Evidence for a specific role of the anterior hippocampal region in successful associative encoding

It has been well established that the hippocampal formation plays a critical role in the formation of memories. However, functional specialization within the hippocampus remains controversial. Using functional magnetic resonance imaging (fMRI) during a face-name associative encoding task, followed by a postscan recognition test for face memory and face-name pair memory, we investigated the roles of anterior and posterior hippocampal regions in successful encoding of associations and items. Whole-brain and region of interest (ROI) analyses revealed that the anterior hippocampal formation showed increased activation for subsequently remembered face-name associations compared with pairs that were forgotten. In contrast, the posterior hippocampal formation showed activation above baseline during attempted encoding of face-name pairs, but no evidence of differential activation based on subsequent memory. Furthermore, exploratory whole-brain analyses revealed that a parahippocampal region, most likely corresponding to perirhinal cortex, showed subsequent memory effects for faces. These data provide evidence for functional specialization within the hippocampal formation based on the associative nature of the stimuli and subsequent memory.     

Improvement in learning associated with increase in hippocampal formation volume.

BACKGROUND: Patients with spontaneous Cushing's syndrome are exposed to elevated levels of endogenous cortisol for months to years. We previously reported that hippocampal formation volume (HFV) increased in such patients after treatment lowered cortisol to normal concentrations. In the present study, we examined whether the structural increase was associated with improvement in cognition. METHODS: Twenty-four patients with Cushing's disease were studied before treatment and following treatment. Magnetic resonance imaging was used to measure HFV and caudate head volume. Neuropsychologic tests of verbal cognition, learning, and memory were also administered. RESULTS: Patients showed variability in improvement on neuropsychologic test performance. After partialing out age, education, duration of illness, and time since surgical treatment, greater improvement in word list learning, as measured by the Selective Reminding Test was associated with greater increase in HFV (r =.59, p <.02). There were no significant associations between improvement in paragraph or paired-word learning or memory tasks and increase in HFV. Improvement in other verbal tasks not strongly dependent on the hippocampus were not significantly associated with increase in HFV. CONCLUSIONS: After cortisol levels decline to normal concentrations, structural volumetric increase in HFV is accompanied by functional improvement in learning of unrelated words.     

Insular and hippocampal contributions to remembering people with an impression of bad personality

Our impressions of other people are formed mainly from the two possible factors of facial attractiveness and trustworthiness. Previous studies have shown the importance of orbitofrontal–hippocampal interactions in the better remembering of attractive faces, and psychological data have indicated that faces giving an impression of untrustworthiness are remembered more accurately than those giving an impression of trustworthiness. However, the neural mechanisms of the latter effect are largely unknown. To investigate this issue, we investigated neural activities with event-related fMRI while the female participants rated their impressions of the personalities of men in terms of trustworthiness. After the rating, memory for faces was tested to identify successful encoding activity. As expected, faces that gave bad impressions were remembered better than those that gave neutral or good impressions. In fMRI data, right insular activity reflected an increasing function of bad impressions, and bilateral hippocampal activities predicted subsequent memory success. Additionally, correlation between these insular and hippocampal regions was significant only in the encoding of faces associated with a bad impression. Better memory for faces associated with an impression of bad personality could reflect greater interaction between the avoidance-related insular region and the encoding-related hippocampal region.     

BDNF val66met affects hippocampal volume and emotion-related hippocampal memory activity

The val⁶⁶met polymorphism on the BDNF gene has been reported to explain individual differences in hippocampal volume and memory-related activity. These findings, however, have not been replicated consistently and no studies to date controlled for the potentially confounding impact of early life stress, such as childhood abuse, and psychiatric status. Using structural and functional MRI, we therefore investigated in 126 depressed and/or anxious patients and 31 healthy control subjects the effects of val⁶⁶met on hippocampal volume and encoding activity of neutral, positive and negative words, while taking into account childhood abuse and psychiatric status. Our results show slightly lower hippocampal volumes in carriers of a met allele (n=54) relative to val/val homozygotes (n=103) (P=0.02, effect size (Cohen''s d)=0.37), which appeared to be independent of childhood abuse and psychiatric status. For hippocampal encoding activity, we found a val⁶⁶met–word valence interaction (P=0.02) such that carriers of a met allele showed increased levels of activation in response to negative words relative to activation in the neutral word condition and relative to val/val homozygotes. This, however, was only evident in the absence of childhood abuse, as abused val/val homozygotes showed hippocampal encoding activity for negative words that was comparable to that of carriers of a met allele. Neither psychiatric status nor memory accuracy did account for these associations. In conclusion, BDNF val⁶⁶met has a significant impact on hippocampal volume independently of childhood abuse and psychiatric status. Furthermore, early adverse experiences such as childhood abuse account for individual differences in hippocampal encoding activity of negative stimuli but this effect manifests differently as a function of val⁶⁶met.     

