Correlation Between Non-Motor Symptoms And Functional Near-Infrared Spectroscopy In Multiple Sclerosis

Background and Objective: In addition to physical disabilities,patients with multiple sclerosis(MS)usually have non-motor symptoms such as cognitive impairement,mood problems,and fatigue.The burden of non-motor symptoms and physical injuries increased over time.Functional near-infrared spectroscopy(f NIRS)has been gradually applied in clinical practice due to its high consistency with functional magnetic resonance imaging(f MRI).f NIRS has the advantages of convenience,non-invasiveness,sustainable monitoring and high tolerance.The aim of this study was to perform a comprehensive cognitive and clinical assessment in patients with MS,combined with f NIRS to assess cortical activation in the task state.Materials and methods: This study was a case-control study.Sixteen patients with MS who were treated in the First Affiliated Hospital of Dalian Medical University from January 1,2021 to December 1,2022 were selected as the study subjects,and 10 healthy volunteers matched with the case group in gender,age and education were selected as the control group.According to the expanded disability status scale(EDSS),the MS patients were divided into a relatively severe disability group(EDSS>3)and a relatively mild physical disability group(EDSS≤3)for subgroup analysis.Demographic information(age,gender,education level),global cognition and specific cognitive domains(memory,attention,language function,and executive function),anxiety,depression,and fatigue were collected.The differences in clinical data between the MS group and the healthy control group were analyzed by comparison between the two groups.At the same time,f NIRS data of subjects were collected under the verbal fluency test(VFT)task.One-sample T test was used to analyze the differences within groups.Two independent samples t-test was used to analyze the differences between MS group and healthy control group,and between EDSS≤3 group、EDSS > 3 group and healthy control group.Pearson correlation analysis was performed between f NIRS and clinical data in the MS group to explore the correlation between clinical manifestations and f NIRS activation degree in MS patients.Statistical analysis was performed using SPSS 25.0,and P<0.05 was considered statistically significant.Results:1.Sixteen patients with MS were included in the study,with an average age of38.19±10.05 years and an average education level of 15.00(9.75-16.00)years.There were no significant differences in gender,age and education level between the MS group and the healthy control group(P>0.05).2.Compared with the healthy control group,the MS group had significantly lower RAVLT1-5(P=0.002)and RAVLT-7(P=0.011)scores,and significantly longer STT-A(P=0.031)and STTA+B(P=0.004)time.The scores of VFT semantic(P=0.029),BNT(P=0.001)and DST(P<0.005)were significantly lower than those of the control group.The degree of fatigue(P=0.017)and depression(P=0.017)in MS group were higher than those in healthy control group.There were no significant difference between the two groups in global cognitive function tests,anxiety,VFT phonological and VFT behavioral performance.3.In the verbal fluency task(VFT),the MS group(intra-group comparison)showed extensive activation in the frontal lobe(P=0.020,FDR corrected),while the HC group(intra-group comparison)showed no significant difference in the activation of each channel.Compared with the healthy control group,the MS group had a trend of increased activation(P=0.05,FDR corrected).The activations of Ch28,Ch29,Ch39 and Ch50 in MS patients with severe physical disability(EDSS>3)were significantly higher than those in the control group(P=0.0054,FDR corrected).4.In MS group,RAVLT-7 score was significantly correlated with Ch29(r=0.502,P=0.047)、Ch39(r=0.747,P=0.001)and Ch50(r=0.645,P=0.007)oxyhemoglobin level(β value).DST backward was positively correlated with Ch29(r=0.762,P=0.001)and Ch50(r=0.545,P=0.029)oxyhemoglobin level(β value).The total DST(forward + backward)was positively correlated with Ch29(r=0.582,P=0.018)oxyhemoglobin level(β value).Number of VFT words was negatively correlated with Ch28(r=-0.771,P <0.001),Ch29(r=-0.568,P=0.022),Ch39(r=-0.641,P=0.007)and Ch50(r=-0.670,P=0.005)oxyhemoglobin levels(β value).There was a significant negative correlation between 9HPT time and Ch29(r=-0.589,P=0.016)oxyhemoglobin level(β value).There was no significant correlation between multiple sclerosis functional composite(MSFC)、EDSS and frontal lobe oxyhemoglobin level(β value).Conclusions:1.MS patients have cognitive impairment,fatigue and depression.The MS group showed extensive activation in the prefrontal cortex during the VFT task.2.The activation of frontal lobe is related to verbal memory and attention.f NIRS is expected to be a new assessment method to provide clues for early detection of non-motor symptoms in patients with multiple sclerosis.