Cranial computed tomographic observations in multi-infarct dementia. A controlled study.

Abstract

Background and Purpose:We compared cranial computed tomography findings among 58 multi-infarct dementia index cases and 74 multi-infarct control subjects without cognitive impairment to identify potential determinants of multi-infarct dementia.Methods: The cranial computed tomography records of acute ischemic stroke patients with a history of multiple cerebral infarcts were compared to determine the number, location, and size of cerebral infarcts; the pattern of infarction; brain volume loss; and the degree of white matter lucency, sulcal enlargement, and ventricular enlargement Multi-infarct patients were divided into two groups: 1) index cases were defined as those with multi-infarct dementia as defined by the Diagnostic and Statistical Manual of Mental Disorders, edition 3 (DSM-II1) criteria; and 2) control subjects were defined as those multi-infarct patients without dementia or multi-infarct dementia according to DSM-LU criteria.Results: Overall, multi-infarct index cases had more cerebral infarcts, more cortical and subcortical left hemisphere infarcts, higher mean ventricular volume to brain volume ratio, more extensive enlargement of the body of the lateral ventricles and cortical sulci, and a higher prevalence of white matter lucencies. Among multi-infarct cases and control subjects the most frequent site of infarction was the subcortical region, and the most frequent pattern of infarction was lacunar. Stepwise logistic regression analysis examined cranial computed tomography as well as other factors and showed that level of education, stroke severity, left cortical infarction, and diffuse enlargement of the left lateral ventricle were the best overall predictors of multi-infarct dementia.Conclusions: Level of education, stroke severity, and left hemisphere infarction may be predictors of multi-infarct dementia. (Stroke 1992^3:804-811) KEY WORDS • dementia • tomography, x-ray computed • cerebral infarction

Cognitive correlates of ventricular enlargement and cerebral white matter lesions on magnetic resonance imaging. The Rotterdam Study.

“…40 In patients with multiple infarcts or with subcortical arteriosclerotic encephalopathy the accompanying dilatation of the ventricular system is thought to be secondary to the white matter changes resulting from ischemia. 15 -' 8 However, this does not explain why several studies found, as we did, that the relation between ventricular enlargement and cognitive function, or subsequent development of dementia, was independent of the effect of white matter lesions and infarcts. 161719 Our results suggest that the two measures to some extent reflect different underlying processes.…”

“…To control for differences in individual head size and height, the volume of the lateral ventricles was expressed as the percentage of the total brain volume (ventricle-to-brain ratio). 15 '…”

“…Clinical, epidemiological, and pathological studies consistently indicate a vascular cause for the majority of these lesions. 15 However, their clinical significance in nondemented subjects remains controversial. Most previous studies that investigated whether these lesions are related to cognitive impairment suffered from methodological drawbacks that limited the interpretation of their results; eg, they mainly included demented patients, 67 were based on highly selective samples of volunteers, 8 ' 11 or had very small sample sizes.…”

Cerebral complications of hypertension

“…138,142,[144][145][146][147] Risk factors for post-stroke dementia At least three different groups of factors, each acting independently, rather than a single pathophysiological mechanism probably contribute to the development of post-stroke dementia: 111,148 (1) stroke-related factors such as the location and the severity of the brain lesions; 149,150 (2) the overall cardiovascular risk profile as determined by the presence of atrial fibrillation 140 or diabetes mellitus; 149 (3) non-strokerelated factors similar to those found in Alzheimer's disease including increasing age, 149,151 low education, 149 cortical atrophy. 145,152 Hypertension has been identified as a risk factor by Pohjasvaara et al (1998), 111 but not by Skoog et al (1996). 101 In addition to those risk factors, coexisting Alzheimer's disease pathology may also play a role, as indicated 146 9.6 Andersen et al, 1996 147 5.5 Kokmen et al, 1996 138 8.4 Hénon et al, 1997 144 16.3 Pohjaasvara et al, 1997 142 12.2…”

William M. Feinberg Lecture: Cognitive Vitality and the Role of Stroke and Cardiovascular Disease Risk Factors

“…19 Finally, in a second and separate neuroimaging study that assessed computed tomography and magnetic resonance imaging findings among black subjects with Alzheimer, vascular dementia, and stroke without dementia, the presence of white matter lesions, nonlacunar infarcts, and left subcortical infarcts on computed tomography were predictors of vascular dementia when compared with Alzheimer disease, and widening of the third ventricle and right hemisphere infarcts on magnetic resonance imaging were neuroimaging predictors of vascular dementia when compared with Alzheimer disease. 20 Later, I performed a review of risk factors for vascular dementia and graded the available data according to the quality and strength of evidence rating.…”