The Contribution of Medial Temporal Lobe Atrophy and Vascular Pathology to Cognitive Impairment in Vascular Dementia

Bastos-Leite, António J.; Flier, Wiesje M. van der; Straaten, E.C.W. van; Staekenborg, Salka S.; Scheltens, Philip; Barkhof, Frederik

doi:10.1161/strokeaha.107.490102

Cited by 113 publications

(74 citation statements)

References 26 publications

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“…4 -6 MTA has been shown to be present not only in patients with AD but also in other dementias (like VaD and DLB). [22][23][24] This is in line with our noticeable, though nonsignificant, Ͼ2-fold, increased risk of MTA for progression to a non-Alzheimer dementia.…”

Section: Discussionsupporting

confidence: 84%

Progression of Mild Cognitive Impairment to Dementia

Staekenborg

Koedam

Henneman

et al. 2009

Stroke

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123

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Background and Purpose-We sought to determine the predictive value of magnetic resonance imaging measures of vascular disease (white matter hyperintensities [WMHs], lacunes, microbleeds, and infarcts) compared with atrophy on the progression of mild cognitive impairment to dementia. Methods-We included 152 consecutive patients with mild cognitive impairment. Baseline magnetic resonance imaging was used to determine the presence of medial temporal lobe atrophy and vascular disease (presence of lacunes, microbleeds, and infarcts was determined, and WMHs were rated on a semiquantitative scale). Patients were followed up for 2Ϯ1 years. Results-Seventy-two (47%) patients progressed to dementia during follow-up. Of these, 56 (37%) patients were diagnosed with Alzheimer's disease, and 16 (10%) patients were diagnosed with a non-Alzheimer dementia (including vascular dementia, frontotemporal lobar degeneration, and Parkinson dementia). Converters were older and had a lower Mini-Mental State Examination score at baseline. On baseline magnetic resonance imaging, patients who progressed to a non-Alzheimer dementia showed more severe WMHs and had a higher prevalence of lacunes in the basal ganglia and microbleeds compared with nonconverters. Cox proportional-hazard models showed that, adjusted for age and sex, baseline medial temporal lobe atrophy (hazard ratioϭ2.9; 95% CI, 1.7 to 5.3), but not vascular disease, was associated with progression to Alzheimer's disease. By contrast, deep WMHs (hazard ratioϭ5.7; 95% CI, 1.2 to 26.7) and periventricular hyperintensities (hazard ratioϭ6.5; 95% CI, 1.4 to 29.8) predicted progression to non-Alzheimer dementia. Furthermore, microbleeds (hazard ratioϭ2.6; 95% CI, 0.9 to 7.5) yielded a Ͼ2-fold increased, though nonsignificant, risk of non-Alzheimer dementia. Conclusion-Medial

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Section: Discussionsupporting

confidence: 84%

Progression of Mild Cognitive Impairment to Dementia

Staekenborg

Koedam

Henneman

et al. 2009

Stroke

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123

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“…Of the atrophy measures, MTA had the strongest individual contribution to cognition, as it independently predicted both baseline performance and longitudinal decline in a wide range of cognitive domains including global cognitive function, psychomotor speed, executive functions, and memory. The role of MTA in global cognitive decline has been suggested by earlier studies in cross-sectional 1,10,11 and longitudinal 31 settings. In subjects with vascular changes, MTA has been strongly associated with memory impairment, [11][12][13] but also with deficits in other domains such as mental speed 12 and executive functions.…”

Section: Figure 2 Combined Effects Of White Matter Lesions (Wml) and mentioning

confidence: 85%

“…In subjects with vascular changes, MTA has been strongly associated with memory impairment, [11][12][13] but also with deficits in other domains such as mental speed 12 and executive functions. 1,13 Independently of MTA and WML volume, global brain atrophy was also associated with baseline performance and the rate of cognitive decline. This effect was more strongly accounted by subcortical than cortical atrophy.…”

