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Accumulation of MRI Markers of Cerebral Small Vessel Disease is Associated with Decreased Cognitive Function. A Study in First-Ever Lacunar Stroke and Hypertensive Patients.

Huijts M, Duits A, van Oostenbrugge RJ, Kroon AA, de Leeuw PW, Staals J - Front Aging Neurosci (2013)

Bottom Line: Correlation analyses revealed significant associations between accumulating cSVD burden and decreased performance on all cognitive domains (all p ≤ 0.001).Testing of trend using linear regression analyses revealed the same results.We tested a new approach to capture total brain damage resulting from cSVD and found that accumulation of MRI burden of cSVD is associated with decreased performance on tests of information processing speed and overall cognition, implying that accumulating brain damage is accompanied by worse cognitive functioning.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Maastricht University , Maastricht , Netherlands ; School for Mental Health and Neuroscience (MHeNS), Maastricht University , Maastricht , Netherlands ; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , Netherlands.

ABSTRACT

Background: White matter lesions (WMLs), asymptomatic lacunar infarcts, brain microbleeds (BMBs), and enlarged perivascular spaces (EPVS) have been identified as silent lesions due to cerebral small vessel disease (cSVD). All these markers have been individually linked to cognitive functioning, but are also strongly correlated with each other. The combined effect of these markers on cognitive function has never been studied and would possibly provide more useful information on the effect on cognitive function.

Methods: Brain MRI and extensive neuropsychological assessment were performed in 189 patients at risk for cSVD (112 hypertensive patients and 77 first-ever lacunar stroke patients). We rated the presence of any asymptomatic lacunar infarct, extensive WMLs, any deep BMB, and moderate to extensive EPVS in the basal ganglia. The presence of each marker was summed to an ordinal score between 0 and 4. Associations with domains of cognitive function (memory, executive function, information processing speed, and overall cognition) were analyzed with correlation analyses.

Results: Correlation analyses revealed significant associations between accumulating cSVD burden and decreased performance on all cognitive domains (all p ≤ 0.001). RESULTS remained significant for information processing speed (r = -0.181, p = 0.013) and overall cognition (r = -0.178, p = 0.017), after correction for age and sex. Testing of trend using linear regression analyses revealed the same results.

Discussion: We tested a new approach to capture total brain damage resulting from cSVD and found that accumulation of MRI burden of cSVD is associated with decreased performance on tests of information processing speed and overall cognition, implying that accumulating brain damage is accompanied by worse cognitive functioning.

No MeSH data available.


Related in: MedlinePlus

Distribution of (combinations of) cSVD manifestations according to total burden of cSVD. (A) Percentages of each lesion when one lesion is present. (B) Percentages of the combinations when two lesions are present. (C) Percentages of the combinations when three lesions are present. LAC, asymptomatic lacunar infarcts; WML, white matter lesions; BMB, brain microbleeds; EPVS, enlarged perivascular spaces.
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Figure 1: Distribution of (combinations of) cSVD manifestations according to total burden of cSVD. (A) Percentages of each lesion when one lesion is present. (B) Percentages of the combinations when two lesions are present. (C) Percentages of the combinations when three lesions are present. LAC, asymptomatic lacunar infarcts; WML, white matter lesions; BMB, brain microbleeds; EPVS, enlarged perivascular spaces.

Mentions: Ninety-one patients (48.1%) had none of the silent MRI markers for cSVD, and five patients (2.6%) presented with all four markers. For patients with one, two, or three markers, the presence of the cSVD markers within each category is shown in Table 2 and the distribution of combinations is shown in Figure 1. Age increased significantly with increasing categories (0–4) of total burden of cSVD (54.4 ± 12.4; 60.6 ± 9.3; 65.5 ± 11.2; 70.6 ± 9.1; 77.8 ± 6.0 years, respectively, p < 0.001). Sex was not significantly different across the categories.


Accumulation of MRI Markers of Cerebral Small Vessel Disease is Associated with Decreased Cognitive Function. A Study in First-Ever Lacunar Stroke and Hypertensive Patients.

Huijts M, Duits A, van Oostenbrugge RJ, Kroon AA, de Leeuw PW, Staals J - Front Aging Neurosci (2013)

Distribution of (combinations of) cSVD manifestations according to total burden of cSVD. (A) Percentages of each lesion when one lesion is present. (B) Percentages of the combinations when two lesions are present. (C) Percentages of the combinations when three lesions are present. LAC, asymptomatic lacunar infarcts; WML, white matter lesions; BMB, brain microbleeds; EPVS, enlarged perivascular spaces.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3818574&req=5

Figure 1: Distribution of (combinations of) cSVD manifestations according to total burden of cSVD. (A) Percentages of each lesion when one lesion is present. (B) Percentages of the combinations when two lesions are present. (C) Percentages of the combinations when three lesions are present. LAC, asymptomatic lacunar infarcts; WML, white matter lesions; BMB, brain microbleeds; EPVS, enlarged perivascular spaces.
Mentions: Ninety-one patients (48.1%) had none of the silent MRI markers for cSVD, and five patients (2.6%) presented with all four markers. For patients with one, two, or three markers, the presence of the cSVD markers within each category is shown in Table 2 and the distribution of combinations is shown in Figure 1. Age increased significantly with increasing categories (0–4) of total burden of cSVD (54.4 ± 12.4; 60.6 ± 9.3; 65.5 ± 11.2; 70.6 ± 9.1; 77.8 ± 6.0 years, respectively, p < 0.001). Sex was not significantly different across the categories.

Bottom Line: Correlation analyses revealed significant associations between accumulating cSVD burden and decreased performance on all cognitive domains (all p ≤ 0.001).Testing of trend using linear regression analyses revealed the same results.We tested a new approach to capture total brain damage resulting from cSVD and found that accumulation of MRI burden of cSVD is associated with decreased performance on tests of information processing speed and overall cognition, implying that accumulating brain damage is accompanied by worse cognitive functioning.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Maastricht University , Maastricht , Netherlands ; School for Mental Health and Neuroscience (MHeNS), Maastricht University , Maastricht , Netherlands ; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , Netherlands.

ABSTRACT

Background: White matter lesions (WMLs), asymptomatic lacunar infarcts, brain microbleeds (BMBs), and enlarged perivascular spaces (EPVS) have been identified as silent lesions due to cerebral small vessel disease (cSVD). All these markers have been individually linked to cognitive functioning, but are also strongly correlated with each other. The combined effect of these markers on cognitive function has never been studied and would possibly provide more useful information on the effect on cognitive function.

Methods: Brain MRI and extensive neuropsychological assessment were performed in 189 patients at risk for cSVD (112 hypertensive patients and 77 first-ever lacunar stroke patients). We rated the presence of any asymptomatic lacunar infarct, extensive WMLs, any deep BMB, and moderate to extensive EPVS in the basal ganglia. The presence of each marker was summed to an ordinal score between 0 and 4. Associations with domains of cognitive function (memory, executive function, information processing speed, and overall cognition) were analyzed with correlation analyses.

Results: Correlation analyses revealed significant associations between accumulating cSVD burden and decreased performance on all cognitive domains (all p ≤ 0.001). RESULTS remained significant for information processing speed (r = -0.181, p = 0.013) and overall cognition (r = -0.178, p = 0.017), after correction for age and sex. Testing of trend using linear regression analyses revealed the same results.

Discussion: We tested a new approach to capture total brain damage resulting from cSVD and found that accumulation of MRI burden of cSVD is associated with decreased performance on tests of information processing speed and overall cognition, implying that accumulating brain damage is accompanied by worse cognitive functioning.

No MeSH data available.


Related in: MedlinePlus