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Brain atrophy accelerates cognitive decline in cerebral small vessel disease

2012; Lippincott Williams & Wilkins; Volume: 78; Issue: 22 Linguagem: Inglês

10.1212/wnl.0b013e3182583070

1526-632X

Hanna Jokinen, Jari Lipsanen, Reinhold Schmidt, Franz Fazekas, Alida A. Gouw, Wiesje M. van der Flier, Frederik Barkhof, S. Madureira, Ana Verdelho, José M. Ferro, Anders Wallin, Leonardo Pantoni, Domenico Inzitari, Timo Erkinjuntti, Timo Erkinjuntti, Tarja Pohjasvaara, Pia Pihanen, Raija Ylikoski, Hanna Jokinen, Meija-Marjut Somerkoski, Riitta Mäntylä, Oili Salonen, Franz Fazekas, Reinhold Schmidt, Stefan Ropele, Brigitte Rous, Katja Petrovic, Ulrike Garmehi, Alexandra Seewann, José M. Ferro, Ana Verdelho, Sofia Madureira, Carla Moleiro, Philip Scheltens, Elisabeth C.W. van Straaten, Frederik Barkhof, Alida A. Gouw, Wiesje M. van der Flier, Anders Wallin, Michael Jonsson, K. Lind, Arto Nordlund, Sindre Rolstad, Ingela Isblad, Lars‐Olof Wahlund, Milita Crisby, Ånna Pettersson, Kaarina Amberla, Hugues Chabriat, K. Hernandez, Annie Kurtz, Dominique Hervé, Sarah Benisty, J.-P. Guichard, Michael G. Hennerici, Christian Blahak, Hansjörg Bäezner, Martin Wiarda, Susanne Seip, Gunhild Waldemar, Egill Rostrup, Charlotte Ryberg, Tim B. Dyrby, Olaf B. Paulson, Ellen Garde, Kristian Steen Frederiksen, John T. O’Brien, Sanjeet Pakrasi, Mani S. Krishnan, Andrew Teodorczuk, Michael Firbank, Philip English, Thaı́s Minett, Domenico Inzitari, Luciano Bartolini, Anna Basile, Eliana Magnani, Monica Martini, Mario Mascalchi, Marco Moretti, Leonardo Pantoni, Anna Poggesi, Giovanni Pracucci, Emilia Salvadori, Michela Simoni,

Cerebrovascular and genetic disorders

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. AD= : Alzheimer disease; DSM-IV = : Diagnostic and Statistical Manual of Mental Disorders, 4th edition; FLAIR= : fluid-attenuated inversion recovery; LADIS= : Leukoaraiosis and Disability; MMSE= : Mini-Mental State Examination; MPRAGE= : magnetization-prepared rapid gradient echo; MTA= : medial temporal lobe atrophy; SVD= : small vessel disease; VADAS= : Vascular Dementia Assessment Scale; WML= : white matter lesion