Neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease

Starkstein, Sergio E.; Sabe, Liliana; Vázquez, Silvia; Lorenzo, Guillermo; Martinez, Andrew B.; Petracca, Gustavo; Tesón, Alejandra; Chemerinski, Erán; Leiguarda, R

doi:10.1136/jnnp.63.1.66

Cited by 86 publications

(89 citation statements)

References 38 publications

(27 reference statements)

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“…72 Positive associations between WM changes and psychiatric symptoms have been reported in subjects without dementia. 73,74 Although previous studies have failed to find a relationship between WM changes and neurobehavioral signs in patients with dementia, 14,21,28,30 the present study clearly demonstrated that WM changes were involved in the development of aberrant motor behaviors. Aberrant motor behaviors, including wandering, pacing, and rummaging, belong to repetitive and excessive behaviors, which are likely to be caused by frontal lobe dysfunction.…”

Section: Discussionmentioning

confidence: 52%

Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease

Hirono

Kitagaki

Kazui

et al. 2000

Stroke

176

123

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Background and Purpose-There have been conflicting results involving the clinical significance of white matter changes in patients with Alzheimer's disease (AD). We studied the association between the volume of white matter hyperintensities (WMHs) on T2-weighted images and cognitive, neurological, and neuropsychiatric symptoms. Methods-The subjects were 76 AD patients who had WMHs but no obvious cerebrovascular diseases. We quantified the volume of WMHs by using fast-fluid-attenuated inversion recovery images and whole brain atrophy by using 3D spoiled gradient-echo images. Effects of WMHs and brain atrophy on dementia severity, cognitive function, neuropsychiatric disturbances, and neurological findings were examined. Results-Whole brain atrophy was significantly associated with dementia severity and cognitive disturbances, as well as with grasp reflex and some kinds of neuropsychiatric disturbances. After we controlled for the effects of brain atrophy, duration of symptoms, and demographic factors, we found that WMH volume was not associated with global cognitive disturbances or dementia severity but was significantly associated with urinary incontinence, grasp reflex, and aberrant motor behaviors. Brain atrophy and WMH volume were not significantly correlated either before or after controlling for age, sex, education, and duration of symptoms. WMH volume was associated with hypertension, but brain atrophy was not positively correlated with any vascular risk factors. Conclusions-Our results support the hypothesis that WMHs in AD patients are superimposed phenomena of vascular origin. WMHs contribute to specific neurological and neuropsychiatric manifestations but not to global cognitive impairment, which is more closely associated with brain atrophy. (Stroke. 2000;31:2182-2188.)

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Section: Discussionmentioning

confidence: 52%

Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease

Hirono

Kitagaki

Kazui

et al. 2000

Stroke

176

123

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“…3 Because WMH most probably represent ischemic small vessel disease, 1,4 we hypothesized that subjects with diffuse confluent WMH should have lower cerebral blood flow (CBF) measurements than subjects with punctiform or beginning confluent WMH. In fact, single-photon emission CT, positron-emission tomography, and dynamic susceptibility contrast perfusion-weighted MR imaging studies have shown that diffuse confluent WMH are associated with reduced cerebral perfusion, [5][6][7] but most of them did not yield quantification of CBF. To our knowledge, no previous study has shown a relation between different grades of WMH and CBF measurements by means of ASL.…”

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confidence: 99%

Cerebral Blood Flow by Using Pulsed Arterial Spin-Labeling in Elderly Subjects with White Matter Hyperintensities

Bastos-Leite¹,

Kuijer²,

Rombouts³

et al. 2008

AJNR Am J Neuroradiol

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AND PURPOSE: On MR imaging, white matter hyperintensities (WMH) on T2-weighted images are generally considered as a surrogate marker of ischemic small vessel disease in elderly subjects. Pulsed arterial spin-labeling (PASL) is a noninvasive MR perfusion-weighted technique. We hypothesized that elderly subjects with diffuse confluent WMH should have lower cerebral blood flow (CBF) measurements than subjects with punctiform or beginning confluent WMH.

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“…Some studies have found relationships between various BPSD and subcortical lesions (foremost in the white matter) in AD. These include positive associations with anxiety [6], aberrant motor behavior [6,7], apathy [8] and depression [9] as well as a trend for delusions [6]. However, other studies have failed to confirm these associations [10,11,12,13].…”

Section: Introductionmentioning

confidence: 95%

“…One way of examining its independent impact on BPSD is to adjust for atrophy (both global and temporal) and cognitive ability, which are closely related to AD pathology and disease severity [23,24,25]. Unfortunately, many previous studies did not adjust for atrophy [6,8,9]. …”

Section: Introductionmentioning

confidence: 99%

“…The overrepresentation of the lesions in AD could be explained by the reserve capacity hypothesis, a mutual interaction or perhaps a common risk factor [20]. Patients with subcortical lesions have reduced cerebral perfusion [8] and recent data show that the lesions independently predict functional and cognitive decline in healthy elderly [21,22]. The association with function and cognition in AD is less apparent or nonexistent, probably due to the overshadowing effect of the AD pathology [7,17].…”

Section: Introductionmentioning

confidence: 99%

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Association between Subcortical Lesions and Behavioral and Psychological Symptoms in Patients with Alzheimer's Disease

Palmqvist

Sarwari

Wattmo

et al. 2011

Dement Geriatr Cogn Disord

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Background/Aims: The most devastating features of Alz-heimer's disease (AD) are often the behavioral and psychological symptoms in dementia (BPSD). There is controversy as to whether subcortical lesions contribute to BPSD. The aim of this study was to examine the relationship between BPSD and subcortical lesions (white-matter lesions and lacunes) in AD. Methods: CT or MRI from 259 patients with mild-to-moderate AD were assessed with the Age-Related White Matter Changes scale. Linear measures of global and temporal atrophy and Mini-Mental State Examination scores were used to adjust for AD pathology and disease severity in logistic regression models with the BPSD items delusions, hallucinations, agitation, depression, anxiety, apathy and irritability. Results: Lacunes in the left basal ganglia were asso-ciated with delusions (OR 2.57, 95% CI 1.21-5.48) and hallucinations (OR 3.33, 95% CI 1.38-8.01) and lacunes in the right basal ganglia were associated with depression (OR 2.13, 95% CI 1.01-4.51). Conclusion: Lacunes in the basal ganglia resulted in a 2- to 3-fold increased risk of delusions, hallucinations and depression, when adjusting for cognition and atrophy. This suggests that basal ganglia lesions can contribute to BPSD in patients with AD, independently of the AD process.

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Neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease

Cited by 86 publications

References 38 publications

Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease

Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease

Cerebral Blood Flow by Using Pulsed Arterial Spin-Labeling in Elderly Subjects with White Matter Hyperintensities

Association between Subcortical Lesions and Behavioral and Psychological Symptoms in Patients with Alzheimer's Disease

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