The Effect of White Matter Low Attenuation on Cognitive Performance in Dementia of the Alzheimer Type

Amar, Khaled; Bucks, Romola S.; Lewis, Timothy; Scott, Margaret; Wilcock, Gordon

doi:10.1093/ageing/25.6.443

Cited by 34 publications

(29 citation statements)

References 25 publications

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“…Seven normal controls had incomplete batteries, and 8 of the 171 individuals with cognitive impairment either refused or were unable to complete one or more of the Boston naming, 3 Benton line orientation, 5 FAS fluency, 2 and digit span 3 tests. Six of these had probable AD and 2 had probable VaD.…”

Section: Resultsmentioning

confidence: 99%

“…In otherwise healthy elderly individuals, those with global atrophy and WMHI often show reduced speed of information processing and impaired executive function compared with those with neither atrophy nor WMHI. 3,4 Those with AD and WMHI show greater visuospatial dysfunction, 5 attention/concentration impairment, 6 slower cognitive processing, and greater executive dysfunction 6 than those with AD alone, but other studies find no neuropsychological differences between these 2 groups. [7][8][9] Functional imaging studies show different activation patterns in those with and without WMHI, suggesting that an equivalent level of cognitive impairment results from different mechanisms in AD with and without WMHI.…”

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confidence: 95%

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Independent Cognitive Effects of Atrophy and Diffuse Subcortical and Thalamico-Cortical Cerebrovascular Disease in Dementia

Swartz

Stuss²,

Gao³

et al. 2008

Stroke

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Background and Purpose-Brain atrophy, cortical infarction, and subcortical ischemic vasculopathy have all been associated with cognitive dysfunction. The interrelationships between these pathologies and their independent contributions to cognitive function remain unclear. Despite the high frequency of Alzheimer disease (AD) in those with clinically diagnosed vascular dementia, and the frequent findings of vascular disease in those with clinically diagnosed AD, many studies of brain-behavior relationships in dementia consider these populations separately. The present study sought to identify the correlates of independent domains of cognitive impairment in an unselected sample across a large range of severity and overlap of AD and VaD. Methods-Two hundred five individuals from the Sunnybrook Dementia Study recruited from a university Memory clinic had detailed neuropsychological testing and MRI quantification using a multi-step postprocessing algorithm. A factor analysis of the cognitive protocol yielded a 3-factor solution, provisionally labeled: (1) short-term memory and language, (2) attention and working memory, and (3) mental flexibility. Results-A factor analysis of brain measures identified 3 independent factors with measures of (1) brain atrophy, (2) subcortical vascular disease, and (3) strategic infarcts (anterior-medial thalamus and cortical infarcts). After accounting for the effects of age and education, measures of brain atrophy were the strongest correlates of all cognitive domains. Small vessel disease was independently associated with general severity, impaired short-term memory/language, and reduced mental flexibility, but not with poor working memory, presumably through disruption of frontal-subcortical connections. In contrast, strategic infarcts to anterior-medial thalamus and cortical gray matter were associated with poor short-term and working memory, but not with impairments in mental flexibility or global severity measures. Conclusions-These data support the hypothesis that the thalamico-cortical network subserves both short-term and working memory. The findings also suggest that each type of pathology (atrophy, small vessel disease, and strategic infarcts) contribute independently to the pattern of cognitive disabilities associated with dementia. Particular attention to cerebrovascular disease in deep white or gray matter structures of the thalamico-cortical system is certainly warranted.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 95%

Independent Cognitive Effects of Atrophy and Diffuse Subcortical and Thalamico-Cortical Cerebrovascular Disease in Dementia

Swartz

Stuss²,

Gao³

et al. 2008

Stroke

View full text Add to dashboard Cite

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“…In patients with Alzheimer's disease, widespread white matter lesions were associated with poorer performance, particularly in tests on attention (the digit span test), cognitive speed and visual recognition [5]. The following studies included only neurologically healthy, non-demented elderly men.…”

