13 Neuroimaging correlates of vascular cognitive impairment: prevalence and clinical relevance of mesial temporal lobe atrophy in a stroke service cohort. Issue 3 (15th February 2011)

• Record Type: Journal Article
• Authors: Gregoire, S; Kebets, V; Scheffler, G; Smith, K; Benjamin, M; Brown, M M; Jäger, H R; Ciplotti, L; Werring, D J
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 82:Issue 3(2011)
• Page Start: e1
• Page End: e1
• Publication Date: 2011-02-15
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp.2010.235572.13
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objectives: Vascular cognitive impairment and Alzheimer's disease (AD) may interact and co-exist. We investigated the prevalence and impact of mesial temporal lobe atrophy (MTA), a radiological marker for AD, in a population of stroke patients. Methods: Patients referred to a stroke service underwent detailed neuropsychological testing and standardised imaging, including GRE T2* MRI and FLAIR. We assessed MTA on FLAIR images using a newly developed and validated visual rating scale based on the Scheltens scale (scores 0 to 4; mild MTA <2 and severe ≥2). Microbleeds and white matter changes (WMC) were rated using validated scales. The effect of MTA on cognitive functions was tested using multivariate regression analyses. Findings: 396 patients with full neuropsychological testing and complete MRI sequences were included (358 mild and 38 severe MTA). 171 patients (43%) showed some degree (score ≥1) of MTA. Patients with severe MTA were older (76 vs 64, p=0.000), more hypertensive (97% vs 66%, p=0.000), and had more severe WMC (median 9 vs 5.5, p=0.000) than patients with mild or no MTA. In adjusted multivariate analyses, MTA was a predictor of verbal memory impairment (OR 1.81, p=0.004) and frontal executive dysfunction (OR 1.48, p=0.023). Conclusions: MTA is common in stroke patients and is independently associated with verbal memory and frontal executive deficits. Alzheimer pathology may play an important role in cognitive impairment in patients with cerebrovascular disease.