Dynamically changing effects of corticosteroids on human hippocampal and prefrontal processing

Stress has a powerful impact on memory. Corticosteroids, released in response to stress, are thought to mediate, at least in part, these effects by affecting neuronal plasticity in brain regions involved in memory formation, including the hippocampus and prefrontal cortex. Animal studies have delineated aspects of the underlying physiological mechanisms, revealing rapid, nongenomic effects facilitating synaptic plasticity, followed several hours later by a gene‐mediated suppression of this plasticity. Here, we tested the hypothesis that corticosteroids would also rapidly upregulate and slowly downregulate brain regions critical for episodic memory formation in humans. To target rapid and slow effects of corticosteroids on neural processing associated with memory formation, we investigated 18 young, healthy men who received 20 mg hydrocortisone either 30 or 180 min before a memory encoding task in a double‐blind, placebo‐controlled, counter‐balanced, crossover design. We used functional MRI to measure neural responses during these memory encoding sessions, which were separated by a month. Results revealed that corticosteroids' slow effects reduced both prefrontal and hippocampal responses, while no significant rapid actions of corticosteroids were observed. Thereby, this study provides initial evidence for dynamically changing corticosteroid effects on brain regions involved in memory formation in humans. Hum Brain Mapp, 2012. © 2011 Wiley Periodicals, Inc.     

Neural bases of autobiographical support for episodic recollection of faces

Incidental retrieval of autobiographical knowledge can provide rich contextual support for episodic recollection of a recent event. We examined the neural bases of these two processes by performing fMRI scanning during a recognition memory test for faces that were unfamiliar, famous, or personally known. The presence of pre‐experimental knowledge of a face was incidental to the task, but nonetheless resulted in improved performance. Two distinct networks of activation were associated with correct recollection of a face's prior presentation (recollection hits vs. correct rejections) on one hand, and with pre‐experimental knowledge about it (famous or personally known vs. unfamiliar faces) on the other. The former included mid/posterior cingulate cortex, precuneus, and ventral striatum. The latter included bilateral hippocampus, retrosplenial, and ventromedial prefrontal cortices. Anterior and medial thalamic activations showed an interaction between both effects, driven by increased activation for recollection of unfamiliar faces. When recollecting the presentation of a famous or personally known face, hippocampal activation increased with participants' ratings of how well they felt they knew the person shown. Ventromedial prefrontal cortex showed significantly greater activation for personally known than famous faces. Our results indicate a dissociation between the involvement of retrosplenial vs. mid/posterior cingulate and precuneus in memory tasks. They also indicate that, during recognition memory experiments, the hippocampus supports incidental retrieval of pre‐experimental knowledge about the stimuli presented. This type of knowledge likely underlies the additional recollection found for prior presentation of well known stimuli compared with novel ones and may link hippocampal activation at encoding to subsequent memory performance more generally. © 2009 Wiley‐Liss, Inc.     

Effects of memory consolidation on human hippocampal activity during retrieval

Day-to-day memories undergo transformation from short-term to long-term storage, a process called memory consolidation. Animal studies showed that memory consolidation requires protein synthesis and the growth of new hippocampal synapses within 24 h. To test for effects of memory consolidation in the human, we examined brain activation during the retrieval of information at 10 min and at 24 h following learning using functional magnetic resonance imaging (fMRI), an indirect measure of synaptic activity. Learning instructions were adjusted to yield a comparable retrieval quantity and retrieval quality at 10 min and 24 h after learning. The left hippocampal formation exhibited enhanced activity during the retrieval at the 24 h lag compared to the retrieval at the 10 min lag. Moreover, the activity in the left anterior hippocampal formation showed stronger correlations with retrieval quantity and retrieval quality at the 24 h lag than at the 10 min lag. This suggests that the relation between left anterior hippocampal activity and retrieval success became closer as consolidation progressed. These fMRI results in the human hippocampal formation may correspond to the neurobiological results in the animal hippocampal formation of a strengthening and growth of synaptic connections within 24 h.     

