Cognitive Consequences of Multiple Lacunes and Leukoaraiosis as Vascular Cognitive Impairment in Community-Dwelling Elderly Individuals

Koga, Hiroshi; Takashima, Yuki; Ryo, Murakawa; Uchino, Akira; Yuzuriha, Takefumi; Yao, Hiroshi

doi:10.1016/j.jstrokecerebrovasdis.2008.07.010

Cited by 58 publications

(34 citation statements)

References 30 publications

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“…Subcortical vascular disease and DWMLs seen in community-dwelling subjects are associated with cognitive impairment or dementia, depression and gait disturbance. [7][8][9][11][12][13]19 Similarly, multiple lacunes cause frontal lobe dysfunction, 15 including a difficulty in shifting set, impaired executive functions, decreased verbal fluency and apathy. Apathy observed in this study might have occurred when the frontal cortex was functionally disconnected from relevant limbic input through basal ganglia by DWMLs.…”

Section: Discussionmentioning

confidence: 99%

“…6 Multiple lacunes and leukoaraiosis cause various neuropsychiatric symptoms [7][8][9][10] as well as cognitive impairment. [11][12][13] According to the vascular depression hypothesis, small vessel diseases such as silent brain infarction (that is, subcortical lacunes) and/or white matter lesions (WMLs) may disrupt frontal-subcortical circuits and generate depressive symptoms. 7 Apathy can be the clinical expression of a depressed state, but it is distinct from depression as a disorder of motivation rather than mood.…”

Section: Introductionmentioning

confidence: 99%

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Hypertension and white matter lesions are independently associated with apathetic behavior in healthy elderly subjects: the Sefuri brain MRI study

et al. 2009

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Apathy is defined as a syndrome of primary loss of motivation not attributable to emotional distress, intellectual impairment or consciousness disturbance. The aim of our study was to investigate the effects of vascular risk factors and silent ischemic brain lesions on apathetic behavior of community-dwelling elderly subjects. Brain MRI and other medical examinations were performed on 222 non-demented community-dwelling elderly subjects (96 men and 126 women, average age 70.1 years). The apathy group was defined as the most apathetic quintile determined by Starkstein's apathy scale. Silent infarction, deep white matter lesions (DWMLs) and periventricular hyperintensities were detected in 12.2, 39.2 and 22.5%, respectively. Linear regression analysis (Pearson) revealed that the scores on the apathy scale correlated slightly but significantly with logarithmically transformed scores of the Modified Stroop Test (r¼0.135, P¼0.045), but not with the Mini-Mental State Examination. The apathy group tended to have more high blood pressure (141.6/82.6 vs. 136.1/79.6 mm Hg), less prevalent hyperlipidemia (18 vs. 35%) and lower serum albumin. Multivariate analysis (the forward stepwise method of logistic analysis) revealed an independent correlation between the apathy and grade of DWMLs (odds ratio 1.826, 95% confidence interval (CI) 1.129-2.953 per grade) or diastolic blood pressure (DBP) (odds ratio 1.055, 95% CI 1.014-1.098 per mm Hg) after adjusting for possible confounders. The mean apathy scale score in the DBP^90 mm Hg group was significantly lower (more apathetic) than that in the DBPo80 group (P¼0.011, analysis of covariance). This study showed that hypertension and DWMLs are independently associated with apathy in healthy elderly subjects.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypertension and white matter lesions are independently associated with apathetic behavior in healthy elderly subjects: the Sefuri brain MRI study

et al. 2009

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“…The CLS patients' inclusion criteria were as follows: the patients had stroke-like symptoms persisting for 30 days, and CLS lesions were found in MR images. The CLS lesions were defined as small lesions (10 mm or less in diameter) with a low signal on T1-weighted images, a high signal on T2-weighted images, and a peri-lesion halo on T2-FLAIR images [13]. Patients who were medically unstable or had intracerebral hemorrhage, dementia, consciousness disorders, a cerebral tumor, cerebral trauma, or an arteriovenous malformation were imaged using conventional MRI scanning and were excluded from this study.…”

Section: Patientsmentioning

confidence: 99%

Pseudo-continuous arterial spin labeling quantifies cerebral blood flow in patients with acute ischemic stroke and chronic lacunar stroke

Guo

Zhang²,

Ding

et al. 2014

Clinical Neurology and Neurosurgery

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“…1 However, because these markers are associated with increased stroke and mortality risk and worse functioning on domains as gait and cognition, they should not be disregarded. 1,2,[7][8][9] Elevated blood pressure (BP) is considered to be an important and modifiable risk factor for cSVD. 2,10 Previous studies showed that elevated BP levels are associated with each of the MRI markers of cSVD separately.…”

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Ambulatory Blood Pressure in Patients With Lacunar Stroke

Klarenbeek

Oostenbrugge

Rouhl

et al. 2013

Stroke

208

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Background and Purpose-Asymptomatic lacunar infarcts, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces are MRI markers of cerebral small vessel disease (cSVD). Higher blood pressure (BP) levels are associated with the presence of these markers separately, but the association with the total burden of cSVD on brain MRI, expressed by the simultaneous presence of multiple markers of cSVD (a compound score), has not been investigated. Methods-We performed 24-hour ambulatory BP monitoring in 122 patients with first-ever lacunar stroke. On brain MRI, we scored the presence of each marker of cSVD. One point was awarded for the presence of each marker, producing a score between 0 and 4. Associations with BP levels were tested with ordinal regression analyses. Results-Eighteen (15%) patients had no markers of cSVD, and 6 (5%) patients had 4 markers. Most patients (45; 37%) had 2 different markers. After correction for age and sex, higher 24-hour, day, and night systolic (24-hour odds ratio, 1.25; 95% confidence interval, 1.02-1.52 per 10 mm Hg) and diastolic (24-hour odds ratio, 1.32; 95% confidence interval, 1.12-1.56 per 5 mm Hg) BP were all significantly associated with an increasing total burden of cSVD. Conclusions-We found a positive association of ambulatory BP levels with total burden of cSVD on brain MRI. With increasing BP levels, there is a piling up of damage in the brain. We suggest that further cSVD studies also consider viewing the total burden in addition to each of the MRI markers separately.

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Cognitive Consequences of Multiple Lacunes and Leukoaraiosis as Vascular Cognitive Impairment in Community-Dwelling Elderly Individuals

Cited by 58 publications

References 30 publications

Hypertension and white matter lesions are independently associated with apathetic behavior in healthy elderly subjects: the Sefuri brain MRI study

Hypertension and white matter lesions are independently associated with apathetic behavior in healthy elderly subjects: the Sefuri brain MRI study

Pseudo-continuous arterial spin labeling quantifies cerebral blood flow in patients with acute ischemic stroke and chronic lacunar stroke

Ambulatory Blood Pressure in Patients With Lacunar Stroke

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