MRI-Defined Subcortical Ischemic Vascular Disease: Baseline Clinical and Neuropsychological Findings

Abstract

Background: Subcortical ischemic vascular disease (SIVD) is a common, but often overlooked cause of vascular cognitive impairment. Diagnostic research criteria for SIVD are based on magnetic resonance imaging (MRI) findings including substantial white matter lesions (WML) and multiple lacunar infarcts. Empirical studies validating these imaging criteria are still few. The purpose of the study was to describe the clinical and cognitive characteristics of the MRI-defined SIVD in a mixed sample of functionally independent elderly subjects with WML. Methods: The subjects of the Leukoaraiosis and Disability (LADIS) study, aged 65–84 years, underwent comprehensive clinical and neuropsychological examinations, and brain MRI at the baseline assessment. The subjects meeting the SIVD imaging criteria (n = 89) were compared to the other subjects of the sample (n = 524). Results: SIVD was associated with lower education, hypertension and, independently, with obesity. The subjects with SIVD had more often motor impairment, a history of falls, and subtle impairment in activities of daily living, but they did not differ for depressive symptoms. SIVD subjects performed significantly inferiorly in tests of global cognitive function, psychomotor speed, attention and executive functions, verbal fluency, and working memory. Conclusion: In this population of nondisabled older adults with WML, SIVD was related to specific clinical and functional characteristics. Neuropsychological features included psychomotor slowing as well as deficits in attention and executive functions.

Diffusion Tensor Imaging and Gait in Elderly Persons With Cerebral Small Vessel Disease

“…Based on the former assessments, these 503 individuals had acute symptoms, such as TIA or lacunar syndrome (nϭ219), or subacute symptoms, such as cognitive disturbances (nϭ245), motor disturbances (nϭ97), depressive symptoms (nϭ100), or a combination thereof. A motor disturbance was defined in accordance with operationalization as used in other large-scale studies on cerebral SVD and gait 25 as follows: a reported history of Ն1 falls during the past year or a self-reported slowing of gait.…”

Heterogeneity in age-related white matter changes

“…Consequences on cognitive function represent a key clinical finding related to age-related white matter changes. White matter lesions affect executive function often severely enough to impair activities of daily life resulting from erroneous goal formation, planning, and organization [39][40][41]57]. Abstract reasoning is also commonly affected, but patients only suffer from mild memory deficits [38] with slight recognition and cueing difficulties [16].…”

Gait in Elderly With Cerebral Small Vessel Disease

“…These 503 individuals had symptoms of transient ischemic attack or lacunar syndrome (nϭ219), cognitive disturbances (nϭ245), motor disturbances (nϭ97), depressive symptoms (nϭ100), or a combination thereof. A motor disturbance was defined, in accordance with operationalization as used in other large-scale studies on cerebral SVD and gait, 16 as follows: a reported history of Ն1 falls during the past year or a self-reported slowing of gait. All participants signed an informed consent form.…”