Bilateral hippocampal volume reduction in adults with post-traumatic stress disorder: a meta-analysis of structural MRI studies

Over the last decade a significant number of studies have reported smaller hippocampal volume in individuals with symptoms of post-traumatic stress disorder (PTSD) relative to control groups, and in some cases hemispheric asymmetries in this effect have been noted. However these reported asymmetries have not been in a consistent direction, and other well-controlled studies have failed to observe any hippocampal volume difference. This paper reports a systematic review and meta-analysis of studies in which hippocampal volume was estimated from magnetic resonance images in adult patients with PTSD. After applying a variety of selection criteria intended to minimize potential confounds in pooled effect-size estimates, the meta-analysis included 13 studies of adult patients with PTSD that compared the patients to well-matched control groups, for a total of 215 patients and 325 control subjects. The studies varied with respect to participant age, gender distribution, source of trauma, severity of symptoms, duration of disorder, the nature of the control groups, and the methods employed for volumetric quantification. Despite these differences, pooled effect size calculations across the studies indicated significant volume differences in both hemispheres. On average PTSD patients had a 6.9% smaller left hippocampal volume and a 6.6% smaller right hippocampal volume compared with control subjects. These volume differences were smaller when comparing PTSD patients with control subjects exposed to similar levels of trauma, and larger when comparing PTSD patients to control subjects without significant trauma exposure. Such differences are consistent with the notion that exposure to stressful experiences can lead to hippocampal atrophy, although prospective studies would be necessary to unambiguously establish such a relationship.     

Look at me, I'll remember you: the perception of self-relevant social cues enhances memory and right hippocampal activity

Being looked at by a person enhances the subsequent memorability of her/his identity. Here, we tested the specificity of this effect and its underlying brain processes. We manipulated three social cues displayed by an agent: Gaze Direction (Direct/Averted), Emotional Expression (Anger/Neutral), and Pointing gesture (Presence/Absence). Our behavioral experiment showed that direct as compared with averted gaze perception enhanced subsequent retrieval of face identity. Similar effect of enhanced retrieval was found when pointing finger was absent as compared with present but not for anger as compared with neutral expression. The fMRI results revealed amygdala activity for both Anger and Direct gaze conditions, suggesting emotional arousal. Yet, the right hippocampus, known to play a role in self-relevant memory processes, was only revealed during direct gaze perception. Further investigations suggest that right hippocampal activity was maximal for the most self-relevant social event (i.e. actor expressing anger and pointing toward the participant with direct gaze). Altogether, our results suggest that the perception of self-relevant social cues such as direct gaze automatically prompts "self-relevant memory" processes.     

Functional connectivity maps based on hippocampal and thalamic dynamics may account for the default‐mode network

The default‐mode network (DMN) has been reported to comprise a set of inter‐connected transmodal cortical areas, including the posterior cingulate cortex (PCC), medial prefrontal cortex, posterior inferior parietal lobule, lateral temporal region and others. However, the subcortical constituents of the DMN are still not clear. This study aimed to examine whether the correlation maps derived from subcortical structures may also account for neural pattern of the DMN. Structural magnetic resonance imaging (MRI) and resting‐state functional MRI scans of 36 subjects were selected from the Rockland sample (Nathan Kline Institute). The hippocampus and thalamus were chosen as subcortical regions of interest (ROIs). Each ROI was partitioned into composite modules which in turn provided simplified and representative dynamics of blood‐oxygen‐level‐dependent (BOLD) signals. PCC‐seeded and ROI‐based correlation maps were compared by conjunction analyses and paired t‐tests (corrected P < 0.05). Our results unveiled that the hippocampus‐, thalamus‐ and PCC‐centred correlation patterns actually overlapped to a substantial degree. Integrating the signals in the thalamus and hippocampus altogether fully explained the PCC‐seeded DMN. Supplementary analyses based on the BOLD dynamics in several subcortical nuclei (caudate, putamen and globus pallidus) were dissimilar to the DMN. The DMN derived from the ROI/seed‐based approach may represent combined limbic and region‐specific informatics (and their closely interacting neural substrates). The possible causes for previous methods of task‐induced deactivation and seed‐based correlation that failed to depict the holistic limbic picture are discussed. The neocortical manifestation of DMN may reflect the limbic information in the transmodal brain regions.     

