatry 28, 1783–1792 (2023). https://doi.org/10.1038/s41380-023-01996-2

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