Additive effect of cerebral atrophy on cognition in dementia-free elderly with cerebrovascular disease. Issue 3 (20th June 2019)

• Record Type: Journal Article
• Authors: Xu, Xin; Phua, April; Collinson, Simon L; Hilal, Saima; Ikram, Mohammad Kamran; Wong, Tien Yin; Cheng, Ching Yu; Venketasubramanian, Narayanaswamy; Chen, Christopher
• Is Part Of: Stroke and vascular neurology. Volume 4:Issue 3(2019)
• Page Start: 135
• Page End: 140
• Publication Date: 2019-06-20
• Subjects: cerebrovascular disease -- atrophy -- cognition -- dementia; Cerebrovascular disease -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.81005
• DOI: 10.1136/svn-2018-000202
• Languages: English
• ISSNs: 2059-8688

Abstract

Abstract : Objective: To explore the additive effect of neurodegenerative diseases, measured by atrophy, on neurocognitive function in Asian dementia-free elderly with cerebrovascular disease (CeVD). Methods: The present study employed a cross-sectional design and was conducted between 2010 and 2015 among community-dwelling elderly participants recruited into the study. Eligible participants were evaluated with an extensive neuropsychological battery and neuroimaging. The weighted CeVD burden scale comprising markers of both small- and large-vessel diseases was applied, with a score of ≥2, indicating significant CeVD burden. Cortical atrophy (CA) and medial temporal atrophy (MTA) were graded using the global cortical atrophy scale and Schelten's scale, respectively. Global and domain-specific (attention, executive function, language, visuomotor speed, visuoconstruction, visual memory, and verbal memory) neurocognitive performance was measured using a locally validated neuropsychological battery (Vascular Dementia Battery, VDB). Results: A total of 819 dementia-free participants were included in the analysis. Among none-mild CeVD subjects, there was no significant difference in the global cognitive performance across atrophy groups (no atrophy, CA, and CA+MTA). However, in moderate-severe CeVD subjects, CA+MTA showed significantly worse global cognitive performance compared with those with CA alone (mean difference=−0.35, 95% CI −0.60 to −0.11, p=0.002) and those without atrophy (mean difference=−0.46, 95% CI −0.74 to −0.19, p<0.001, p<0.001). In domain-specific cognitive performance, subjects with CA+MTA performed worse than other groups in visual memory (p=0.005), executive function (p=0.001) and visuomotor speed (p<0.001) in moderate-severe CeVD but not in none-mild CeVD. Conclusions and relevance: Atrophy and moderate-severe CeVD burden showed an additive effect on global and domain-specific cognitive performance. This study highlights the importance of investigating the mechanisms of clinico-pathological interactions between neurodegenerative processes and vascular damage, particularly in the pre-dementia stage.