4.7 Article

Incident lacunes influence cognitive decline The LADIS study

Journal

NEUROLOGY
Volume 76, Issue 22, Pages 1872-1878

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e31821d752f

Keywords

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Funding

  1. European Union [QLRT-2000-00446]
  2. Clinical Research Institute
  3. Helsinki University Central Hospital
  4. Ella and Georg Ehrnrooth Foundation
  5. Dutch MS Research Foundation
  6. Lundbeck Inc.
  7. Alzheimer Nederland
  8. Alzheimer Center
  9. Stichting VUmc fonds
  10. Biogen Idec
  11. Bayer Schering Pharma
  12. Merck Serono
  13. sanofi-aventis

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Background: In cerebral small vessel disease, the core MRI findings include white matter lesions (WML) and lacunar infarcts. While the clinical significance of WML is better understood, the contribution of lacunes to the rate of cognitive decline has not been established. This study investigated whether incident lacunes on MRI determine longitudinal cognitive change in elderly subjects with WML. Methods: Within the Leukoaraiosis and Disability Study (LADIS), 387 subjects were evaluated with repeated MRI and neuropsychological assessment at baseline and after 3 years. Predictors of change in global cognitive function and specific cognitive domains over time were analyzed with multivariate linear regression. Results: After controlling for demographic factors, baseline cognitive performance, baseline lacunar and WML lesion load, and WML progression, the number of new lacunes was related to subtle decrease in compound scores for executive functions (p = 0.021) and speed and motor control (p = 0.045), but not for memory or global cognitive function. Irrespective of lacunes, WML progression was associated with decrease in executive functions score (p = 0.016). Conclusion: Incident lacunes on MRI parallel a steeper rate of decline in executive functions and psychomotor speed. Accordingly, in addition to WML, lacunes determine longitudinal cognitive impairment in small vessel disease. Although the individual contribution of lacunes on cognition was modest, they cannot be considered benign findings, but indicate a risk of progressive cognitive impairment. Neurology (R) 2011; 76: 1872-1878

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