Although the dystrophin gene produces various isoforms, only the largest isoform, Dp427, is well understood, as it links the extracellular matrix and the cytoskeleton in skeletal muscle. Yet nearly one-third of DMD patients present with serious cognitive impairment of which the severity is correlated with the successive loss of smaller dystrophin isoforms. MRI studies have demonstrated that DMD patients have smaller gray matter volumes, higher white matter diffusivity, and lower fractional anisotropy, with mutations that affected the expression of Dp140 contributing the most to gray matter volume differences.