Functional imaging of emotional memory in bipolar disorder and schizophrenia

Objectives: Although in current diagnostic criteria there exists a distinction between bipolar disorder and schizophrenia, many patients manifest features of both disorders, and it is unclear which aspects, if any, confer diagnostic specificity. In the present study, we investigate whether there are differences in medial temporal lobe (MTL) activation in bipolar disorder and schizophrenia. We also investigate associations between activation levels and symptom severity across the disorders. Methods: Functional magnetic resonance imaging scans were conducted on 14 healthy controls, 14 patients with bipolar disorder, and 15 patients with schizophrenia undergoing an emotional memory paradigm. Results: All groups demonstrated the expected pattern of behavioural responses during encoding and retrieval, and there were no significant group differences in performance. Robust MTL activation was seen in all three groups during viewing of emotional scenes, which correlated significantly with recognition memory for emotional stimuli. The bipolar group demonstrated relatively greater increases in activation for emotional versus neutral scenes in the left hippocampus than both controls and patients with schizophrenia. There was a significant positive correlation between mania scores and activation in the anterior cingulate, and a significant negative correlation between depression scores and activation in the dorsolateral prefrontal cortex. Conclusion: These results provide evidence that there are distinct patterns of activation in the MTL during an emotional memory task in bipolar disorder and schizophrenia. They also demonstrate that different mood states are associated with different neurobiological responses to emotion across the patient groups.     

Smaller hippocampal volume in Dutch police officers with posttraumatic stress disorder.

BACKGROUND: Previous magnetic resonance imaging studies of posttraumatic stress disorder (PTSD) have reported smaller hippocampal volume, especially in war and sexual abuse victims. Our aim was to assess hippocampal volume in traumatized police officers with and without PTSD in the absence of alcohol abuse and moderate to severe major depression. METHODS: In a case-matched control study, 14 police officers with current PTSD and 14 traumatized police officers without lifetime PTSD were examined using magnetic resonance imaging. Three temporal lobe areas were manually segmented: hippocampus, amygdala, and parahippocampal gyrus. Volumetric analysis was used to measure gray matter, white matter, and cerebrospinal fluid. RESULTS: After controlling for total brain volume, the hippocampal volume in the PTSD group was significantly smaller in comparison with the traumatized control group (total 10.6%; left 12.6%). Volumes of amygdala, parahippocampal gyrus, gray matter, white matter, and cerebrospinal fluid were not significantly altered. A significant negative correlation was found between reexperiencing symptoms and hippocampal volume in the PTSD group. CONCLUSIONS: We confirmed previous findings of smaller hippocampal volume in PTSD in a new population made up of police officers, excluding comorbidity as a confounder. The finding of smaller hippocampal volume was specific to PTSD.     

Regional analysis of hippocampal activation during memory encoding and retrieval: fMRI study

Investigators have recently begun to examine the differential role of subregions of the hippocampus in episodic memory. Two distinct models have gained prominence in the field. One model, outlined by Moser and Moser (Hippocampus 1998;8:608-619), based mainly on animal studies, has proposed that episodic memory is subserved by the posterior two-thirds of the hippocampus alone. A second model, derived by Lepage et al. (Hippocampus 1998;8:313-322) from their review of 52 PET studies, has suggested that the anterior hippocampus is activated by memory encoding while the posterior hippocampus is activated by memory retrieval. Functional magnetic resonance imaging (fMRI) studies have tended to show limited activation in the anteriormost regions of the hippocampus, providing support for the Moser and Moser model. A potential confounding factor in these fMRI studies, however, is that susceptibility artifact may differentially reduce signal in the anterior versus the posterior hippocampus. In the present study, we examined activation differences between hippocampal subregions during encoding and retrieval of words and interpreted our findings within the context of these two models. We also examined the extent to which susceptibility artifact affects the analysis and interpretation of hippocampal activation by demonstrating its differential effect on the anterior versus the posterior hippocampus. Both voxel-by-voxel and region-of-interest analyses were conducted, allowing us to quantify differences between the anterior and posterior aspects of the hippocampus. We detected significant hippocampal activation in both the encoding and retrieval conditions. Our data do not provide evidence for regional anatomic differences in activation between encoding and retrieval. The data do suggest that, even after accounting for susceptibility artifact, both encoding and retrieval of verbal stimuli activate the middle and posterior hippocampus more strongly than the anterior hippocampus. Finally, this study is the first to quantify the effects of susceptibility-induced signal loss on hippocampal activation and suggests that this artifact has significantly biased the interpretation of earlier fMRI studies.     

