MRI load of cerebral microvascular lesions and neurodegeneration, cognitive decline, and dementia

Wang, Rui; Laveskog, Anna; Laukka, Erika J.; Kalpouzos, Grégoria; Bäckman, Lars; Fratiglioni, Laura; Qiu, Chengxuan

doi:10.1212/wnl.0000000000006355

Cited by 37 publications

(46 citation statements)

References 39 publications

(62 reference statements)

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“…However, previous studies have shown that not only the presence or absence of lacunar infarcts 15 and WMH predicts dementia, but the number of lacunar infarcts and the severity of WMH have additional predictive value. 15,19 Therefore we constructed an amended score in which there were a number of categories for both the number of lacunar infarcts and the severity of WMH. This amended score appeared to improve the predictive ability slightly.…”

Section: Discussionmentioning

confidence: 99%

Simple MRI score aids prediction of dementia in cerebral small vessel disease

et al. 2020

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ObjectiveTo determine whether a simple small vessel disease (SVD) score, which uses information available on rapid visual assessment of clinical MRI scans, predicts risk of cognitive decline and dementia, above that provided by simple clinical measures. Methods Three prospective longitudinal cohort studies (SCANS [St George's Cognition and Neuroimaging in Stroke], RUN DMC [Radboud University Nijmegen Diffusion Imaging and Magnetic Resonance Imaging Cohort], and the ASPS [Austrian StrokePrevention Study]), which covered a range of SVD severity from mild and asymptomatic to severe and symptomatic, were included. In all studies, MRI was performed at baseline, cognitive tests repeated during follow-up, and progression to dementia recorded prospectively. Outcome measures were cognitive decline and onset of dementia during follow-up. We determined whether the SVD score predicted risk of cognitive decline and future dementia. We also determined whether using the score to select a group of patients with more severe disease would reduce sample sizes for clinical intervention trials. ResultsIn a pooled analysis of all 3 cohorts, the score improved prediction of dementia (area under the curve [AUC], 0.85; 95% confidence interval [CI], 0.81-0.89) compared with that from clinical risk factors alone (AUC, 0.76; 95% CI, 0.71-0.81). Predictive performance was higher in patients with more severe SVD. Power calculations showed selecting patients with a higher score reduced sample sizes required for hypothetical clinical trials by 40%-66% depending on the outcome measure used. ConclusionsA simple SVD score, easily obtainable from clinical MRI scans and therefore applicable in routine clinical practice, aided prediction of future dementia risk.

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Section: Discussionmentioning

confidence: 99%

Simple MRI score aids prediction of dementia in cerebral small vessel disease

et al. 2020

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“…Therefore, comparisons to our results in this regard could not be made. 49 In contrast, we used quantitative WMH volume as a continuous predictor and 3 cognitive domains as outcomes rather than global cognitive score in our study.…”

Section: Discussionmentioning

confidence: 99%

APOE ε4, white matter hyperintensities, and cognition in Alzheimer and Lewy body dementia

et al. 2019

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ObjectiveTo determine if APOE ε4 influences the association between white matter hyperintensities (WMH) and cognitive impairment in Alzheimer disease (AD) and dementia with Lewy bodies (DLB).MethodsA total of 289 patients (AD = 239; DLB = 50) underwent volumetric MRI, neuropsychological testing, and APOE ε4 genotyping. Total WMH volumes were quantified. Neuropsychological test scores were included in a confirmatory factor analysis to identify cognitive domains encompassing attention/executive functions, learning/memory, and language, and factor scores for each domain were calculated per participant. After testing interactions between WMH and APOE ε4 in the full sample, we tested associations of WMH with factor scores using linear regression models in APOE ε4 carriers (n = 167) and noncarriers (n = 122). We hypothesized that greater WMH volume would relate to worse cognition more strongly in APOE ε4 carriers. Findings were replicated in 198 patients with AD from the Alzheimer's Disease Neuroimaging Initiative (ADNI-I), and estimates from both samples were meta-analyzed.ResultsA significant interaction was observed between WMH and APOE ε4 for language, but not for memory or executive functions. Separate analyses in APOE ε4 carriers and noncarriers showed that greater WMH volume was associated with worse attention/executive functions, learning/memory, and language in APOE ε4 carriers only. In ADNI-I, greater WMH burden was associated with worse attention/executive functions and language in APOE ε4 carriers only. No significant associations were observed in noncarriers. Meta-analyses showed that greater WMH volume was associated with worse performance on all cognitive domains in APOE ε4 carriers only.ConclusionAPOE ε4 may influence the association between WMH and cognitive performance in AD and DLB.

