Do white matter changes contribute to the subsequent development of dementia in patients with mild cognitive impairment? A longitudinal study

Wolf, Henrike; Ecke, Gustav Martin; Bettin, S.; Dietrich, Joachim; Gertz, Hermann‐Josef

doi:10.1002/1099-1166(200009)15:9<803::aid-gps190>3.3.co;2-n

Cited by 46 publications

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“…One previous study 13 found an association between white matter changes on CT-scan and conversion to AD in 27 MCI patients. Another study 14 failed to demonstrate any association between vascular lesions on cerebral MRI and conversion to dementia in 52 MCI patients and found that the impairment in memory and executive performance were the best predictors of conversion.…”

Section: Discussionmentioning

confidence: 99%

“…Another study 14 failed to demonstrate any association between vascular lesions on cerebral MRI and conversion to dementia in 52 MCI patients and found that the impairment in memory and executive performance were the best predictors of conversion. Compared to the first study where white matter changes were probably quite extensive to be visible on CT-scan, 13 large volumes of white matter lesions were uncommon in the second study, 14 reducing the power to detect an effect of these lesions. Furthermore, none of these studies assessed the relationship between subcortical lesions and conversion to different types of dementia.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies have investigated the association of subcortical lesions with conversion to dementia in MCI patients, 13,14 providing conflicting results. In a previous paper, we have shown that the annual rate of global cognitive decline in MCI patients was higher with increasing amounts of subcortical, and especially periventricular hyperintensities on cerebral MRI at baseline, irrespective of the MCI subtype.…”

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confidence: 96%

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Vascular Subcortical Hyperintensities Predict Conversion to Vascular and Mixed Dementia in MCI Patients

Bombois

Debette

Bruandet

et al. 2008

Stroke

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Background and Purpose-Patients with mild cognitive impairment (MCI) have an increased risk of dementia. The identification of predictors of conversion to dementia is therefore important. The aim of our study was to test the hypothesis that subcortical hyperintensities (SH) are associated with an increased rate of conversion to dementia in MCI patients. Methods-This was an observational study on consecutive MCI patients attending a memory clinic. We assessed SH on a baseline MRI scan, using a semiquantitative rating scale.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 96%

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Vascular Subcortical Hyperintensities Predict Conversion to Vascular and Mixed Dementia in MCI Patients

Bombois

Debette

Bruandet

et al. 2008

Stroke

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“…7,8 WMH may also increase the likelihood of progression from MCI to dementia 8,9 and are associated with reduced performance on several neuropsychological tasks in patients with Alzheimer disease (AD). [10][11][12] Debate persists, however, regarding differences in the extent and regional distribution of WMH between cognitively normal older individuals (CN) and those with MCI or AD.…”

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Extent and distribution of white matter hyperintensities in normal aging, MCI, and AD

