Neurology Central

Cognitive impairment in multiple sclerosis: a matter of connectivity?

We recently spoke to Menno Schoonheim at ECTRIMS 2016 (London, UK, 14–17 September 2016) to discuss his work on brain connectivity approaches to studying and treating multiple sclerosis (MS), the hurdles in the field and his highlights from the conference.

Menno Schoonheim is a neuroscientist, currently working as an Assistant Professor at the MS center Amsterdam, department of Anatomy and Neurosciences, VU University Medical Center in Amsterdam, The Netherlands. He received his PhD (Cum Laude) in 2014, based on his thesis entitled “Are you connected? A network perspective on cognitive dysfunction in early multiple sclerosis”. His research mainly focuses on understanding cognitive impairment and disease progression in MS by studying brain networks, brain atrophy and DTI. He is especially interested in how important functional brain networks, like the default mode network, behave in cognitively impaired patients. Do they communicate less with some regions, but more with others? Is this a form of disinhibition of these networks, or is it a way to compensate for structural damage, i.e., functional reorganization? Can we use these measurements to monitor patients over time? What is the prognostic value of these networks?

First, please could you tell us a little about your background and current research focuses?

After receiving my MSc in Neurosciences I became a research assistant in the lab of Prof Frederik Barkhof at the VU University Medical Center in Amsterdam. During that year I worked on functional MRI in Alzheimer’s disease (AD), looking at how network changes are related to cognition. After that year, my work shifted to MS, although I am still very interested in AD and Parkinson’s disease (PD). I began working on my PhD in 2008, with Prof Barkhof and Prof Jeroen Geurts as my promotors, and Dr Hugo Vrenken and Prof Chris Polman as co-promotors. The aim of that project was to investigate cognitive dysfunction in MS in a large homogeneous cohort of early MS patients, all six years after diagnosis. Here, we discovered the power of networks in MS: their abnormalities related much more strongly to a patient’s cognitive functioning than conventional measures such as lesion load. This research line still continues, although my PhD is finished, as all these patients are currently coming back for their follow-up visits.

You recently presented your work at ECTRIMS 2016 – ‘Mechanisms of cognitive impairment: insights from imaging’ – please could you give us an overview of this?

I was very grateful to have been asked to present at ECTRIMS. The talk first outlined cognitive impairment in MS: 43–70% of patients have it, with a very large impact on their quality of life. It can occur in all stages of the disease and can affect all cognitive domains, although especially information processing speed and memory. Conventional measures, such as lesion load or location, have not been able to explain the large heterogeneity, i.e., the clinico-radiological paradox in MS. More advanced imaging measures such as double inversion recovery (DIR) and diffusion tensor imaging (DTI) have proven very powerful, indicating that cortical lesions and subtle white matter damage have a large impact on cognition.

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