Gender does not moderate hippocampal volume deficits in adults with posttraumatic stress disorder: a meta-analysis

Epidemiological studies show a higher point prevalence of posttraumatic stress disorder (PTSD) in women than in men, and early evidence has suggested that gender may moderate hippocampal volume deficits in PTSD. Our objective was to use random-effects meta-regression to assess gender effects on hippocampal volume deficits in PTSD. Using the terms posttraumatic stress disorder, gender, MRI, hippocampus, trauma, and abuse, we searched electronic databases for peer-reviewed articles up to April 2009 containing data for hippocampal volume and gender composition in PTSD adults compared with controls. We identified 23 studies that met inclusion criteria and calculated effect sizes for differences in hippocampal mean volumes for each study and used the percentage of men with PTSD as a continuous moderating variable in meta-regression. Additionally, we did a subgroup analysis of hippocampal volume deficits between women and men with gender as a categorical moderating variable. Hippocampal volumes were significantly smaller in the PTSD group compared to the control group, but gender did not significantly moderate any effect sizes in the meta-regression or subgroup analyses. The lack of gender moderation on hippocampal volume deficits suggests that hippocampal volume deficits in PTSD are independent of gender. The higher prevalence of PTSD in females than in males does not correspond to increased hippocampal volume deficits in women with PTSD compared to men with PTSD, and neither gender appears protective against hippocampal volume deficits in adults with PTSD.     

脑组织的表达数量性状遗传位点定位方法解析精神疾病遗传基础(英文)

全基因组关联分析(genome-wide association study, GWAS)是一种在人类全基因组范围内寻找与疾病相关的序列变异的方法,它也是寻找精神疾病易感基因的一个有力工具。然而,疾病遗传力的来源在很大程度上仍未知,期待将来的研究能发现更多的疾病易感基因。对遗传变异生物学功能的了解能提高GWAS发现新易感基因的效能。表达数量性状遗传位点(expression quantitative trait loci, eQTLs)是指一些能调节基因表达水平的位点。eQTL作图法可揭示众多单核苷酸多态(single nucleotide polymorphisms, SNPs)的未知生物学功能。本综述主要回顾了脑组织中eQTL的研究现状,并对eQTL定位方法的局限性及相应的对策进行了讨论。此外,对在实际研究中经常被忽略的一些能导致假阳性和假阴性关联结果的问题(例如批次效应、协变量和多重测试)进行了探讨。最后,对eQTL研究在GWAS 分析中的应用进行了展望。     

Hippocampal activation during a cognitive task is associated with subsequent neuroendocrine and cognitive responses to psychological stress

Increased activation of the hypothalamus pituitary adrenal (HPA) axis, marked by increased secretion of cortisol, is a biological marker of psychological stress. It is well established that the hippocampus plays an important role in the regulation of HPA axis activity. The relationship between cortisol (stress‐related elevation or exogenous administration) and the hippocampal‐related cognitive function is often examined. However, few human studies to date have examined the effect of stress on hippocampal activity and the interactions between stress‐induced activation of the HPA axis and hippocampal function during different phases of cognitive function. On the basis of our previous work, we hypothesized that group differences in stress‐sensitivity relate to differences in hippocampal‐related stress‐integration. To test this hypothesis, we conducted a functional MRI study using tasks known to involve the hippocampal formation: novel‐picture encoding, psychological stress, and paired‐picture recognition. On the basis of their cortisol responses to stress, we divided subjects into stress‐responders (increase in cortisol, n = 9) and nonresponders (decrease in cortisol, n = 10). Responders showed higher hippocampal deactivation during the stress task and lower recognition scores due to a larger number of misses. Intriguingly, stress‐responders showed significant differences in hippocampal activation already prior to stress, with higher levels of hippocampal activity during the picture encoding. Although effects of both cortisol and hippocampal activation on recognition were present in responders, similar effects were absent in the nonresponder group. Our results indicate that hippocampus plays an important role in adaptive behavioral responses. We hypothesize that states of hippocampal activation prior to stress might reflect states of vigilance or anxiety, which might be important for determining interindividual differences in subsequent stress response and cognitive performance. © 2009 Wiley‐Liss, Inc.     

