Simple versus complex assessment of white matter hyperintensities in relation to physical performance and cognition: the LADIS study

Gouw, Alida A.; Flier, Wiesje M. van der; Straaten, E.C.W. van; Barkhof, Frederik; Ferro, José M.; Baezner, Hansjoerg; Pantoni, Leonardo; Inzitari, Domenico; Erkinjuntti, Timo; Wahlund, Lars Olof; Waldemar, Gunhild; Schmidt, Reinhold; Fazekas, Franz; Scheltens, Philip

doi:10.1007/s00415-006-0193-5

Cited by 109 publications

(90 citation statements)

References 33 publications

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“…The present observations suggest that this differential relation of RSS DWMH and PWMH with cognition might be caused by the accuracy of the RSS DWMH scale and does not necessarily indicate that DWMH and PWMH have differential effects on cognition. A number of previous studies have compared different WMH scoring methods, including volumetry, in relation to cognitive function [28,29,30]. In a small study involving 39 patients with vascular dementia, volumetric assessment was superior to visual assessment, but these results cannot directly be applied to patients with a lower lesion load [28].…”

Section: Discussionmentioning

confidence: 99%

Automated and Visual Scoring Methods of Cerebral White Matter Hyperintensities: Relation with Age and Cognitive Function

Tiehuis¹,

Vincken²,

Mali³

et al. 2007

Cerebrovasc Dis

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Background and Purpose: A reliable scoring method for ischemic cerebral white matter hyperintensities (WMH) will help to clarify the causes and consequences of these brain lesions. We compared an automated and two visual WMH scoring methods in their relations with age and cognitive function. Methods: MRI of the brain was performed on 154 participants of the Utrecht Diabetic Encephalopathy Study. WMH volumes were obtained with an automated segmentation method. Visual rating of deep and periventricular WMH (DWMH and PWMH) was performed with the Scheltens scale and the Rotterdam Scan Study (RSS) scale, respectively. Cognition was assessed with a battery of 11 tests. Results: Within the whole study group, the association with age was most evident for the automated measured WMH volume (β = 0.43, 95% CI = 0.29–0.57). With regard to cognition, automated measured WMH volume and Scheltens DWMH were significantly associated with information processing speed (β = –0.22, 95% CI = –0.40 to –0.06; β = –0.26, 95% CI = –0.42 to –0.10), whereas RSS PWMH were associated with attention and executive function (β = –0.19, 95% CI = –0.36 to –0.02). Conclusion: Measurements of WMH with an automated quantitative segmentation method are comparable with visual rating scales and highly suitable for use in future studies to assess the relationship between WMH and subtle impairments in cognitive function.

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Section: Discussionmentioning

confidence: 99%

Automated and Visual Scoring Methods of Cerebral White Matter Hyperintensities: Relation with Age and Cognitive Function

Tiehuis¹,

Vincken²,

Mali³

et al. 2007

Cerebrovasc Dis

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“…WMH volumetry can not be regarded as such, as WMH volumetry is equal to visual scales with respect to associations with clinical measures such as physical performance and cognition [22]. Furthermore, the sample that was used in this study consisted of consecutive Amsterdam participants of the LADIS study that was stratified for WMH grade in order to include a wide range of WMH.…”

Section: Discussionmentioning

confidence: 99%

Reliability and Sensitivity of Visual Scales versus Volumetry for Evaluating White Matter Hyperintensity Progression