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“…Moreover, the EPVS score in the region of basal ganglia significantly correlated to the severity of tremor and the EPVS score in the region of centrum semiovale was much higher in PD patients of PIGD motor phenotype than that in patients of the non PIGD motor phenotype. Currently, clinical studies have mainly focused on investigating the association between EPVS and cognitive impairment, poor blood pressure control or disease worsening in patients with dementia (Wang et al., ), stroke (Liu et al., ), or systematic inflammation (Cavallari et al., ). The relevant studies proposed that a higher EPVS severity degree might result in impaired cerebrovascular reactivity, blood‐brain barrier dysfunction and perivascular inflammation in the diseases (Brown et al., ).…”

Section: Discussionmentioning

confidence: 99%

Exploring the association between Cerebral small‐vessel diseases and motor symptoms in Parkinson's disease

Wan

Gan

et al. 2019

Brain and Behavior

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Objectives to explore the association between cerebral small‐vessel diseases (CSVDs) and motor symptoms in Parkinson's disease (PD). Methods 137 PD patients were recruited into the study. Detailed motor symptoms, including tremor, rigidity, bradykinesia, and axial impairment, were evaluated using Unified Parkinson's disease Rating Scale (UPDRS). Non‐motor symptoms, including cognition, anxiety, and depression, were evaluated using Montreal Cognitive Assessment (MoCA), Hamilton anxiety scale (HAMA), and Hamilton depression scale (HAMD). Brain MRI was used to assess the subtypes of CSVDs, including lacunes, enlarged perivascular spaces (EPVS), and white matter hyperintensities (WMH). WMH were furtherly divided into deep WMH (DWMH) and periventricular hyperintensities (PVH). The association between CSVDs and motor symptoms was analyzed. Patients were divided into the postural instability and gait disability (PIGD) group and non‐PIGD group. Demographic, clinical and CSVDs variables were compared between the two groups. Results CSVDs subtypes were all detected in the participants with different prevalence rates and severity degrees. We found a close association between EPVS in basal ganglia and the tremor score (p = 0.032), and between DWMH in the frontal and occipital lobes and the axial motor score (p < 0.05) through the spearman and multivariate liner regression analysis. Compared with the non‐PIGD group, the PIGD group demonstrated more serious cognitive impairment and DWMH in the frontal and occipital lobes (p < 0.05). The demographic characteristics and vascular risk factors of the PIGD group were not different from those of the non‐PIGD group. Cognitive impairment and DWMH in the frontal lobe were identified to be independent risk factors of PIGD motor phenotype. Conclusions We identified a close association between the CSVDs and motor symptoms in PD and DWMH in the frontal lobe was a risk factor of PIGD motor phenotype, which supports the contribution of vascular pathology in PD.

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MRI load of cerebral microvascular lesions and neurodegeneration, cognitive decline, and dementia

Cited by 37 publications

References 39 publications

Simple MRI score aids prediction of dementia in cerebral small vessel disease

Simple MRI score aids prediction of dementia in cerebral small vessel disease

APOE ε4, white matter hyperintensities, and cognition in Alzheimer and Lewy body dementia

Exploring the association between Cerebral small‐vessel diseases and motor symptoms in Parkinson's disease

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