Journal of Neurology

, Volume 255, Issue 3, pp 360–366

Cognitive function correlates with frontal white matter apparent diffusion coefficients in patients with leukoaraiosis

  • M. Viana-Baptista
  • P. Bugalho
  • C. Jordão
  • N. Ferreira
  • Á. Ferreira
  • M. Forjaz Secca
  • J. A. Esperança-Pina
  • J. M. Ferro
ORIGINAL COMMUNICATION

Abstract

Background and aims

Diffusion weighted imaging (DWI) displays a high sensitivity to white matter changes, even in areas where no lesions are visible. Correlation with vascular risk factors and cognitive dysfunction seems to be feasible using this technique. We aimed to test relations between age, blood pressure and cognitive function,with lesion load and average Apparent Diffusion Coefficient (ADC) values in lesioned (LWM) and in normal appearing white matter (NAWM), in patients with age related white matter lesions (ARWML).

Methods

Subjects were 29 patients (mean age 72.6 ± 5.2 years) with different severity of ARWML on MRI and no (or mild) disability assessed by the Instrumental Activities of Daily Living Scale. Imaging lesion load was quantified in bilateral frontal, temporal, parieto-occipital, basal ganglia and infratentorial regions, using a simple visual rating scale; ADC was measured bilaterally in Regions of Interest in parieto-occipital and frontal NAWM, and in frontal periventricular LWM. Neuropsychological examination consisted of Raven Colored Progressive Matrices, Rey’s Complex Figure, Digit Canceling. Symbol digit Substitution, Inverse Digit Repetition and Verbal Fluency tests.

Results

Visual scales scores and ADC were significantly higher in frontal and parieto-occipital regions. Both were significantly correlated to age and blood pressure, in frontal (visual scale scores and ADC) and parieto-occipital regions (ADC). Attention skills were negatively correlated to ADC in LWM and NAWM in frontal regions and with frontal region visual scale scores.

Conclusion

Our findings suggest that severity of white matter ischemic changes is correlated with worse cognitive function, as well as advanced age and higher blood pressure.A higher vulnerability of frontal white matter to vascular disease seems to play an important role in executive dysfunction, mainly determined by impairment of attentional skills.DWI results suggest this could be true even for NAWM.

