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Cognitive decline in possible vascular cognitive impairment (VCI): Does the form of vascular brain injury matter?
Author(s) -
Boomsma Jooske,
Exalto Lieza G.,
Barkhof Frederik,
Leeuwis Anna E.,
Prins Niels D.,
Scheltens Philip,
Teunissen Charlotte E.,
Weinstein Henry C.,
Biessels Geert Jan,
van der Flier Wiesje M
Publication year - 2021
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.052331
Subject(s) - hyperintensity , vascular dementia , dementia , cognitive decline , psychology , population , neuropsychology , executive dysfunction , medicine , cognition , traumatic brain injury , neuropsychological test , trail making test , white matter , cardiology , psychiatry , magnetic resonance imaging , radiology , disease , environmental health
Background Patients presenting at a memory clinic with possible VCI include a heterogeneous population in terms of cognitive profile, vascular brain injury and prognosis. Little is known about the trajectories of cognitive decline on cognitive test performance in relation to the different forms of vascular brain injury. Method We included 474 memory clinic patients(age 68(±8.2) years, 44% female, mean MMSE 25.9(±2.9), 212(44.7%) patients with dementia) from the prospective TRACE‐VCI cohort study with possible VCI; cognitive complaints and vascular brain injury on MRI. We assessed cognitive functioning at baseline and follow‐up(mean follow‐up time 2.5(±1.4) years, total of 1176 neuropsychological tests) including the Rey Auditory Verbal Learning Test(RAVLT) immediate and delayed recall(memory), the Trail Making Test(TMT) A and B(attention and executive functioning, respectively), category fluency(language) and MMSE. Linear mixed models were used to evaluate the effect of different forms of vascular brain injury on cognitive decline. Models included(dichotomized) terms for vascular brain injury(infarct(s), lacune(s), white matter hyperintensities(WMH), microbleed(s)), time and vascular brain injury*time. All models were adjusted for sex, age, diagnosis (dementia versus no dementia), education and medial temporal lobe atrophy(MTA) score(dichotomized as ≥1.5). Also, the models were evaluated in patients with a positive(+CSF‐AD) and negative(‐CSF‐AD) biomarker CSF Alzheimer profile. Result Vascular brain injury(multiple forms in one patient possible) consisted of infarct(s) in 54(11.4%), lacune(s) in 108(22.8%), moderate/severe WMH in 212(44.7%) and microbleed(s) in 203(42.8%) patients. In 164(54.3%) patients the MTA score was ≥1.5. We found no association between any form of vascular brain injury and baseline cognition. Infarct(s) showed an association with worsening on the TMTB(β;30.19,p=.00), especially in patients with a –CSF‐AD(β;65.93,p=.00). This effect was not found in patients with a +CSF‐AD(β;‐25.24,p=.18). Lacune(s) were associated with a rate of decline in immediate memory(β;1.62), delayed recall(β;.33), category fluency(β;.44) and MMSE(β;.46;all p<0.05). Infarct(s) were associated with a slower rate of decline on category fluency(β;.96,p=.01). We found no association between WMH, microbleed(s) and rate of cognitive decline. Conclusion In patients with possible VCI, infarct(s) were associated with steeper decline in executive functioning, especially in patients with a –CSF‐AD. Counterintuitively, the presence of lacune(s) and infarct(s) predisposed for a more favorable trajectory in memory.