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Cognitive Health and Sphinogine-1-Phospate Receptor Modulators in Multiple Sclerosis - Episode 5

The Role of Imaging in the Assessment of Brain Health and Cognition

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Heidi Crayton, MD, shares a patient story to highlight the importance of imaging modalities in identifying brain loss and atrophy in patients with multiple sclerosis [MS].

Stephen Krieger, MD: Let us have a discussion about something that many of you have alluded to, which is the brain imaging findings that correlate with cognitive dysfunction, that suggest cognitive dysfunction. Earlier, Dr Crayton, you said sometimes you look at the brain MRI scan and you know, it’s heartbreaking, because you sort of see the damage that MS has caused and not just lesions, but atrophy and loss of brain parenchyma, as well. Would you talk to me a little bit about that? Do you do that in a standardized way in your practice? Is it more of a gestalt? And then we’ll see what research has shown in that area? How do you look at brain volume and cognition together?

Heidi Crayton, MD: With new patients coming to see me, I have someone who starts off gathering information and history from that new patient while I’m looking at MRIs that they brought me. I know then, going in to see the patient, what I should be looking for, actually. I’ve kind of cheated, I guess. I’ll never forget a young person who was in his early 30s and I had seen him check in for the appointment, and a young, carefree, good-looking guy, it was summertime, he had on shorts, he was in amazing physical shape, and he looked completely normal. I saw his MRIs, I looked at his brain MRI and I was really taken aback because there was such profound atrophy and when my nurse came in, she said it was very difficult to get a cohesive history. “Does he have atrophy?” And I said, “Yes he does.” She said, “He’s newly diagnosed, and he is incredibly concerned about walking. He’s so convinced he’s going to lose the ability to walk and that is his focus.” It was very empowering for me to know—really my focus was, of course, his brain and I say to patients, “I really do love legs, but I love brain more.” That was kind of my focus, and I really got a history of attention deficit issues that started in college and you know these things that had way preceded any kind of physical change. The MRI, I think, is incredibly insightful and you see people sometimes that have quite a bit of cortical atrophy that function at a very high level, but then you see people that have a very wide third ventricle and you know that they’ve lost deep gray structures and those are the people that you know the questions to ask them, so I guess it’s almost kind of cheating in the puzzle. Just to give you insight.

Stephen Krieger, MD: It’s not cheating.

Heidi Crayton, MD: It gives insight, direction.

Transcript Edited for Clarity