Medial temporal lobe atrophy and white matter hyperintensities are associated with mild cognitive deficits in non-disabled elderly people: The LADIS study

University of Florence, Florens, Tuscany, Italy
Journal of Neurology Neurosurgery & Psychiatry (Impact Factor: 6.81). 12/2005; 76(11):1497-500. DOI: 10.1136/jnnp.2005.064998
Source: PubMed


To assess the associations of medial temporal lobe atrophy (MTA) and white matter hyperintensities (WMH) with cognitive function in a large group of independently functioning elderly people.
Data were drawn from the multicentre, multinational leukoaraiosis and disability (LADIS) project which is studying prospectively the role of WMH as an independent predictor of the transition to disability in non-disabled elderly people. In all, 639 participants were enrolled in the LADIS study. For the present analysis, data on 581 subjects were available. Cognitive function was assessed by the mini-mental state examination (MMSE). Visual ratings of WMH and MTA were undertaken on magnetic resonance images (MRI).
The presence of either severe WMH or MTA was associated with a modest but non-significant increase in frequency of mild cognitive deficits (severe WMH: odds ratio (OR) = 1.9 (95% confidence interval (CI), 1.0 to 3.7); MTA present: OR = 1.5 (95% CI, 0.8 to 2.8)). However, subjects with the combination of MTA and severe WMH had a more than fourfold increase in frequency of mild cognitive deficits (OR = 4.1 (95% CI, 2.3 to 7.4)). Analysis of variance with post hoc Bonferroni t tests showed that subjects with both MTA and severe WMH performed worse on MMSE than those with either no MRI abnormality or a single MRI abnormality (p<0.05).
These results provide further evidence for the combined involvement of both Alzheimer type pathology and vascular pathology in the earliest stages of cognitive decline and suggest an additive effect of WMH and MTA.

Download full-text


Available from: Ph Scheltens, Oct 01, 2015
12 Reads
  • Source
    • "The increase in white matter changes and the accumulation of small infarcts proved to be associated with the cognitive decline [7]. Data show that brain atrophy is also associated with cognitive deterioration [9]. Phenotypic expression of subcortical VaD is variable. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Dementia is one of the most disabling conditions. Alzheimer's disease and vascular dementia (VaD) are the most frequent causes. Subcortical VaD is consequent to deep-brain small vessel disease (SVD) and is the most frequent form of VaD. Its pathological hallmarks are ischemic white matter changes and lacunar infarcts. Degenerative and vascular changes often coexist, but mechanisms of interaction are incompletely understood. The term mild cognitive impairment defines a transitional state between normal ageing and dementia. Pre-dementia stages of VaD are also acknowledged (vascular mild cognitive impairment, VMCI). Progression relates mostly to the subcortical VaD type, but determinants of such transition are unknown. Variability of phenotypic expression is not fully explained by severity grade of lesions, as depicted by conventional MRI that is not sensitive to microstructural and metabolic alterations. Advanced neuroimaging techniques seem able to achieve this. Beside hypoperfusion, blood-brain-barrier dysfunction has been also demonstrated in subcortical VaD. The aim of the Vascular Mild Cognitive Impairment Tuscany Study is to expand knowledge about determinants of transition from mild cognitive impairment to dementia in patients with cerebral SVD. This paper summarizes the main aims and methodological aspects of this multicenter, ongoing, observational study enrolling patients affected by VMCI with SVD.
    International Journal of Alzheimer's Disease 04/2012; 2012(2090-8024):608013. DOI:10.1155/2012/608013
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is estimated that within the next 50 years the number of patients with dementia in Europe will rise to over 16 million, due to increasing life expectancy in Western society. Besides the physical, social and psychological burden on carers of patients with dementia, the financial burden on society will grow exponentially too. Dementia is defined as an acquired impairment of cognitive function in at least two cognitive domains, including memory, which interferes with normal social or occupational performance. Dementia can be caused by various underlying diseases, the most common of which is Alzheimer’s disease. The first part of this chapter will discuss the clinical signs and symptoms and neuropathological findings of the most important types of dementia. An accurate diagnosis of a certain type of dementia is crucial for therapy and counselling of the patient and his family. Therefore, the second part of this chapter will review history and physical examination and the contribution of ancillary investigations, such as MRI, cerebrospinal fluid markers, PET and EEG in diagnosing dementia. Finally, therapeutic options will be reviewed.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. Leukoaraiosis describes changes in cerebral white matter that appear as hyperintensities in T2 potentiated magnetic resonance imaging (MRI) sequences. The etiopa- thogenesis of leukoaraiosis is still unknown. There is some disa- greement between histopathology and the findings of previous studies comparing white matter hyperintensities in post-mor- tem MRI. Objectives. This study aims to describe and visually quantify changes in white matter both in post-mortem MRI and in histologic studies, and to correlate the findings. Method. A study was made of forty six brain tissue samples from the «Banco de Tejidos Neurológicos del Centro de Investigación Biomédica del Servicio Navarro de Salud» (Brain Bank of the Biomedical Investigation Centre of Navarra Health Service). Visual assessment of leukoaraiosis in the right hemisphere was carried out not only by MRI but also by analysing histopatho- logic samples. Three affected regions were evaluated; subcorti- cal frontal, subcortical parietal and periventricular frontal, and radiologic and histopathologic findings were correlated. Conclusions. A statistically significant relation was found between the area showing leukoaraiosis on MRI and that been seen by visual histopathological assessment. Discussion. The study contributes to research findings regarding the etiopatho- genesis and clinical expression of leukoaraiosis and emphasi- zes the need of working in an homogeneous way, especially with regard to quantification scales for measuring leukoaraiosis.
Show more