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Multiple Sclerosis International
Volume 2014 (2014), Article ID 609694, 9 pages
Review Article

Gray Matters in Multiple Sclerosis: Cognitive Impairment and Structural MRI

Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Via S. Sofia 78, 95123 Catania, Italy

Received 6 April 2013; Revised 30 September 2013; Accepted 29 October 2013; Published 22 January 2014

Academic Editor: Rob Bermel

Copyright © 2014 Silvia Messina and Francesco Patti. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Multiple sclerosis (MS) is an immune-mediated disease affecting central nervous system (CNS). Although MS is classically considered a white matter (WM) disease, the involvement of gray matter (GM) in the pathogenic process has been confirmed by pathology studies and MRI studies. Impairment of cognitive domains such as memory, mental processing speed, attention, and executive function can occur from the early stage of the disease and tends to worsen over time, despite stable physical symptoms. WM demyelination is moderately correlated with CI, suggesting that probably WM abnormalities alone cannot fully explain the extent of clinical symptoms in MS, including CI. Several MRI techniques have shown the involvement of GM in MS and the association between GM damage, physical disability, and CI. The aim of this review is to provide an overview of CI and GM damage assessed by structural brain MRI.