Key words

leukoaraiosis diffusion weighted imaging aging frontal lobe executive function 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hachinski VC, Potter P, Merskey H (1987) Leuko-araiosis. Arch Neurol 44(1):21–23PubMedGoogle Scholar
  2. 2.
    Pantoni L, Garcia JH (1995) The significance of cerebral white matter abnormalities 100 years after Binswanger’s report. A review. Stroke 26(7):1293–1301PubMedGoogle Scholar
  3. 3.
    O'Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler JV, Ballard C, DeCarli C, Gorelick PB, Rockwood K, Burns A, Gauthier S, DeKosky ST (2003) Vascular cognitive impairment. Lancet Neurol 2(2):89–98PubMedCrossRefGoogle Scholar
  4. 4.
    Tupler LA, Coffey CE, Logue PE, Djang WT, Fagan SM (1992) Neuropsychological importance of subcortical white matter hyperintensity. Arch Neurol 49(12):1248–1252PubMedGoogle Scholar
  5. 5.
    Awad IA, Spetzler RF, Hodak JA, Awad CA, Carey R (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke 17(6):1084–1089PubMedGoogle Scholar
  6. 6.
    Hunt AL, Orrison WW, Yeo RA, Haaland KY, Rhyne RL, Garry PJ, Rosenberg GA (1989) Clinical significance of MRI white matter lesions in the elderly Neurology 39(11):1470–1474PubMedGoogle Scholar
  7. 7.
    Schmidt R, Fazekas F, Offenbacher H, Dusek T, Zach E, Reinhart B, Grieshofer P, Freidl W, Eber B, Schumacher M et al. (1993) Neuropsychologic correlates of MRI white matter hyperintensities: a study of 150 normal volunteers. Neurology 43(12):2490–2494PubMedGoogle Scholar
  8. 8.
    Helenius J, Soinne L, Salonen O, Kaste M, Tatlisumak T (2002) Leukoaraiosis, ischemic stroke, and normal white matter on diffusion-weighted MRI. Stroke 33(1):45–50PubMedCrossRefGoogle Scholar
  9. 9.
    Sullivan EV, Adalsteinsson E, Hedehus M, Ju C, Moseley M, Lim KO, Pfefferbaum A (2001) Equivalent disruption of regional white matter microstructure in ageing healthy men and women. Neuroreport 12(1):99–104PubMedCrossRefGoogle Scholar
  10. 10.
    Charlton RA, Barrick TR, McIntyre DJ, Shen Y, O’Sullivan M, Howe FA, Clark CA, Morris RG, Markus HS (2006) White matter damage on diffusion tensor imaging correlates with agerelated cognitive decline. Neurology 66(2):217–222PubMedCrossRefGoogle Scholar
  11. 11.
    Head D, Buckner RL, Shimony JS, Williams LE, Akbudak E, Conturo TE, McAvoy M, Morris JC, Snyder AZ (2004) Differential vulnerability of anterior white matter in nondemented aging with minimal acceleration in dementia of the Alzheimer type: evidence from diffusion tensor imaging. Cereb Cortex 14(4):410–423PubMedCrossRefGoogle Scholar
  12. 12.
    Madden DJ, Whiting WL, Huettel SA, White LE, MacFall JR, Provenzale JM (2004) Diffusion tensor imaging of adult age differences in cerebral white matter: relation to response time. Neuroimage 21(3):1174–1181PubMedCrossRefGoogle Scholar
  13. 13.
    O'Sullivan M, Jones DK, Summers PE, Morris RG, Williams SC, Markus HS (2001) Evidence for cortical “disconnection” as a mechanism of agerelated cognitive decline. Neurology 57(4):632–638PubMedGoogle Scholar
  14. 14.
    Pfefferbaum A, Sullivan EV, Hedehus M, Lim KO, Adalsteinsson E, Moseley M (2000) Age-related decline in brain white matter anisotropy measured with spatially corrected echo-planar diffusion tensor imaging. Magn Reson Med 44(2):259–268PubMedCrossRefGoogle Scholar
  15. 15.
    Shenkin SD, Bastin ME, Macgillivray TJ, Deary IJ, Starr JM, Rivers CS, Wardlaw JM (2005) Cognitive correlates of cerebral white matter lesions and water diffusion tensor parameters in community-dwelling older people. Cerebrovasc Dis 20(5):310–318PubMedCrossRefGoogle Scholar
  16. 16.
    O'Sullivan M, Morris RG, Huckstep B, Jones DK, Williams SC, Markus HS (2004) Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis. J Neurol Neurosurg Psychiatry 75(3):441–447PubMedCrossRefGoogle Scholar
  17. 17.
    Lawton MP, Brody EM (1969) Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186PubMedGoogle Scholar
  18. 18.
    American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th ed. ) Washington, DC: American Psychiatric AssociationGoogle Scholar
  19. 19.
    Raven JC, Court JH, Raven J (1977) Manual for Raven’s Progressive Matrices and Vocabulary Scales. London, HK LewisGoogle Scholar
  20. 20.
    Lezak MD (1983) Neuropsychological Assessment. 2nd ed. New York, NY: Oxford Univer PressGoogle Scholar
  21. 21.
    Ferris SH (2003) General measures of cognition. Int Psychogeriatr 15 (Suppl 1):215–217PubMedCrossRefGoogle Scholar
  22. 22.
    Wahlund LO BF, Fazekas F, Bronge L, Augustin M, Sjogren M, Wallin A, Ader H, Leys D, Pantoni L, Pasquier F, Erkinjuntti T, Scheltens P (2001) European Task Force on Age-Related White Matter Changes. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke 32:1318–1322PubMedGoogle Scholar
  23. 23.
    de Groot JC, de Leeuw FE, Oudkerk M, van Gijn J, Hofman A, Jolles J, Breteler MM (2000) Cerebral white matter lesions and cognitive function: the Rotterdam Scan Study. Ann Neurol 47(2):145–151PubMedCrossRefGoogle Scholar
  24. 24.
    Kramer JH, Reed BR, Mungas D, Weiner MW, Chui HC (2002) Executive dysfunction in subcortical ischaemic vascular disease. J Neurol Neurosurg Psychiatry 72(2):217–220PubMedCrossRefGoogle Scholar
  25. 25.
    Price CC, Jefferson AL, Merino JG, Heilman KM, Libon DJ (2005) Subcortical vascular dementia: integrating neuropsychological and neuroradiologic data. Neurology 65(3):376–382PubMedCrossRefGoogle Scholar
  26. 26.
    Koga H, Yuzuriha T, Yao H, Endo K, Hiejima S, Takashima Y, Sadanaga F, Matsumoto T, Uchino A, Ogomori K, Ichimiya A, Uchimura H, Tashiro N (2002) Quantitative MRI findings and cognitive impairment among community dwelling elderly subjects. J Neurol Neurosurg Psychiatry 72(6):737–741PubMedCrossRefGoogle Scholar
  27. 27.
    Gunning-Dixon FM, Raz N (2003) Neuroanatomical correlates of selected executive functions in middle-aged and older adults: a prospective MRI study. Neuropsychologia 41(14):1929–1941PubMedCrossRefGoogle Scholar
  28. 28.
    O'Brien JT, Wiseman R, Burton EJ, Barber B, Wesnes K, Saxby B, Ford GA (2002) Cognitive associations of subcortical white matter lesions in older people. Ann N Y Acad Sci 977:436–444PubMedCrossRefGoogle Scholar
  29. 29.
    Heilman KH, Valenstein E (2003) Clinical Neuropsychology. 4th ed. New York, NY: Oxford Univer PressGoogle Scholar
  30. 30.
    Prins ND, van Dijk EJ, den Heijer T, Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM (2004) Cerebral white matter lesions and the risk of dementia. Arch Neurol 61(10):1531–1534PubMedCrossRefGoogle Scholar
  31. 31.
    Pergener TV (1998) What’s wrong with Bonferroni adjustments. BMJ 316:1236–1238Google Scholar

Copyright information

© Steinkopff-Verlag 2008

Authors and Affiliations

  • M. Viana-Baptista
    • 1
    • 7
  • P. Bugalho
    • 1
  • C. Jordão
    • 2
  • N. Ferreira
    • 3
  • Á. Ferreira
    • 3
  • M. Forjaz Secca
    • 2
    • 4
  • J. A. Esperança-Pina
    • 5
  • J. M. Ferro
    • 6
  1. 1.Neurology Department, Hospital de Egas Moniz (CHLO)Faculty of Medical Sciences, Universidade Nova de LisboaPortugal
  2. 2.Ressonância Magnética de CaselasLisboaPortugal
  3. 3.Neuropsychology DepartmentHospital de Egas Moniz (CHLO)LisboaPortugal
  4. 4.CEFITEC, Dept. of PhysicsUniversidade Nova de LisboaPortugal
  5. 5.Anatomy Department, Faculty of Medical Sciences Universidade Nova de LisboaPortugala
  6. 6.Neurology Department, Faculty of MedicineHospital Santa MariaLisboaPortugal
  7. 7.Dept. of NeurologyHospital de Egas MonizLisboaPortugal

Personalised recommendations