et al. 2006

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Objective-To analyze the extent and spatial distribution of white matter hyperintensities (WMH) in brain regions from cognitively normal older individuals (CN) and patients with mild cognitive impairment (MCI) and Alzheimer disease (AD).Methods-We studied 26 mild AD, 28 MCI, and 33 CN. MRI analysis included quantification of WMH volume, nonlinear mapping onto a common anatomic image, and spatial localization of each WMH voxel to create an anatomically precise frequency distribution map. Areas of greatest frequency of WMH from the WMH composite map were used to identify 10 anatomic regions involving periventricular areas and the corpus callosum (CC) for group comparisons.Results-Total WMH volumes were associated with age, extent of concurrent vascular risk factors, and diagnosis. After correcting for age, total WMH volumes remained significantly associated with diagnosis and extent of vascular risk. Regional WMH analyses revealed significant differences in WMH across regions that also differed significantly according to diagnosis. In post-hoc analyses, significant differences were seen between CN and AD in posterior periventricular regions and the splenium of the CC. MCI subjects had intermediate values at all regions. Repeated measures analysis including vascular risk factors in the model found a significant relationship between periventricular WMH and vascular risk that differed by region, but regional differences according to diagnosis remained significant and there was no interaction between diagnosis and vascular risk.Conclusions-Differences in white matter hyperintensities (WMH) associated with increasing cognitive impairment appear related to both extent and spatial location. Multiple regression analysis of regional WMH, vascular risk factors, and diagnosis suggest that these spatial differences may result from the additive effects of vascular and degenerative injury. Posterior periventricular and corpus callosum extension of WMH associated with mild cognitive impairment and Alzheimer disease indicate involvement of strategic white matter bundles that may contribute to the cognitive deficits seen with these syndromes.White matter hyperintensities (WMH) are areas of increased signal on T2-weighted and fluid-attenuated inversion recovery (FLAIR) MRI sequences of the brain. In this study, we applied image segmentation and nonlinear image mapping techniques to determine the extent and spatial location of WMH among CN, MCI, and AD. We then tested whether differences in anatomic distribution were associated with cognitive status and vascular risk. The CDR score was determined independently of neuropsychological information according to published protocol. In addition, participants received a standardized MRI scan of the brain at the baseline evaluation. Methods SubjectsThe institutional review boards at all participating institutions approved this study, and subjects or their legal representatives gave written informed consent. Vascular risk factorsThe presence or absence of six cerebrovascular risk fact...

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“…To our knowledge, this hypothesis has not been evaluated yet. Two studies have investigated the association of subcortical lesions with the rate of conversion to overt dementia, 16,17 and they provided conflicting results. The first study found that white-matter changes on computed tomography scans were associated with a higher rate of conversion to AD in 27 MCI patients.…”

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Subcortical Hyperintensities Are Associated With Cognitive Decline in Patients With Mild Cognitive Impairment

Debette

Bombois

Bruandet

et al. 2007

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110

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Background and Purpose-It has been suggested that subcortical lesions may influence cognitive performances at early stages of cognitive impairment but not in late stages of dementia. We aimed to test whether cognitive decline is associated with subcortical hyperintensities in patients with mild cognitive impairment (MCI). Methods-We included 170 consecutive MCI patients (mean follow-up, 3.8Ϯ1.6 years). We assessed subcortical hyperintensities on a baseline magnetic resonance imaging scan with a semiquantitative rating scale. The mean annual cognitive decline was calculated with the Mini-Mental State Examination and the Dementia Rating Scale at baseline and the end of follow-up. Results-Compared with patients whose cognitive performances remained stable or improved during follow-up, patients whose cognitive performances declined often had a larger amount (greater than the median of the distribution) of periventricular (PVH) (Pϭ0.0005) and white-matter (Pϭ0.02) hyperintensities. The rate of cognitive decline was higher with increasing PVH: mean change in the Mini-Mental State Examination scoreϭ0.16 vs Ϫ0.66 points/year in patients with PVH in the first versus third tertile (Pϭ0.0002). The rate of decline in executive functioning was also higher with increasing PVH: mean change in the Dementia Rating Scale initiation subscoreϭϪ0.05 vs Ϫ1.42 points/year in patients with PVH in the first versus third tertile (Pϭ0.04). These associations were independent of vascular risk factors, temporal lobe atrophy, and MCI subtype and were stronger in patients with baseline executive dysfunction. Conclusion-White-matter hyperintensities and especially PVH were significantly associated with cognitive decline in MCI patients. This result was independent of the MCI subtype but stronger in cases of executive dysfunction at baseline.

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Do white matter changes contribute to the subsequent development of dementia in patients with mild cognitive impairment? A longitudinal study

Cited by 46 publications

References 0 publications

Vascular Subcortical Hyperintensities Predict Conversion to Vascular and Mixed Dementia in MCI Patients

Vascular Subcortical Hyperintensities Predict Conversion to Vascular and Mixed Dementia in MCI Patients

Extent and distribution of white matter hyperintensities in normal aging, MCI, and AD

Subcortical Hyperintensities Are Associated With Cognitive Decline in Patients With Mild Cognitive Impairment

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