Gouw¹,

Flier²,

Straaten³

et al. 2008

Cerebrovasc Dis

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Background: Investigating associations between the change of white matter hyperintensities (WMH) and clinical symptoms over time is crucial for establishing a causal relationship. However, the most suitable method for measuring WMH progression has not been established yet. We compared the reliability and sensitivity of cross-sectional and longitudinal visual scales with volumetry for measuring WMH progression. Methods: Twenty MRI scan pairs (interval 2 years) were included from the Amsterdam center of the LADIS study. Semi-automated volumetry of WMH was performed twice by one rater. Three cross-sectional scales (Fazekas Scale, Age-Related White Matter Changes Scale, Scheltens Scale) and two progression scales (Rotterdam Progression Scale, Schmidt Progression Scale) were scored by 4 and repeated by 2 raters. Results: Mean WMH volume (24.6 ± 27.9 ml at baseline) increased by 4.6 ± 5.1 ml [median volume change (range) = 2.7 (–0.6 to 15.7) ml]. Measuring volumetric change in WMH was reliable (intraobserver:intraclass coefficient = 0.88). All visual scales showed significant change of WMH over time, although the sensitivity was highest for both of the progression scales. Proportional volumetric change of WMH correlated best with the Rotterdam Progression Scale (Spearman’s r = 0.80, p < 0.001) and the Schmidt Progression Scale (Spearman’s r = 0.64, p < 0.01). Although all scales were reliable for assessment of WMH cross-sectionally, WMH progression assessment using visual scales was less reliable, except for the Rotterdam Progression scale which had moderate to good reliability [weighted Cohen’s ĸ = 0.63 (intraobserver), 0.59 (interobserver)]. Conclusion: To determine change in WMH, dedicated progression scales are more sensitive and/or reliable and correlate better with volumetric volume change than cross-sectional scales.

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“…Separate DWM hyperintensity was graded as 0=absent, 1=punctuate foci, 2=beginning confluence of foci, or 3=large confluent areas. 26 This scale previously has been validated as a reliable measure for degree of LA with good interrater reliability, [27][28][29][30] and has been used extensively to grade severity of LA in stroke and in epidemiological studies. 8,17,29,30 …”

Section: Data Recordingmentioning

confidence: 99%

Leukoaraiosis on Magnetic Resonance Imaging Correlates With Worse Outcomes After Spontaneous Intracerebral Hemorrhage

Caprio

Maas

Rosenberg³

et al. 2013

Stroke

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Background and Purpose-Leukoaraiosis (LA) is associated with dementia, ischemic stroke, and intracerebral hemorrhage (ICH), but there are few data on how LA might impact outcomes after acute ICH. We tested the hypothesis that the severity of LA on magnetic resonance imaging is related to worse functional outcomes after spontaneous ICH. Methods-We prospectively identified patients with spontaneous acute ICH. LA was identified on magnetic resonance imaging and its severity was graded using the Fazekas method to include a score for the deep white matter and periventricular regions. Outcomes were obtained at 14 days, 28 days, and 3 months with the modified Rankin Scale (mRS; a validated scale from 0 [no symptoms] to 6 [dead]) and analyzed with multivariate logistic regression. Results-Higher Fazekas total (periventricular plus deep white matter) score correlated with higher mRS score at 14 days (P=0.02) and 3 months (P=0.02). This relationship was driven by the periventricular score, for which higher score (more severe disease) correlated with higher National Institute of Health Stroke Scale at 14 days (P=0.03), and higher mRS score at 14 days (P<0.001), 28 days (P=0.004), and 3 months (P=0.005). A higher (more severe) Fazekas periventricular score was associated with dependence or death at 3 months (odds ratio, 1.8 per point; 95% confidence interval, 1.02-3.1; P=0.04) after correction for the ICH score. Conclusions-Increased LA is an independent predictor of worse functional outcomes in patients after spontaneous ICH.The pathophysiology associating LA with worse outcomes requires further study.

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Simple versus complex assessment of white matter hyperintensities in relation to physical performance and cognition: the LADIS study

Abstract: Simple and complex measures of WMH yield comparable associations with measures of physical performance and cognition. This suggests that a simple visual rating scale may be sufficient, when analyzing relationships between clinical parameters and WMH in a clinical setting.

Cited by 109 publications

References 33 publications

Automated and Visual Scoring Methods of Cerebral White Matter Hyperintensities: Relation with Age and Cognitive Function

Automated and Visual Scoring Methods of Cerebral White Matter Hyperintensities: Relation with Age and Cognitive Function

Reliability and Sensitivity of Visual Scales versus Volumetry for Evaluating White Matter Hyperintensity Progression

Leukoaraiosis on Magnetic Resonance Imaging Correlates With Worse Outcomes After Spontaneous Intracerebral Hemorrhage

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