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Predictors for cognitive decline in patients with confluent white matter hyperintensities.

AbstractBACKGROUND:
Although patients harboring confluent white matter hyperintensities (WMH) are at high risk of cognitive decline, this risk varies among individuals. We investigated the predictors for cognitive decline in stroke patients with confluent WMH.
METHODS:
We followed up 100 stroke patients with confluent WMH who were participants of the VITAmins TO Prevent Stroke study for 2 years. We investigated the association between clinical features, apolipoprotein E status, imaging measures (infarcts, microbleeds, volumes of WMH, cortical gray matter [cGM], lateral ventricles, and hippocampi), and B vitamins with changes in cognitive measures (clinical dementia rating scale, Mini-Mental State Examination, Mattis dementia rating scale--initiation/perseveration subscale). We performed Pittsburgh compound B imaging among dementia converters.
RESULTS:
Multivariate regression analysis showed that increase in clinical dementia rating scale grade was associated with cGM atrophy, absence of hyperlipidemia, and lower diastolic blood pressure at baseline. cGM atrophy and absence of hyperlipidemia were also associated with deterioration in Mini-Mental State Examination and Mattis dementia rating scale--initiation/perseveration subscale scores. Pittsburgh compound B retention typical of Alzheimer's disease was found only in 10% of dementia converters. Incident stroke and B vitamins were not associated with cognitive decline.
CONCLUSIONS:
Among stroke patients with confluent WMH, cGM atrophy and absence of hyperlipidemia are important predictors for cognitive decline. Significant cognitive decline can occur in the absence of incident stroke or Alzheimer's pathology.
AuthorsVincent Mok, Yunyun Xiong, Kelvin K Wong, Adrian Wong, Reinhold Schmidt, Winnie W C Chu, Xintao Hu, Eric Yim Lung Leung, Sirong Chen, Yangkun Chen, Wai Kwong Tang, Xiangyan Chen, Chi Lai Ho, Ka Sing Wong, Stephen T C Wong
JournalAlzheimer's & dementia : the journal of the Alzheimer's Association (Alzheimers Dement) Vol. 8 Issue 5 Suppl Pg. S96-S103 (Oct 2012) ISSN: 1552-5279 [Electronic] United States
PMID22651941 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2012 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Vitamin B Complex
  • Vitamin B 6
  • Folic Acid
  • Vitamin B 12
Topics
  • Aged
  • Atrophy (pathology)
  • Brain (pathology, physiopathology)
  • Cognition Disorders (etiology, pathology, physiopathology)
  • Double-Blind Method
  • Female
  • Folic Acid (therapeutic use)
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Nerve Fibers, Myelinated (pathology)
  • Secondary Prevention
  • Stroke (complications, drug therapy, pathology)
  • Vitamin B 12 (therapeutic use)
  • Vitamin B 6 (therapeutic use)
  • Vitamin B Complex (therapeutic use)

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