White Matter Hyperintensities Are Associated With Impairment of Memory, Attention, and Global Cognitive Performance in Older Stroke Patients

Background— The importance of white matter hyperintensities (WMH) for cognitive performance in older stroke patients is largely unknown. We hypothesized that processing speed and executive dysfunction will be associated with frontal WMH whereas impaired memory will be associated with temporal WMH. Methods— Neuropsychological assessments using the Cambridge Cognitive Examination (CAMCOG) and the Cognitive Drug Research (CDR) were completed for 96 stroke survivors aged older than 75 and 23 age-matched controls. Magnetic resonance imaging whole-brain axial FLAIR images were undertaken to visualize WMH and an automated threshold technique was used to determine their volume. Results— In comparison to controls, the stroke patients had significantly greater volume of WMH in all key areas. Within the stroke group, a consistent pattern of significant association was identified between total and frontal WHM volumes and attention and processing speed tasks (eg, choice reaction time [right:R= 0.24 P= 0.02; left:R= 0.26, P= 0.01]), but not with executive function. There were significant associations between memory and temporal WMH volumes (right:R= 0.27, P= 0.008; left:R= 0.20, P= 0.047). Conclusion— In older stroke patients, cognitive processing speed and performance on measures of attention are significantly associated with WMH volume, particularly in the frontal lobe regions, whereas memory impairment is associated with the volume of temporal lobe WMH.

[1]  J. O'Brien,et al.  Changes in DWI and MRS associated with white matter hyperintensities in elderly subjects , 2003, Neurology.

[2]  Karl J. Friston,et al.  Voxel-Based Morphometry—The Methods , 2000, NeuroImage.

[3]  D B Hier,et al.  Dementia in stroke survivors in the Stroke Data Bank cohort. Prevalence, incidence, risk factors, and computed tomographic findings. , 1990, Stroke.

[4]  Zhaowei Jiang,et al.  Consistency analysis for digitized three-dimensional Talairach's Co-Planner Stereotactic Atlas of the human brain , 1997 .

[5]  J. Haxby,et al.  The effect of white matter hyperintensity volume on brain structure, cognitive performance, and cerebral metabolism of glucose in 51 healthy adults , 1995, Neurology.

[6]  G. E. Alexander,et al.  Functional architecture of basal ganglia circuits: neural substrates of parallel processing , 1990, Trends in Neurosciences.

[7]  M. Kaste,et al.  MRI correlates of executive dysfunction in patients with ischaemic stroke , 2003, European journal of neurology.

[8]  F. Huppert,et al.  CAMDEX: A Standardised Instrument for the Diagnosis of Mental Disorder in the Elderly with Special Reference to the Early Detection of Dementia , 1986, British Journal of Psychiatry.

[9]  J. O'Brien,et al.  Neuropsychological Deficits in Older Stroke Patients , 2002, Annals of the New York Academy of Sciences.

[10]  J. O'Brien,et al.  Cognitive Associations of Subcortical White Matter Lesions in Older People , 2002, Annals of the New York Academy of Sciences.

[11]  W. O'Fallon,et al.  Dementia after ischemic stroke , 1996, Neurology.

[12]  N. Schuff,et al.  MRI predictors of cognition in subcortical ischemic vascular disease and Alzheimer’s disease , 2001, Neurology.

[13]  Keith Wesnes,et al.  The cognitive drug research computerized assessment system for demented patients: A validation study , 1991 .

[14]  E. Rostrup,et al.  Relation between age-related decline in intelligence and cerebral white-matter hyperintensities in healthy octogenarians: a longitudinal study , 2000, The Lancet.

[15]  J. Fisk,et al.  Neuropsychological Predictors of Incident Dementia in Patients With Vascular Cognitive Impairment, Without Dementia , 2002, Stroke.

[16]  P. Scheltens,et al.  A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging , 1993, Journal of the Neurological Sciences.

[17]  M. Torrens.  Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268 , 1990 .

[18]  M. Kaste,et al.  Dementia three months after stroke. Baseline frequency and effect of different definitions of dementia in the Helsinki Stroke Aging Memory Study (SAM) cohort. , 1997, Stroke.

[19]  J. Ashburner,et al.  Nonlinear spatial normalization using basis functions , 1999, Human brain mapping.

[20]  Ronald A Cohen,et al.  The relationship of subcortical MRI hyperintensities and brain volume to cognitive function in vascular dementia , 2002, Journal of the International Neuropsychological Society.

[21]  C. Jack,et al.  Memory and MRI-based hippocampal volumes in aging and AD , 2000, Neurology.

[22]  R. Sacco,et al.  Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community , 1994, Neurology.

[23]  P. Colletti,et al.  Quantitative magnetic resonance imaging and the severity of dementia in Alzheimer's disease. , 1988, The American journal of psychiatry.

[24]  M. Chopp,et al.  Multiparametric MRI Tissue Characterization in Clinical Stroke With Correlation to Clinical Outcome: Part 2 , 2001, Stroke.

[25]  B. Cesana,et al.  Dementia after first stroke. , 1996, Stroke.

[26]  J. Desmond,et al.  Material-specific lateralization in the medial temporal lobe and prefrontal cortex during memory encoding. , 2001, Brain : a journal of neurology.

[27]  E. Mori,et al.  Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease: A Quantitative Study , 2000, Stroke.

[28]  R. Howard,et al.  Neuropsychological impairment in stroke, carotid stenosis, and peripheral vascular disease, A comparison with healthy community residents. , 1999, Stroke.

[29]  B. Reisberg,et al.  Vascular cognitive impairment , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[30]  R. Mayeux,et al.  Clinical determinants of dememtia related to stroke , 1993, Annals of neurology.

[31]  J. Slade,et al.  White matter pathology in Alzheimer's disease and vascular dementia: quantification by amyloid‐β precursor protein immunocytochemistry , 2002 .