Abstract
IntroductionLacunar lesions (LLs) and white matter lesions (WMLs) affect cognition. We assessed whether lesions located in specific white matter tracts were associated with cognitive performance taking into account total lesion burden.MethodsWithin the Second Manifestations of ARTerial disease Magnetic Resonance (SMART-MR) study, cross-sectional analyses were performed on 516 patients with manifest arterial disease. We applied an assumption-free voxel-based lesion-symptom mapping approach to investigate the relation between LL and WML locations on 1.5 Tesla brain MRI and compound scores of executive functioning, memory and processing speed. Secondly, a multivariable linear regression model was used to relate the regional volume of LLs and WMLs within specific white matter tracts to cognitive functioning.ResultsVoxel-based lesion-symptom mapping identified several clusters of voxels with a significant correlation between WMLs and executive functioning, mostly located within the superior longitudinal fasciculus and anterior thalamic radiation. In the multivariable linear regression model, a statistically significant association was found between regional LL volume within the superior longitudinal fasciculus and anterior thalamic radiation and executive functioning after adjustment for total LL and WML burden.ConclusionThese findings identify the superior longitudinal fasciculus and anterior thalamic radiation as key anatomical structures in executive functioning and emphasize the role of strategically located vascular lesions in vascular cognitive impairment.
Highlights
Lacunar lesions (LLs) and white matter lesions (WMLs) affect cognition
Regional volumes of lacunar lesions (LLs) and WMLs located in the anterior thalamic radiation and forceps minor predicted performance in processing speed tasks, whereas there was no independent contribution of the global volume of ischemic lesions
In a cohort of patients with manifest arterial disease (SMART cohort) we previously demonstrated that periventricular WML volume and LLs in the semioval center were associated with poor executive functioning after adjusting for cooccuring infarcts and total WML volume [11]
Summary
Lacunar lesions (LLs) and white matter lesions (WMLs) affect cognition. We assessed whether lesions located in specific white matter tracts were associated with cognitive performance taking into account total lesion burden. A study of patients with CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) demonstrated that strategically located lesions in white matter tracts had a stronger correlation with performance than total lesion volume [10]. In these patients, regional volumes of lacunar lesions (LLs) and WMLs located in the anterior thalamic radiation and forceps minor predicted performance in processing speed tasks, whereas there was no independent contribution of the global volume of ischemic lesions. In a cohort of patients with manifest arterial disease (SMART cohort) we previously demonstrated that periventricular WML volume and LLs in the semioval center were associated with poor executive functioning after adjusting for cooccuring infarcts and total WML volume [11]. It might be reasoned that the impact of WMLs and LLs on executive functioning is likely to be caused by the disruption of strategic white matter tracts
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