Section: Figure 2 Combined Effects Of White Matter Lesions (Wml) and mentioning

confidence: 96%

Brain atrophy accelerates cognitive decline in cerebral small vessel disease

Jokinen¹,

Lipsanen²,

Schmidt

et al. 2012

Neurology

133

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Objective: To examine the independent contributions and combined interactions of medial temporal lobe atrophy (MTA), cortical and subcortical atrophy, and white matter lesion (WML) volume in longitudinal cognitive performance. Methods:A total of 477 subjects with age-related WML were evaluated with brain MRI and annual neuropsychological examinations in 3-year follow-up. Baseline MRI determinants of cognitive decline were analyzed with linear mixed models controlling for multiple confounders.Results: MTA and subcortical atrophy predicted significantly steeper rate of decline in global cognitive measures as well as compound scores for psychomotor speed, executive functions, and memory after adjusting for age, gender, education, lacunes/infarcts, and WML volume. Cortical atrophy independently predicted decline in psychomotor speed. WML volume remained significantly associated with cognitive decline even after controlling for the atrophy scores. Moreover, significant synergistic interactions were found between WML and atrophy measures in overall cognitive performance across time and the rate of cognitive decline. Synergistic effects were also observed between baseline lacunar infarcts and all atrophy measures on change in psychomotor speed. The main results remained robust after exclusion of subjects with clinical stroke or incident dementia, and after additional adjustments for progression of WML and lacunes.Conclusions: Brain atrophy and WML are independently related to longitudinal cognitive decline in small vessel disease. MTA, subcortical, and cortical atrophy seem to potentiate the effect of WML and lacunes on cognitive decline. Neurology ® 2012;78:1785-1792

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“…Last, hippocampal atrophy is known to lack specificity, as it can be present in non-AD forms of dementia, like vascular dementia [19,20], semantic dementia [21], Parkinson's dementia [20], and frontotemporal lobar degeneration [22]. Interestingly, EADC centers seem to endorse the notion that the amyloid cascade stays at the core of the pathophysiology of AD.…”

Section: Discussionmentioning

confidence: 99%

The use of biomarkers for the etiologic diagnosis of MCI in Europe: An EADC survey

Bocchetta

Galluzzi

Kehoe

et al. 2014

Alzheimer's & Dementia

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We investigated the use of Alzheimer's disease (AD) biomarkers in European Alzheimer's Disease Consortium centers and assessed their perceived usefulness for the etiologic diagnosis of mild cognitive impairment (MCI). We surveyed availability, frequency of use, and confidence in diagnostic usefulness of markers of brain amyloidosis (amyloid positron emission tomography [PET], cerebrospinal fluid [CSF] Ab42) and neurodegeneration (medial temporal atrophy [MTA] on MR, fluorodeoxyglucose positron emission tomography [FDG-PET], CSF tau). The most frequently used biomarker is visually rated MTA (75% of the 37 responders reported using it "always/ frequently") followed by CSF markers (22%), FDG-PET (16%), and amyloid-PET (3%). Only 45% of responders perceive MTA as contributing to diagnostic confidence, where the contribution was rated as "moderate". Seventy-nine percent of responders felt "very/extremely" comfortable delivering a diagnosis of MCI due to AD when both amyloid and neuronal injury biomarkers were abnormal (P , .02 versus any individual biomarker). Responders largely agreed that a combination of amyloidosis and neuronal injury biomarkers was a strongly indicative AD signature.

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The Contribution of Medial Temporal Lobe Atrophy and Vascular Pathology to Cognitive Impairment in Vascular Dementia

Abstract: Background and Purpose-Besides cerebrovascular disease, medial temporal lobe atrophy (MTA), a neuroimaging finding suggestive of degenerative pathology, has been shown in vascular dementia (VaD

Cited by 113 publications

References 26 publications

Progression of Mild Cognitive Impairment to Dementia

Progression of Mild Cognitive Impairment to Dementia

Brain atrophy accelerates cognitive decline in cerebral small vessel disease

The use of biomarkers for the etiologic diagnosis of MCI in Europe: An EADC survey

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