# Volumetric MRI Markers of Cognitive Impairment in Relapsing-Remitting Multiple Sclerosis: Cerebellar White Matter Loss, Pallidum Atrophy, and Choroid Plexus Enlargement

## TL;DR

This study identifies MRI markers like cerebellar white matter loss and choroid plexus enlargement that are linked to cognitive impairment in multiple sclerosis patients.

## Contribution

The study introduces novel volumetric MRI markers, including choroid plexus enlargement, for cognitive impairment in relapsing-remitting multiple sclerosis.

## Key findings

- Multidomain cognitive impairment is associated with reduced cerebellar white matter and pallidum volumes in RRMS patients.
- Higher lesion load and choroid plexus enlargement correlate with poorer cognitive performance in MS.
- Volumetric MRI markers show potential as imaging correlates for cognitive impairment in MS.

## Abstract

Cognitive impairment (CI) is a common and disabling manifestation of multiple sclerosis (MS), yet it remains underdiagnosed in clinical settings. This study aims to identify the volumetric MRI markers of CI in MS patients. A total of 79 MS patients were enrolled; after exclusions, 63 with relapsing-remitting MS (RRMS) and 7 with primary progressive MS were analyzed. All participants underwent neuropsychological testing (CVLT, BVRT, CTT, VFT, VST, and SDMT). Brain volumes were analyzed using FreeSurfer. In RRMS, 59% had CI (35% single-domain, 24% multidomain). Multidomain CI was linked to reduced left cerebellar white matter and bilateral pallidum volumes, slight choroid plexus enlargement, and higher lesion volume versus cognitively preserved patients. Significant correlations were found between brain volumes and cognitive test scores: cerebellar and cerebral white matter, corpus callosum, subcortical gray matter, and thalamus volumes correlated positively with measures of processing speed, memory, and verbal fluency, while higher lesion load and larger choroid plexus volumes were associated with poorer cognitive performance. CI in MS is linked to both global and regional brain atrophy, as well as lesion load. Volumetric MRI, including choroid plexus analysis, may represent candidate imaging correlates of CI; however, longitudinal and externally validated studies are needed to confirm their predictive value and clinical utility.