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Predictors for cognitive decline in patients with confluent white matter hyperintensities
Author(s) -
Mok Vincent,
Xiong Yunyun,
Wong Kelvin K.,
Wong Adrian,
Schmidt Reinhold,
Chu Winnie W.C.,
Hu Xintao,
Lung Leung Eric Yim,
Chen Sirong,
Chen Yangkun,
Tang Wai Kwong,
Chen Xiangyan,
Ho Chi Lai,
Wong Ka Sing,
Wong Stephen T.C.
Publication year - 2012
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.2011.10.004
Subject(s) - dementia , cognitive decline , clinical dementia rating , hyperintensity , stroke (engine) , cardiology , medicine , mini–mental state examination , psychology , hyperlipidemia , atrophy , rating scale , disease , magnetic resonance imaging , endocrinology , radiology , developmental psychology , diabetes mellitus , mechanical engineering , engineering
Background Although patients harboring confluent white matter hyperintensities (WMH) are at high risk of cognitive decline, this risk varies among individuals. We investigated the predictors for cognitive decline in stroke patients with confluent WMH. Methods We followed up 100 stroke patients with confluent WMH who were participants of the VITAmins TO Prevent Stroke study for 2 years. We investigated the association between clinical features, apolipoprotein E status, imaging measures (infarcts, microbleeds, volumes of WMH, cortical gray matter [cGM], lateral ventricles, and hippocampi), and B vitamins with changes in cognitive measures (clinical dementia rating scale, Mini‐Mental State Examination, Mattis dementia rating scale—initiation/perseveration subscale). We performed Pittsburgh compound B imaging among dementia converters. Results Multivariate regression analysis showed that increase in clinical dementia rating scale grade was associated with cGM atrophy, absence of hyperlipidemia, and lower diastolic blood pressure at baseline. cGM atrophy and absence of hyperlipidemia were also associated with deterioration in Mini‐Mental State Examination and Mattis dementia rating scale—initiation/perseveration subscale scores. Pittsburgh compound B retention typical of Alzheimer's disease was found only in 10% of dementia converters. Incident stroke and B vitamins were not associated with cognitive decline. Conclusions Among stroke patients with confluent WMH, cGM atrophy and absence of hyperlipidemia are important predictors for cognitive decline. Significant cognitive decline can occur in the absence of incident stroke or Alzheimer's pathology.