White Matter Microstructural Damage in Small Vessel Disease Is Associated With Montreal Cognitive Assessment But Not With Mini Mental State Examination Performances

Abstract

Background and Purpose-Montreal Cognitive Assessment (MoCA) has been proposed as a screening tool in vascular cognitive impairment. Diffusion tensor imaging is sensitive to white matter microstructural damage. We investigated if diffusion tensor imaging-derived indices are more strongly associated with performances on MoCA or on the widely used mini mental state examination in patients with mild cognitive impairment and small vessel disease. Methods-Mild cognitive impairment patients with moderate/severe degrees of white matter hyperintensities on MRI were enrolled. Lacunar infarcts, cortical atrophy, medial temporal lobe atrophy and median values of mean diffusivity and fractional anisotropy of the cerebral white matter were studied and correlated with cognitive tests performances. Results-Seventy-six patients (mean age 75.1±6.8 years, mean years of education 8.0±4.3) were assessed. In univariate analyses, a significant association of both MoCA and mini mental state examination scores with age, education, cortical atrophy, and medial temporal lobe atrophy was found, whereas mean diffusivity and fractional anisotropy were associated with MoCA. In partial correlation analyses, adjusting for all demographic and neuroimaging variables, both mean diffusivity and fractional anisotropy were associated only with MoCA (mean diffusivity: r= −0.

Using DTI to assess white matter microstructure in cerebral small vessel disease (SVD) in multicentre studies

“…In contrast, we found no independent associations between WMH lesion load and cognition and only two for brain volume (with MoCA and EuroQoL). This is in-line with most previous literature from single-centre studies, which have found weak or absent associations between WMH and cognition in patients with severe symptomatic SVD [8,29,39]. However, it has been previously shown, as we also have, that the presence and number of lacunar infarcts [8,38] and the extent of diffuse WM damage assessed on DTI [8,12,29,31,38,39], are the strongest predictors of cognitive functioning.…”

“…This is in-line with most previous literature from single-centre studies, which have found weak or absent associations between WMH and cognition in patients with severe symptomatic SVD [8,29,39]. However, it has been previously shown, as we also have, that the presence and number of lacunar infarcts [8,38] and the extent of diffuse WM damage assessed on DTI [8,12,29,31,38,39], are the strongest predictors of cognitive functioning. Furthermore, both have been shown to predict risk of dementia in longitudinal studies [41,42], while lacunes and the apparent diffusion coefficient (a diffusion-weighted imaging measure highly similar to MD) have also been shown to predict future cognitive decline [43,44].…”

“…Supplementary Table S2 details these papers and includes key findings from each study. Of note, one of these [39] is a multicentre study across three sites using identical 1.5T scanners and acquisition sequences, with MoCA and MMSE as cognitive measures.…”

White matter microstructural damage and depressive symptoms in patients with mild cognitive impairment and cerebral small vessel disease: the VMCI‐Tuscany Study

“…The Vascular MCI‐Tuscany Study is an ongoing multicenter, prospective, observational study aimed at evaluating predictors of the transition from MCI to dementia in a cohort of SVD patients. The rationale and methodology are fully described in previous papers (Poggesi et al ., ; Pasi et al ., ). In brief, to be included, patients, referred from neurologic or geriatric clinics, had to be classified as affected by MCI with SVD according to the following inclusion criteria: (i) MCI defined according to the criteria of Winblad et al .…”

Have Stroke Neurologists Entered the Arena of Stroke-Related Cognitive Dysfunctions?

“…2 These data are also in agreement with previous studies showing that the MoCA is more specifically associated with microstructural damage in white matter than the Mini Mental State Examination. 3 Some issues, such as the appropriate normality cutoffs for these tests, remain open, but these studies, however, have the great merit of raising a series of relevant points concerning the cognitive costs of cerebrovascular diseases.…”