Background:
In older community populations some WMH lesions have been found to be associated with impaired memory, processing speed and executive dysfunction. The same association has also been found in patients with sub-cortical ischemic VaD. The importance of this association has not been evaluated in people with cerebral vascular disease but no dementia. The current study will evaluate correlates between the volume of WMH and cognitive performance in older stroke patients without dementia. It is hypothesized that processing speed and executive dysfunction will be associated with frontal WMH and that impaired memory will be associated with Temporal WMH.
Methods:
Neuropsychological assessments using the CAMCOG (section B) and the Cognitive Drug Research (CDR) were carried out on 103 stoke survivors aged 75+ . Within 3 months of baseline assessments, MRI images were acquired by a 1.5T GE Signa system using an adjusted contour threshold technique (Firbank, 2003). Whole brain FLAIR images were carried out in the axial plane to visualize and determine the volume of WMH. FSPGR images were also carried out as part of the imaging protocol.
Results:
In comparison to controls, the stroke patients had significantly greater volume of WMH in all key areas. Within the stroke group, significant association was identified between frontal WHM volumes and Choice Reaction Time ( right: r=0.01, Left: r=0.26, P=0.01), but not with the CAMCOG test of executive function (right: r=0.12, p=0.21, left: r=0.14, p=0.17). There was significant associations between memory and temporal WMH volumes (right: r=0.27, p=0.008, left: R=0.20, p=0.047). Total moderate WMH were associated with attentional impairments (CRT: t=2.4, p=0.017, Digit Vigilance: t=3.0, p=0.004). Severe WHM was associated with global cognitive performance (total CAMCOG t=2.3, p=0.02, memory: t=2.2, p=0.03).
Conclusion:
The results indicate that cognitive processing speed and performance on measures of attention are significantly associated with WMH volume in the left and right frontal lobe regions, where as memory impairment is associated with the volume of temporal lobe WMH. Moderate WMH is associated with attentional impairments but only severe WMH are associated with global impairments. No significant association was found between WMH and executive function. The association between memory impairment and the severity of temporal lobe WMH has not previously been reported, in addition it appears that WMH are associated with global cognitive impairment. These findings are important as they indicate that in stoke patients without dementia, WMH are a substrate of a broad range of cognitive functions beyond just attentional performance. These findings emphasize the potential value of WMH as a treatment target for the preventing dementia in individuals with cerebrovascular disease.
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