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Cerebral Microbleeds in Multiple Sclerosis Associated with Increased Disability Risks

Summary: A new study reports cerebral microbleeds are associated with an increased risk for physical and cognitive disabilities in those with multiple sclerosis.

Source: University at Buffalo.

An important predictor of dementia may also point to significant disability in multiple sclerosis, a new UB study finds.

Leaky blood vessels in the brain called cerebral microbleeds are associated with an increased risk of physical and cognitive disability in patients with multiple sclerosis (MS), according to a new study by researchers in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

The study, published online today in Radiology, is among the first to examine what cerebral microbleeds may mean for clinical outcomes in MS.

Cerebral microbleeds, which become more common with age and are a known risk factor for dementia, also have been associated with traumatic brain injury, stroke, Alzheimer’s disease and Parkinson’s disease.

The UB researchers decided to study cerebral microbleeds and MS because they saw significant overlap in the risk factors for each condition, according to Robert Zivadinov, MD, PhD, first author, professor of neurology, director of the Buffalo Neuroimaging Analysis Center and director of Magnetic Resonance Imaging in the Clinical and Translational Research Center of the Jacobs School of Medicine and Biomedical Sciences at UB.

“Our hypothesis was that there is increased prevalence of cerebral microbleeds in MS because progression of that disease is associated with increased likelihood of cardiovascular comorbidities, including hypertension, altered lipid metabolism, overweight/obesity, smoking and diabetes and migraine, all risk factors for cerebral microbleeds,” he said.

The study included 445 patients with MS; 45 with clinically isolated syndrome, which is the first MS episode a patient experiences; 51 patients with other neurological diseases; and 177 healthy controls.

All study participants underwent a type of magnetic resonance imaging called susceptibility-weighted imaging that is specifically targeted to better image blood products.

“We found that 20 percent of MS patients over the age of 50 have cerebral microbleeds compared to 7 percent of healthy controls,” said Ferdinand Schweser, PhD, assistant professor of neurology in the Jacobs School of Medicine and Biomedical Sciences at UB and senior author on the paper. Among subjects under the age of 50, 14 percent of patients with clinically isolated syndrome had microbleeds versus just 3 percent of healthy controls.

The researchers found that the more cerebral microbleeds a patient had, the more severe were their physical and cognitive outcomes. In particular, MS patients who had more cerebral microbleeds had more physical disability after adjusting for age, hypertension and whole-brain volume.

“This is significant because it suggests that cerebral microbleeds are associated with increased physical disability in MS patients, independent from these additional risk factors for cerebral microbleeds,” said Zivadinov.

Image shows a microbleed in a brain scan.

Researchers in the Jacobs School of Medicine and Biomedical Sciences at UB are continuing to study cerebral microbleeds, identified in the image above, as indicators of disease progression in multiple sclerosis. NeuroscienceNews.com image is credited to Buffalo Neuroimaging Analysis Center in the Jacobs School of Medicine and Biomedical Sciences at UB.

In terms of cognitive disability, the researchers found that in the subgroup of MS patients who underwent neuropsychological testing, those with more cerebral microbleeds had higher disability on verbal and other cognitive function tests.

“Those MS patients who have cerebral microbleeds are subject to developing more physical and cognitive disabilities earlier in their disease, and therefore monitoring them more closely might be appropriate,” Zivadinov noted.

Significant research is now being done on ways to combat cerebral microbleeds, Zivadinov said, adding that currently, prevention of cardiovascular risk factors was seen as the best way to prevent their formation since there are no currently available target therapies.

The UB researchers are conducting a longitudinal, five-year study of these patients focused on the relationship between cerebral microbleeds, advances in magnetic resonance imaging and clinical outcomes.

About this multiple sclerosis research article

Other UB co-authors are Deepa P. Ramasamy, MD; Ralph R. H. Benedict, PhD; Jesper Hagemeier, PhD; Michael G. Dwyer, PhD; Niels Bergsland, PhD; Bianca Weinstock-Guttman, MD; Channa Kolb, MD; David Hojnacki, MD; Paul Polak; Nicola Bertolino; and Christopher Magnano.

Other authors from Wayne State University include E. Marck Haacke, PhD, and David Utriainen.

Funding: The study was supported in part by the Buffalo Neuroimaging Analysis Center and the Jacquemin Family Foundation.

