Progressive Gray Matter Atrophy in Lacunar Patients with Vascular Mild Cognitive Impairment

Abstract

Background and Method: We investigated the progression of cognitive and cerebral changes in 30 patients with a first-ever lacunar infarct (LI): 15 with vascular mild cognitive impairment (MCI-V) and 15 without cognitive impairment. All cases were followed up 18 ± 6 months after the stroke and underwent neurological, neuropsychological and MRI assessments at baseline and longitudinally. Results: Differences in the changes in cognitive function over time were observed between the 2 groups, with the MCI-V patients showing slight memory improvements and frontal-lobe-related test impairments from baseline to follow-up evaluations. At baseline, the 2 groups presented similar white matter hyperintensity (WMH) ratings and whole brain gray matter (GM) volumes, and at the follow-up evaluations, both groups had increased WMH lesions and decreased GM volumes; no statistical differences between groups were found. In contrast, a voxel-based morphometry analysis revealed that only MCI-V patients presented clear regional GM volume losses between the first and the second evaluations in cortical (frontal and temporal) and subcortical (pons, cerebellum and caudate) regions. Conclusion: Frontal lobe dysfunction and regional cortical and subcortical GM atrophy best differentiate the clinical course of LI patients with and without cognitive impairment.

A Dark Side of Subcortical Diffusion-Weighted Lesions?

“…Prior studies have also shown an association between subcortical infarcts and focal cortical thinning with neuropsychological impairment. [32][33][34] In theory, this could contribute to a worse long-term prognosis with cognitive decline in patients with subcortical infarcts, which may be worse in patients with larger subcortical infarcts considering the potentially larger number of disrupted axons as compared with smaller lacunar infarcts. Differences in cortical atrophy and cognitive deficits between LSI and LI could be a relevant topic for future studies.…”

Alteraciones neuropsicológicas asociadas en pacientes con infarto lacunar.

“…Por otra parte, Grau-Olivares et al (2010) realizaron una investigación con 30 pacientes con infarto lacunar único, estudiando dos grupos, uno con DCVL y otro sin DCVL, con el objetivo de observar la progresión de la alteración cognoscitiva y los cambios cerebrales asociados. Los pacientes con DCVL presentaron mayor progresión (a los 18 ± 6 meses DE) del déficit cognoscitivo global, y específicamente, en el deterioro de funciones como atención y memoria de trabajo; no obstante, observaron una mejoría en el reconocimiento de la memoria visual.…”

Alterations of the cerebral cortex in sporadic small vessel disease: A systematic review of in vivo MRI data

“…Two reports were based on the same small cohort, in which patients were recruited after a first small subcortical ischemic stroke with separate reports of cross-sectional, 27 and longitudinal analyses. 28 Another cohort comprised 100 patients with any type of ischemic stroke and confluent WMH (60 from these 100 patients had a small subcortical ischemic stroke) and was the basis of two different reports. 24,25 In the fifth study, patients were included if they had a history of small subcortical ischemic stroke or a radiologic report of lacune.…”

“…27,28 In seven studies, lacunes were defined as lesions appearing hyperintense on T2 sequence and hypointense on T1 sequence and Flair sequences, and rated either by splitting the population according to the presence and absence of lacunes 19,21 or by assessing the number and/ or volume of lacunes. 20,[26][27][28] Lacunes were not assessed in one study 22 or assessed globally with other infarct types in two others. 24,25 The number of microbleeds was only assessed in two studies based on the same cohort.…”

“…Cross-sectional analyses showed a significant association between cortical gray matter estimates and the extent of WMH that did not persist in longitudinal analyses. 27,28 This discrepancy may be explained by the 25% of loss of follow-up in the longitudinal study and by the lack of adjustment for multiple comparisons in cross-sectional analyses. No association between cortical estimates obtained through VBM analyses and lacunes was reported.…”