Patterns of neuropsychological impairment in MCI patients with small subcortical infarcts or hippocampal atrophy

Abstract

We investigated whether MCI patients with hippocampal atrophy or multiple subcortical infarcts demonstrate neuropsychological patterns and markers considered typical of Alzheimer's disease (AD) and of vascular dementia (VD), respectively. An extensive neuropsychological battery, including tests of memory, visual-spatial and executive functions, language, attention, praxis and psychomotor speed, was administered to 36 mild cognitive impairment (MCI) patients with hippocampal atrophy and 41 MCI patients with multiple subcortical infarcts. Both groups of MCI patients were very mildly impaired and well matched in terms of MMSE scores. A clear, disproportionately severe, episodic memory disorder was observed in MCI patients with hippocampal atrophy. A less specific neuropsychological profile, consisting of impairment on an Action Naming task that is sensitive to frontal lobe lesions, was observed in MCI patients with multiple subcortical infarcts. In MCI patients, a disproportionately severe episodic memory impairment strongly points to an Alzheimer's type brain pathology, whereas the prevalence of executive deficits and other frontal lobe symptoms are a much weaker diagnostic marker of small vessel subcortical disease. (JINS, 2008, 14, 611-619.)

Medial temporal lobe atrophy relates to executive dysfunction in Alzheimer's disease

“…Previous studies have often dichotomized MTA and WMH scores into no/mild MTA (score 0/1) and severe MTA (score ≥ 2) (e.g. Gouw et al, 2006;Bastos-Leite et al, 2007) and into mild/moderate WMH (score 1/2) and severe WMH (score 3) (e.g. van der Flier et al, 2005).…”

“…For the ANOVAs, we therefore unified those participants with the participants who had a score of 1, together representing no/mild MTA (e.g. Gouw et al, 2006). No/mild atrophy was observed in 20 patients, moderate atrophy (score 2) in 35, severe atrophy (score 3) in 29 and very severe atrophy (score 4) in 10 patients.…”

Visualizing Recovery of Cognitive Function in Stroke

“…Lacunar strokes appear to be highly correlated with cognitive dysfunction in patients. Mild cognitive impairment superimposed on hippocampal atrophy translates to a severe, episodic memory disorder, while patients with mild cognitive impairment secondary to multiple subcortical infarcts display executive dysfunction [32]. In patients followed for 3 years post stroke, recurrent lacunar strokes and increased white matter hyperintensities on MRI were noted in 24% of patients which correlated with subsequent reduced functional outcomes as measured by Katz's Index of ADL [33].…”

Mild Cognitive Impairment and Normal Aging

“…Vascular MCI has been less extensively studied in the research literature, though data suggest that patients with vascular disease or signi fi cant vascular risk factors demonstrate poorer attention, executive function, visuospatial performance, and slower processing speed than patients without vascular risk factors [ 103,104 ] . [ 115,116 ] or Brief Visuospatial Memory Test-Revised [ 117 ] Wechsler Memory Scale III (Logical Memory) [ 118 ] Boston Naming Test [ 119 ] Controlled Oral Word Association [ 120 ] and Semantic Fluency (i.e., Animal Fluency) [ 121 ] Wisconsin Card Sorting Test [ 122 ] Clock Drawing and Copy [ 123 ] Finger Tapping Test [ 124 ] Grooved Pegboard [ 125 ] Geriatric Depression Scale [ 126 ] or Beck Depression Inventory, Second Edition [ 127 ] State-Trait Anxiety Inventory [ 128 ] …”