Abstract
In this retrospective study, we investigated the independent effects of white matter hyperintensities (WMH) and hippocampal atrophy on cognitive functions in a broad sample of patients seen in a memory clinic. To ensure generalizability, these associations were examined irrespective of diagnosis and with minimal exclusion criteria. Next to these independent effects, interactions between WMH and hippocampal atrophy were examined. Between January 2006 and September 2011 a total of 500 patients visited the memory clinic, 397 of whom were included. Magnetic resonance images of 397 patients were visually analyzed for WMH, medial temporal atrophy (MTA), and global atrophy. We evaluated the association of WMH and MTA with the following cognitive domains: global cognition, episodic memory, working memory, executive function and psychomotor speed. Main effects and interaction effects were examined by means of correlation and regression analyses. In the regression analyses, we controlled for potential confounding effects of global atrophy. The correlational results revealed that WMH were associated with global cognition, executive function and psychomotor speed, whereas a trend was found for episodic memory. MTA was associated with all these four cognitive domains; an additional trend was observed for working memory. Hierarchical regression analyses revealed main independent effects of MTA for episodic memory, executive function, psychomotor speed and global cognition; WMH were only associated with global cognition. The interaction between MTA and WMH was significant for episodic memory only. This study demonstrates that predominantly MTA is an independent predictor not only for memory function, with which is it classically associated, but also for global cognition and executive function. Taken together, MTA may be an important correlate of cognitive deficits found in people attending the memory clinic.
Highlights
Medial temporal atrophy (MTA), and in particular hippocampal atrophy, is one of the earliest changes seen in the brains of patients with Alzheimer’s Disease (AD), and its presence has proven to be a sensitive marker for the diagnosis of AD (Braak and Braak, 1991)
No or mild White matter hyperintensities (WMH) and MTA was present in 120 patients, moderate/severe MTA combined with no/mild WMH was present in 58 patients, moderate/severe WMH with no/mild MTA was present in 78 patients, whereas 141 patients had combined moderate/severe MTA and WMH
In the present study, we examined the independent effects of WMH and MTA on various cognitive functions in a broad sample of patients seen in a memory clinic, irrespective of diagnosis and without the use of extensive exclusion criteria
Summary
Medial temporal atrophy (MTA), and in particular hippocampal atrophy, is one of the earliest changes seen in the brains of patients with Alzheimer’s Disease (AD), and its presence has proven to be a sensitive marker for the diagnosis of AD (Braak and Braak, 1991). Studies of the relationship between morphological and cognitive measures of AD have demonstrated that MTA, especially of the hippocampus, correlates with episodic memory impairment in AD (de Leon et al, 1997). Compared to the contradictory results regarding the correlations between WMH and cognitive dysfunction, studies examining MTA have shown a more consistent association with cognitive deficits, with memory. MTA correlates with impairments of verbal memory in elderly with cognitive dysfunction (Kohler, 1994; Laakso et al, 1995).
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