Association between diffusion tensor imaging measurements and cognitive performances in people with multiple sclerosis: A systematic review and meta-analysis

Abstract

Background: Alterations in structural connectivity of brain networks have been linked to complex cognitive functions in people with multiple sclerosis (PwMS). However, a definitive consensus on the optimal diffusion tensor imaging (DTI) markers as indicators of cognitive performance remains incomplete and inconclusive. This systematic review and meta-analysis aimed to explore the evidence on the correlation between DTI metrics and cognitive functions in PwMS. Methods: A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, Scopus, and the Web of Science up to March 2024 to identify studies reporting the correlation between DTI metrics and cognitive functions. Cognitive function was assessed using the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test (CVLT), and Brief Visuospatial Memory Test-Revised (BVMT-R). The pooled correlation coefficients were estimated using R software version 4.4.0 with the random effect model. Results: Out of 1952 studies, 38 studies on 2055 PwMS fulfilled the inclusion criteria. The meta-analysis indicated that the SDMT exhibited the greatest correlation with corpus callosum fractional anisotropy (FA) (r = 0.54, 95 CI: 0.4 to 0.66, p-value < 0.001, I-2 = 34.1 , p-heterogeneity = 0.19) and mean diffusivity (MD) (r = -0.48, 95 CI: 0.61 to -0.33, p-value < 0.001, I-2 = 0 , p-heterogeneity = 0.77), white matter FA (r = 0.39, 95 CI: 0.24 to 0.52, p-value < 0.001, I-2 = 0 , p-heterogeneity = 0.1), and fornix FA (r = 0.35, 95 CI: 0.12 to 0.54, p-value = 0.003, I-2 = 50.7 , p-heterogeneity = 0.18) and MD (r = -0.35, 95 CI: 0.49 to -0.19, p-value < 0.001, I-2 = 0 , p-heterogeneity = 0.5). Conclusion: DTI measurements, including corpus callosum FA and MD, white matter FA, and fornix FA and MD, represent the indicators of cognitive performance in PwMS. Nonetheless, these findings warrant cautious interpretation due to the restricted kinds of cognitive tests and methodological variability across studies.