Section: Discussionmentioning

confidence: 99%

“…In magnetic resonance imaging studies, subcortical white matter lesions are related mainly to impairment in psychomotor speed, verbal fluency and attention [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The association between low diastolic blood pressure in middle age and cognitive function in old age. A population-based study

Kilander

Nyman²,

Boberg³

et al. 2000

Age and Ageing

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Background: previous longitudinal studies have shown an inverse relation between blood pressure and cognitive function. Objective: to determine the association between mid-life blood pressure and performance in different areas of cognitive function in late life. Subjects and methods: we recruited 502 men, aged 69-74 years, from a population-based cohort in Uppsala, Sweden. Blood pressure had been measured at age 50 and we examined performance in 13 psychometric tests about 20 years later. Results: after the 39 men with a previous stroke had been excluded, there was an inverse relation between diastolic blood pressure at age 50 and performance 20 years later in the digit span test, the trail-making tests and in verbal fluency. The relationships were significant, independently of age, education and previous occupational level. Men within the lowest category of diastolic blood pressure (Յ 70 mmHg, n = 59) showed the best results. Baseline blood pressure levels were not linked to performance in tasks on vocabulary, verbal learning and memory or figure copying. Conclusions: low blood pressure in mid-life indicates a low long-term cerebrovascular risk and is associated with higher late-life performance in cognitive tests that mainly assess subcortico-frontal cognitive functions.

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“…Mungas studied the MRI predictors of cognition in patients recruited from academic dementia centres and found that WML were weakly associated with measures of executive function [42]. Similarly, both Amar and Skoog showed in separate studies that WML in patients with dementia adversely affected performance on neuro-psychological testing [43,44]. Conversely, Steingart, in his early study on cognitive and neurologic Wndings in Alzheimer patients with WML, failed to show an association between poor psychometric performance and WML after adjusting for the effects of age, sex, education and the presence of cerebral infarctions [45].…”

Section: Discussionmentioning

confidence: 97%

SARS - a geriatrician's perspective

Sitoh¹

2003

Age and Ageing

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Significance of white matter lesions in patients with dementia 65 AbstractBackground: cerebral white matter lesions are commonly seen on neuroimaging in older people and have been associated with clinical features such as gait abnormalities, urinary incontinence and depression. The signiWcance of cerebral white matter lesions in older people with dementia remains uncertain. Objectives: to study the association between cerebral white matter lesions and the presence or absence of dementia in a group of elderly Asian patients; and to determine the clinical signiWcance of cerebral white matter lesions in patients who are diagnosed to have dementia in terms of associated clinical features and the impact of cerebral white matter lesions on cognitive status. Methods: for the Wrst objective, the records of 141 older people of Asian ethnicity presenting to a memory clinic for the evaluation of suspected dementia were reviewed to compare the prevalence of cerebral white matter lesions in patients who did not fulWl the criteria for dementia, patients diagnosed to have Alzheimer's disease and patients diagnosed to have vascular dementia. For the second objective, 115 of these patients who were diagnosed to have dementia were studied to determine if demented patients with cerebral white matter lesions were more likely to have urinary incontinence, Parkinsonism, depression and greater severity of dementia. In addition, a comparison was made between demented patients with cerebral white matter lesions and those without cerebral white matter lesions in terms of psychometric assessment scores. Results: cerebral white matter lesions were more common in Asian patients with vascular dementia. Demented patients with cerebral white matter lesions were also found to have more severe dementia and greater functional disability.

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The Effect of White Matter Low Attenuation on Cognitive Performance in Dementia of the Alzheimer Type

Cited by 34 publications

References 25 publications

Independent Cognitive Effects of Atrophy and Diffuse Subcortical and Thalamico-Cortical Cerebrovascular Disease in Dementia

Independent Cognitive Effects of Atrophy and Diffuse Subcortical and Thalamico-Cortical Cerebrovascular Disease in Dementia

The association between low diastolic blood pressure in middle age and cognitive function in old age. A population-based study

SARS - a geriatrician's perspective

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