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O4–04–04: Prevalence and influence on cognitive decline rate of subcortical vascular lesions in MCI subtypes
Author(s) -
Bombois Stephanie,
Debette Stephanie,
Delbeuck Xavier,
Delmaire Christine,
Bruandet Amelie,
Pasquier Florence
Publication year - 2006
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 - 10.1016/j.jalz.2006.05.321
Subject(s) - hyperintensity , medicine , neuropsychology , fluid attenuated inversion recovery , cardiology , temporal lobe , white matter , memory clinic , cognitive decline , cognitive impairment , psychology , magnetic resonance imaging , cognition , radiology , disease , psychiatry , dementia , epilepsy
Background: While the association of subcortical lesions with Alzheimer’s disease has been widely studied, no systematic evaluation of such lesions has been performed in patients with mild cognitive impairment (MCI). Objective(s): To describe the amount and the distribution of subcortical lesions on cerebral MRI and to test the association between these lesions and the cognitive decline in consecutive MCI patients referred to a memory clinic. Methods: A standardized neuropsychological examination and a cerebral MRI with FLAIR, proton density and T2-weighted scans were performed at baseline and, for the neuropsychological examination at 12 month follow-up. Subcortical hyperintensities (SH) including hyperintensities of the periventricular white matter (PVH), lobar white matter (WMH), basal ganglia (BG) and infratentorial foci of hyperintensity (ITF) were assessed with the Scheltens (1993) semi-quantitative rating scale (range:0-84). Results: We included 148 consecutive MCI patients (mean age: 66.2 9.9 years, women: 51.6%). The MCI subtypes were amnestic in 27.5%, multiple domain in 55.7%, and single non-memory domain in 16.8%. SH were observed in 137 patients (92.6% [95CI: 88.396.8%]), and predominated in the white matter (80.4% of the patients had PVH and 84.5% had WMH) compared to the BG (23.7%), and the ITF (23.0%). In a multivariable logistic regression a SH score 6 was more frequent with increasing age (OR 1.1[95%CI:1.0-1.2], p 0.0004), and temporal lobe atrophy (OR 2.0[95%CI:1.1-3.8], p 0.02), and was not associated with MCI subtype. The mean MMSE score was 28.1 1.2 at baseline. The mean duration of follow-up was 3.6 1.5 years. Over this follow-up period the MMSE score declined in 45.9% of the patients, remained unchanged in 24.3% and improved in 29.7%. The median SH score was 8[1-29] in the patients who declined, 7[0-31] in those who remained stable, and 3[0-28] in those who improved (p 0.004). The mean annual MMSE score decline was 0.3 1.2 points per year. In a random effects model, cognitive decline was more important with increasing PVH (p 0.02), independently of vascular risk factors, temporal lobe atrophy and cognitive pattern. Conclusions: SH were highly prevalent in MCI patients, whatever the clinical subtype, and were associated with increased cognitive decline, independently of vascular risk factors, temporal lobe atrophy and cognitive pattern.