Subcortical Vascular Dementia

Erkinjuntti, Timo

doi:10.1159/000049152

Cited by 111 publications

(74 citation statements)

References 17 publications

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“…During long-term treatment, attention improves, probably because of adaptation of the cerebral circulation to lower BP, and this accounts for improvement also of executive functions, in spite of the similar BP control and greater cerebrovascular damage. Our data confirm the presence of mild cognitive impairment in hypertensive subjects, involving mainly executive functions, 26,27 and the protective effect of antihypertensive treatment against cerebrovascular damage. 9 Association of IMT to cognitive dysfunction has already been shown in patients with cerebrovascular disease and dementia.…”

Section: Discussionsupporting

confidence: 84%

Blood pressure control has distinct effects on executive function, attention, memory and markers of cerebrovascular damage

et al. 2010

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Hypertension causes cognitive impairment, involving mainly executive functions, but the effect of blood pressure (BP) control on the different cognitive domains is still debated. We correlated executive function, attention and memory with BP control and cerebrovascular damage in 60 undemented middle-aged hypertensives at baseline and after 6-year follow-up. At first evaluation, the patients with poor BP control had higher score of white matter lesions, reduced cerebrovascular reserve capacity and greater carotid intima-media thickness (IMT) than those with good BP control. Performance on executive tests correlated with IMT and with performance on attention tests, which was impaired by low diastolic BP. At long-term follow-up, performance in attention and executive tests improved in spite of the minor improvement of BP control, increased IMT and worse memory. Low diastolic BP has a negative effect on attention, which affects executive performance at first cross-sectional examination. This confounding effect has to be taken into consideration when planning studies on cognitive function. Longitudinal studies are required to unravel the effect of BP control on cognitive function, as only long-term antihypertensive treatment improves both attention and executive performance.

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Section: Discussionsupporting

confidence: 84%

Blood pressure control has distinct effects on executive function, attention, memory and markers of cerebrovascular damage

et al. 2010

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“…16 Because the onset of cerebral SVD is often insidious, clinically heterogeneous, and typically with mild symptoms, it has been suggested that the selection of subjects with cerebral SVD in clinical studies should be based on the more consistent brain imaging features. 17 Inclusion criteria were age between 50 and 85 years and cerebral SVD on neuroimaging (WML and/or lacunar infarct). Subsequently, the aforementioned acute or subacute clinical symptoms of SVD were assessed by standardized structured assessments (a questionnaire for TIA and stroke; 18 the Cognitive Failures Questionnaire, which also includes executive functions, for cognition; 19 the Falls Questionnaire 20 and the Freezing of Gait Questionnaire for gait; 21 and the Center of Epidemiological Studies-Depression scale 22 and use of antidepressive medication for depressive symptoms.…”

Section: Methodsmentioning

confidence: 99%

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

Laat

Norden

Gons

et al. 2011

Stroke

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Background and Purpose-Although cerebral small vessel disease, including white matter lesions (WML) and lacunar infarcts, is associated with gait disturbances, not all individuals with small vessel disease have these disturbances. Identical-appearing WML on MRI could reflect different degrees of microstructural integrity. Moreover, conventional MRI does not assess the integrity of normal-appearing white matter (NAWM). We therefore investigated the relation between white matter integrity assessed by diffusion tensor imaging in WML, NAWM, several regions of interest, and gait. Methods-A total of 484 nondemented elderly persons between 50 and 85 years old with cerebral small vessel disease were included in this analysis and underwent MRI and diffusion tensor imaging scanning. Mean diffusivity and fractional anisotropy within WML, NAWM, and regions of interest were related to quantitative and semiquantitative gait parameters. Results-Mean diffusivity in the WML was inversely related with gait (velocity ␤ϭϪ0.15; Pϭ0.002). For the fractional anisotropy, this relation was less evident. The same was found in the NAWM (velocity ␤ϭϪ0.21; PϽ0.001) and for some parameters also after additional adjustment for WML and lacunar infarcts. Conclusion-This study indicates that integrity of both WML and NAWM, beyond the detection limit of conventional MRI, is associated with gait disturbances. (Stroke. 2011;42:373-379.)

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“…As suggested for clinical studies, patients were primarily selected on brain imaging features, because clinical symptoms of SVD are more heterogeneous and typically mild at the onset of cerebral SVD. 16 Therefore, inclusion criteria were (1) age between 50 and 85 years; and (2) WMLs and/or lacunar infarct(s) on neuroimaging. Subsequently, acute (transient ischemic attack or lacunar syndrome) or subacute (cognitive, motor or depressive) symptoms of SVD were assessed by standardized structured assessments.…”

Section: Study Populationmentioning

confidence: 99%

Cerebral White Matter Lesions and Lacunar Infarcts Contribute to the Presence of Mild Parkinsonian Signs

Laat

Norden

Gons

et al. 2012

Stroke

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Background and Purpose-Mild parkinsonian signs (MPS) are common in elderly people and may be an early stage of parkinson(ism). They might be related to cerebral small-vessel disease, although this association remains incompletely understood. To identify subjects at early stages of the disease, we investigated whether the presence of MPS was dependent on the severity and location of small-vessel disease, including white matter lesions and lacunar infarcts. Methods-Four hundred thirty individuals, with small-vessel disease, aged between 50 and 85 years, without dementia or parkinsonism, were included in this analysis and underwent MRI scanning. The number and location of lacunar infarcts were rated. White matter lesion volume was assessed by manual segmentation with automated delineating of different regions. Presence of MPS was based on the motor section of the Unified Parkinson's Disease Rating Scale. Associations were determined using logistic regression analysis adjusted for age, sex, and total brain volume. Results-Severe white matter lesions and the presence of lacunar infarcts were independently associated with the presence of MPS (OR, 2.6; 95% CI, 1.3-4.9 and OR, 1.8; 95% CI, 1.0 -3.0). Frontal and parietal white matter lesions and, to a lesser extent, lacunar infarcts in the thalamus were associated with a higher risk of MPS. The presence of lacunar infarcts was independently related to the bradykinesia category of parkinsonian signs. Conclusions-This study shows that severe small-vessel disease, especially at certain locations, is associated with MPS signs in older adults. Our findings suggest that small-vessel disease interrupts basal ganglia-thalamocortical circuits involving both the frontal and parietal lobes and hence may result in MPS. (Stroke. 2012;43:2574-2579.)

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Subcortical Vascular Dementia

Cited by 111 publications

References 17 publications

Blood pressure control has distinct effects on executive function, attention, memory and markers of cerebrovascular damage

Blood pressure control has distinct effects on executive function, attention, memory and markers of cerebrovascular damage

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

Cerebral White Matter Lesions and Lacunar Infarcts Contribute to the Presence of Mild Parkinsonian Signs

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