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Abstract
Background: In cerebral small vessel disease, the core MRI findings include white matter lesions (WML) and lacunar infarcts. While the clinical significance of WML is better understood, the contribution of lacunes to the rate of cognitive decline has not been established. This study investigated whether incident lacunes on MRI determine longitudinal cognitive change in elderly subjects with WML.
Methods: Within the Leukoaraiosis and Disability Study (LADIS), 387 subjects were evaluated with repeated MRI and neuropsychological assessment at baseline and after 3 years. Predictors of change in global cognitive function and specific cognitive domains over time were analyzed with multivariate linear regression.
Results: After controlling for demographic factors, baseline cognitive performance, baseline lacunar and WML lesion load, and WML progression, the number of new lacunes was related to subtle decrease in compound scores for executive functions (p = 0.021) and speed and motor control (p = 0.045), but not for memory or global cognitive function. Irrespective of lacunes, WML progression was associated with decrease in executive functions score (p = 0.016).
Conclusion: Incident lacunes on MRI parallel a steeper rate of decline in executive functions and psychomotor speed. Accordingly, in addition to WML, lacunes determine longitudinal cognitive impairment in small vessel disease. Although the individual contribution of lacunes on cognition was modest, they cannot be considered benign findings, but indicate a risk of progressive cognitive impairment.
Footnotes
Study funding: The LADIS study was supported by the European Union (QLRT-2000-00446). This study was also supported by the Clinical Research Institute and the Medical Research Fund of the Helsinki University Central Hospital, and the Ella and Georg Ehrnrooth Foundation.
Editorial, page 1856
See page 1879
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- ADAS-Cog
- Alzheimer's Disease Assessment Scale–cognitive subscale
- FLAIR
- fluid-attenuated inversion recovery
- LADIS
- Leukoaraiosis and Disability Study
- MMSE
- Mini-Mental State Examination
- MPRAGE
- magnetization-prepared rapid-acquisition gradient-echo
- MTA
- medial temporal lobe atrophy
- SIVD
- subcortical ischemic vascular disease
- SVD
- small vessel disease
- VADAS
- Vascular Dementia Assessment Scale–cognitive subscale
- WML
- white matter lesion
- Received November 1, 2010.
- Accepted February 1, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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