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. 2014 Dec 11;9(12):e114543.
doi: 10.1371/journal.pone.0114543. eCollection 2014.

Microstructural white matter changes underlying cognitive and behavioural impairment in ALS--an in vivo study using DTI

Elisabeth Kasper  1 , Christina Schuster  2 , Judith Machts  3 , Joern Kaufmann  4 , Daniel Bittner  4 , Stefan Vielhaber  5 , Reiner Benecke  6 , Stefan Teipel  7 , Johannes Prudlo  8
Affiliations

Microstructural white matter changes underlying cognitive and behavioural impairment in ALS--an in vivo study using DTI

Elisabeth Kasper et al. PLoS One. .

Abstract

Background: A relevant fraction of patients with amyotrophic lateral sclerosis (ALS) exhibit a fronto-temporal pattern of cognitive and behavioural disturbances with pronounced deficits in executive functioning and cognitive control of behaviour. Structural imaging shows a decline in fronto-temporal brain areas, but most brain imaging studies did not evaluate cognitive status. We investigated microstructural white matter changes underlying cognitive impairment using diffusion tensor imaging (DTI) in a large cohort of ALS patients.

Methods: We assessed 72 non-demented ALS patients and 65 matched healthy control subjects using a comprehensive neuropsychological test battery and DTI. We compared DTI measures of fiber tract integrity using tract-based spatial statistics among ALS patients with and without cognitive impairment and healthy controls. Neuropsychological performance and behavioural measures were correlated with DTI measures.

Results: Patients without cognitive impairment demonstrated white matter changes predominantly in motor tracts, including the corticospinal tract and the body of corpus callosum. Those with impairments (ca. 30%) additionally presented significant white matter alterations in extra-motor regions, particularly the frontal lobe. Executive and memory performance and behavioural measures were correlated with fiber tract integrity in large association tracts.

Conclusion: In non-demented cognitively impaired ALS patients, white matter changes measured by DTI are related to disturbances of executive and memory functions, including prefrontal and temporal regions. In a group comparison, DTI is able to observe differences between cognitively unimpaired and impaired ALS patients.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Group comparisons of diffusivity values between ALS patients and healthy controls.
Effect of group differences along the TBSS fiber tract skeleton. Effects were thresholded at p<0.05, corrected for multiple comparisons. A) blue: comparison between cognitively intact ALS-patients to healthy controls; B) red  =  comparison between cognitively impaired ALS-patients to healthy controls; FA  =  fractional anisotropy; MD  =  mean diffusivity; AD  =  axial diffusivity; RD  =  radial diffusivity
Figure 2
Figure 2. Group comparisons of diffusivity values between ALS-ni patients and ALS-ci patients.
Effect of group differences along the TBSS fiber tract skeleton. Effects were thresholded at p<0.05, corrected for multiple comparisons. Violet: comparison between cognitively intact ALS-patients to cognitively impaired ALS-patients; MD  =  mean diffusivity; AD  =  axial diffusivity; RD  =  radial diffusivity
See this image and copyright information in PMC

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