Clinical characteristics in subcortical ischemic white matter disease

Abstract

-Background: Vascular white matter lesions (WML) represent one of the main neuroimage findings in individuals older than 65 years and its clinical significance is still partially understood. Objective: To describe and analyze the clinical profile of a high severity sample with WML focusing on the frontal executive control. Method: Outpatients (n=20) with high severity WML evaluated with magnetic resonance imaging were selected using the Fazekas scale. Results: Most patients (n=17; 85%) presented an altered Trail Making Test ratio (section B/section A); on verbal fluency, 15 individuals (75%) performed below the cutoff score. Apathy (5.9±4.65) and depression (3.05±3.67) were frequent as assessed by the Neuropsychiatric Inventory. The impairment in functional activities strongly correlated with apathy (r=0.814, p<0.001) and verbal fluency (r=0.744, p<0.001). Conclusion: Executive dysfunction, apathy, and ratio depression were the main characteristics found. Extension of WML may have distinct impact on the clinical picture, but further studies with methodological adjustments are necessary to provide more definitive conclusions.KEy WOrds: neuropsychology, cognition, behavior, function, vascular dementia, white matter lesions.Características clínicas na doença isquêmica da substância branca subcortical resumo -Fundamento: Lesões vasculares em substância branca (LsB) são um dos principais achados de neuroimagem em indivíduos acima de 65 anos e sua importância em termos clínicos é ainda parcialmente conhecida. Objetivo: descrever e analisar o perfil clínico de amostra com LsB grave enfocando as alterações do controle executivo frontal. Método: Pacientes ambulatoriais (n=20) avaliados pela ressonância nuclear magnética e com maior proporção de LsB foram selecionados através da escala de Fazekas. Resultados: A maioria dos pacientes (n=17; 85%) apresentou alteração na proporção teste das trilhas (seção B/A); na fluência verbal, 15 indivíduos (75%) apresentaram desempenho abaixo do ponto de corte. Apatia (5,9±4,65) e depressão (3,05±3,67) foram freqüentes na avaliação pelo Inventário Neuropsiquiátrico. O prejuízo nas atividades funcionais correlacionou-se fortemente à apatia (r=0, 814, p<0,001) e à fluência verbal (r=0, 744, p<0,001). Conclusão: disfunção executiva, apatia e depressão foram as principais características encontradas. A extensão e localização das LsB parecem exercer um impacto distinto nas manifestações clínicas, porém estudos futuros com ajustes metodológicos são necessários para conclusões mais definitivas.PALAVrAs-chAVE: neuropsicologia, cognição, comportamento, função, demência vascular, lesões de substância branca.

The Extension of the German CERAD Neuropsychological Assessment Battery with Tests Assessing Subcortical, Executive and Frontal Functions Improves Accuracy in Dementia Diagnosis

“…In a recent study, executive functions such as measured by TMTB showed predictive accuracy comparable to that of MRI and cerebrospinal fluid biomarkers for the development of AD in amnestic MCI [48]. In types of dementia other than AD, impairment in TMTB, psychomotor speed and verbal fluency even dominate the clinical profile of patients, for example, in VaD and MD [49] as well as in patients with vascular white matter lesions. Impaired verbal fluency [19,50] and reduced speed of processing on the TMT [51] may be caused by subcortical or frontal lesions, the same functions are known to be affected in patients with small vessel disease, which is related to progressive cognitive impairment and a considerable risk of developing dementia [52].…”

Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response

“…Several clinical observations and neuroimaging studies support the notion that apathy may emerge from frontosubcortical network dysfunction and ACC abnormality. Apathy is common in elderly individuals with prominent vascular white matter lesions(Alves et al, 2009; Lavretsky et al, 2007) and focal frontal lobe and basal ganglia lesions(Chase, 2011; Levy and Dubois, 2006). Among various neurodegenerative diseases, apathy develops early and prominently in dementias with greater frontosubcortical pathology (Huntington's, Lewy Body, Parkinson's and HIV dementia)(Chase, 2011; Quaranta et al, 2012; Starkstein et al, 2006), and, in the case of Alzheimer's disease, apathy correlates with neurofibrillary tangle density in the ACC(Marshall et al, 2006) and reduced grey matter volume and metabolic activity of the ACC(Apostolova et al, 2007; Bruen et al, 2008; Marshall et al, 2007; Starkstein et al, 2009).…”

Vascular risk factors, depression, and cognitive change among African American older adults

“…In addition, VRFs often serve as predictors of cognitive ability including processing speed and memory, and in terms of performance on general cognition measures such as the Mini Mental State Examination (MMSE; Sheline et al, 2006;Bielak et al, 2011;Freiheit et al, 2012). Depression has also been linked to increased WMHs among older adults (Jorm et al, 2005;Alves et al, 2009;Sawyer et al, 2012). In sum, individuals with greater vascular burden may be at greater risk for depression and cognitive change, and the prevalence and magnitude of these relationships require further investigation.…”