FreeSurfer-based segmentation of hippocampal subfields: A review of methods and applications,with a novel quality control procedure for ENIGMA studies and other collaborative efforts

Structural hippocampal abnormalities are common in many neurological and psychiatric disorders, and variation in hippocampal measures is related to cognitive performance and other complex phenotypes such as stress sensitivity. Hippocampal subregions are increasingly studied, as automated algorithms have become available for mapping and volume quantification. In the context of the Enhancing Neuro Imaging Genetics through Meta Analysis Consortium, several Disease Working Groups are using the FreeSurfer software to analyze hippocampal subregion (subfield) volumes in patients with neurological and psychiatric conditions along with data from matched controls. In this overview, we explain the algorithm's principles, summarize measurement reliability studies, and demonstrate two additional aspects (subfield autocorrelation and volume/reliability correlation) with illustrative data. We then explain the rationale for a standardized hippocampal subfield segmentation quality control (QC) procedure for improved pipeline harmonization. To guide researchers to make optimal use of the algorithm, we discuss how global size and age effects can be modeled, how QC steps can be incorporated and how subfields may be aggregated into composite volumes. This discussion is based on a synopsis of 162 published neuroimaging studies (01/2013–12/2019) that applied the FreeSurfer hippocampal subfield segmentation in a broad range of domains including cognition and healthy aging, brain development and neurodegeneration, affective disorders, psychosis, stress regulation, neurotoxicity, epilepsy, inflammatory disease, childhood adversity and posttraumatic stress disorder, and candidate and whole genome (epi-)genetics. Finally, we highlight points where FreeSurfer-based hippocampal subfield studies may be optimized.     

Association of the Ser704Cys DISC1 polymorphism with human hippocampal formation gray matter and function during memory encoding

A common nonsynonymous single nucleotide polymorphism leading to a serine‐to‐cysteine substitution at amino acid 704 (Ser⁷⁰⁴Cys) in the DISC1 protein sequence has been recently associated with schizophrenia and with specific hippocampal abnormalities. Here, we used multimodal neuroimaging to investigate in a large sample of healthy subjects the putative association of the Ser⁷⁰⁴Cys DISC1 polymorphism with in vivo brain phenotypes including hippocampal formation (HF) gray matter volume and function (as assessed with functional MRI) as well as HF functional coupling with the neural network engaged during encoding of recognition memory. Individuals homozygous for DISC1 Ser allele relative to carriers of the Cys allele showed greater gray matter volume in the HF. Further, Ser/Ser subjects exhibited greater engagement of the HF together with greater HF–dorsolateral prefrontal cortex functional coupling during memory encoding, in spite of similar behavioral performance. These findings consistently support the notion that Ser⁷⁰⁴Cys DISC1 polymorphism is physiologically relevant. Moreover, they support the hypothesis that genetic variation in DISC1 may affect the risk for schizophrenia by modifying hippocampal gray matter and function.     

Functional adaptive changes within the hippocampal memory system of patients with multiple sclerosis

Memory deficits are highly prevalent in multiple sclerosis (MS). As the hippocampus is crucial to memory processing, a functional magnetic resonance imaging (fMRI) task was used to investigate changes in hippocampal function in MS patients with and without cognitive decline. Fifty patients with MS, (34 cognitively preserved (CP) and 16 cognitively impaired (CI)) and 30 healthy controls completed an episodic memory fMRI task (encoding and retrieval) that was used to specifically activate the hippocampus. During encoding of correctly remembered items, increased brain activation was seen in the parahippocampal areas bilaterally and in the left anterior cingulate gyrus in the CP patients compared to the controls (unclustered, Z ≥ 3.1, P ≤ 0.001). No brain areas showed less activation. In CI patients the right (para)hippocampal areas and the prefrontal cortex showed less brain activation compared to controls (cluster-corrected, P < 0.05). The posterior cingulate gyrus and the left precuneus showed increased activation in CI patients when compared to controls (unclustered Z ≥ 3.1, P ≤ 0.001). No significant differences were found on structural MRI measures between the CP and CI patients. These results suggest the presence of functional adaptation in the memory network before cognitive decline becomes evident in MS, as displayed by the increased brain activation in the hippocampal-cingulate memory system in CP patients. Interestingly, CI patients showed less activation in the hippocampal network during correct encoding. These findings are important for future cognitive therapeutic studies, since cognitive intervention might be most effective before cognitive impairment is present and when adaptive changes of the brain are most prominent.