N-acetyl aspartate (NAA) is a marker of disability in secondary progressive multiple sclerosis: a proton magnetic resonance spectroscopic imaging study

MS-SMART Investigators

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Abstract

Background and Purpose:
We undertook a 1H-MRS imaging study in a large secondary progressive MS (SPMS) cohort, to examine whether metabolic markers of brain injury are associated with measures of disability.
Methods:
A cross-sectional analysis of people with SPMS was performed in 119 participants. They underwent 1H-MRS to obtain estimated concentrations and ratios to total Cr for total NAA, mIns, Glx and total Cho in normal appearing WM (NAWM) and GM. Clinical outcome measures chosen were: Paced auditory serial addition test (PASAT3), Symbol digit modalities test, nine-hole peg test (9HPT), Timed 25-foot walk and Expanded Disability Status Scale. The relationship between these neurometabolites and clinical disability measures was initially examined using Spearman rank correlations. Significant associations were then further analysed in multiple regression models adjusting for age, gender, disease duration, T2 lesion load, normalised brain volume and occurrence of relapses in two years preceding study entry.
Results:
Significant associations which were then confirmed by multiple linear regression were found in NAWM for: tNAA/tCr and 9HPT [Rho=0.23, 95% CI [0.06-0.40]; tNAA and tNAA/tCr and PASAT3 [Rho=0.21, 95% CI [0.03-0.38], [Rho=0.19, 95% CI [0.01-0.36]; mIns/tCr and PASAT3 [Rho= -0.23, 95% CI [-0.39 -to -0.05]; and in GM for tCho and PASAT3 [Rho=-0.24, 95% CI [-0.40 to -0.06]. No other GM or NAWM relationships were found with any metabolite, with associations found during initial correlation testing losing significance after multiple linear regression analysis.

Conclusion:
This study suggests that metabolic markers of neuroaxonal integrity and astrogliosis
Original languageEnglish
JournalAmerican Journal of Neuroradiology
DOIs
Publication statusPublished - 5 Nov 2020

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