Source: Ellen Goldbaum – University at Buffalo
Image Source: This NeuroscienceNews.com image is credited to Buffalo Neuroimaging Analysis Center in the Jacobs School of Medicine and Biomedical Sciences at UB.
Original Research: Abstract for “Cerebral Microbleeds in Multiple Sclerosis Evaluated on Susceptibility-weighted Images and Quantitative Susceptibility Maps: A Case-Control Study” by Robert Zivadinov, Deepa P. Ramasamy, Ralph R. H. Benedict, Paul Polak, Jesper Hagemeier, Christopher Magnano, Michael G. Dwyer, Niels Bergsland, Nicola Bertolino, Bianca Weinstock-Guttman, Channa Kolb, David Hojnacki, David Utriainen, E. Mark Haacke, and Ferdinand Schweser in Radiology. Published online June 16 2016 doi:10.1148/radiol.2016160060

Cite This NeuroscienceNews.com Article
University at Buffalo. “Cerebral Microbleeds in Multiple Sclerosis Associated with Increased Disability Risks.” NeuroscienceNews. NeuroscienceNews, 16 June 2016.
<http://neurosciencenews.com/ms-disability-microbleeds-4491/>.
University at Buffalo. (2016, June 16). Cerebral Microbleeds in Multiple Sclerosis Associated with Increased Disability Risks. NeuroscienceNews. Retrieved June 16, 2016 from http://neurosciencenews.com/ms-disability-microbleeds-4491/
University at Buffalo. “Cerebral Microbleeds in Multiple Sclerosis Associated with Increased Disability Risks.” http://neurosciencenews.com/ms-disability-microbleeds-4491/ (accessed June 16, 2016).

Abstract

Cerebral Microbleeds in Multiple Sclerosis Evaluated on Susceptibility-weighted Images and Quantitative Susceptibility Maps: A Case-Control Study

Purpose
To assess cerebral microbleed (CMB) prevalence in patients with multiple sclerosis (MS) and clinically isolated syndrome (CIS) and associations with clinical outcomes.

Materials and Methods
CMBs are associated with aging and neurodegenerative disorders. The prevalence of CMBs has not previously been well established. In this study, 445 patients with MS (266 with relapsing-remitting MS, 138 with secondary progressive MS, and 41 with primary progressive MS), 45 patients with CIS, 51 patients with other neurological diseases, and 177 healthy control subjects (HCs) underwent 3-T magnetic resonance (MR) imaging and clinical examinations. A subset of 168 patients with MS and 50 HCs underwent neuropsychological testing. Number of CMBs was assessed on susceptibility-weighted minimum intensity projections by using the Microbleed Anatomic Rating Scale; volume was calculated by using quantitative susceptibility maps. Differences between groups were analyzed with the χ2 test, Fisher exact test, Student t test, and analysis of variance; associations of CMBs with clinical and other MR imaging outcomes were explored with correlation and regression analyses. Because CMB frequency increases with age, prevalence was investigated in participants at least 50 years of age and younger than 50 years.

Results
Significantly more patients with MS than HCs had CMBs (19.8% vs 7.4%, respectively; P = .01) in the group at least 50 years old. A trend toward greater presence of CMBs was found in patients with MS (P = .016) and patients with CIS who were younger than 50 years (P = .039) compared with HCs. In regression analysis adjusted for age, hypertension, and normalized brain volume, increased number of CMBs was significantly associated with increased physical disability in the MS population (R2 = 0.23, P < .0001). In correlation analysis, increased number of CMBs was significantly associated with deteriorated auditory and verbal learning and memory (P = .006) and visual information processing speed trends (P = .049) in patients with MS.

Conclusion
Monitoring CMBs may be relevant in patients with MS and CIS at higher risk for developing cognitive and physical disability.

“Cerebral Microbleeds in Multiple Sclerosis Evaluated on Susceptibility-weighted Images and Quantitative Susceptibility Maps: A Case-Control Study” by Robert Zivadinov, Deepa P. Ramasamy, Ralph R. H. Benedict, Paul Polak, Jesper Hagemeier, Christopher Magnano, Michael G. Dwyer, Niels Bergsland, Nicola Bertolino, Bianca Weinstock-Guttman, Channa Kolb, David Hojnacki, David Utriainen, E. Mark Haacke, and Ferdinand Schweser in Radiology. Published online June 16 2016 doi:10.1148/radiol.2016160060

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