Longitudinal Cognitive Decline in Subcortical Ischemic Vascular Disease – The LADIS Study

Abstract

Background: Cross-sectional studies have indicated that subcortical ischemic vascular disease (SIVD), as defined according to imaging criteria, is associated with a specific clinical and cognitive profile. Much less is known about the long-term cognitive consequences of SIVD. The aim of the study was to investigate the longitudinal cognitive performance and incident dementia in subjects with and without SIVD in a sample of older adults with white matter lesions. Methods: In the Leukoaraiosis and Disability (LADIS) study, 639 participants were examined with annual clinical and neuropsychological evaluations for 3 years. The subjects meeting the MRI criteria of SIVD at baseline were compared to the other subjects of the sample with linear mixed models. Results: The overall level of cognitive performance over the follow-up period was inferior in multiple cognitive domains in SIVD subjects as compared to the reference group. The subjects with SIVD presented significantly steeper decline of performance in the Stroop test (parts I and II), Trail Making A test, Verbal fluency test, and Mini-Mental State Examination. They also had a threefold risk of developing dementia during follow-up independently of age, sex, education and medial temporal lobe atrophy. Conclusions: SIVD, as a manifestation of cerebral small vessel disease, is related to progressive cognitive impairment and a considerable risk of developing dementia. SIVD seems to specifically contribute to the deterioration of psychomotor speed, executive control, and global cognitive function.

Heterogeneity in age-related white matter changes

“…Consequences on cognitive function represent a key clinical finding related to age-related white matter changes. White matter lesions affect executive function often severely enough to impair activities of daily life resulting from erroneous goal formation, planning, and organization [39][40][41]57]. Abstract reasoning is also commonly affected, but patients only suffer from mild memory deficits [38] with slight recognition and cueing difficulties [16].…”

Diffuse Tract Damage in the Hemispheric Deep White Matter May Correlate with Global Cognitive Impairment and Callosal Atrophy in Patients with Extensive Leukoaraiosis

“…4,5 Patients with extensive WMLs may be at risk of global cognitive impairment and vascular dementia. 6 However, patients with extensive WMLs show a variable severity of global cognitive impairment, with some patients showing vascular dementia, whereas others have almost normal cognitive function despite extensive WMLs. [7][8][9] A longitudinal study demonstrated that further global cognitive deterioration occurs with time in patients with extensive WMLs whose cognitive impairment was mild initially.…”

“…[7][8][9] A longitudinal study demonstrated that further global cognitive deterioration occurs with time in patients with extensive WMLs whose cognitive impairment was mild initially. 6 Therefore, understanding the pathophysiology that may cause a variable severity of cognitive impairment in patients with similar extensive WMLs may lead to the development of optimal therapeutic interventions preventing vascular dementia.…”

Analysis of Cerebral Blood Flow with Single Photon Emission Computed Tomography in Mild Subcortical Ischemic Vascular Dementia

“…Although patients with subcortical ischemic vascular disease have been reported to have a threefold risk of developing dementia, memory impairment does not seem to be prominent feature in its early phases [15]. Early detection of mild SIVaD can slow the progression of cognitive decline, and appropriate treatment of vascular risk factors can reduce the incidence of cognitive impairment [16].…”