(Stroke. 2000;31:2182.)
© 2000 American Heart Association, Inc.
Original Contributions |
Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease
A Quantitative Study
From the Divisions of Clinical Neurosciences (N.H., H. Kazui, M.H., E.M.) and Neuroimaging Research (H. Kitagaki), Hyogo Institute for Aging Brain and Cognitive Disorders, Himeji, Japan.
Correspondence to Dr Nobutsugu Hirono, Division of Clinical Neuroscience, Hyogo Institute for Aging Brain and Cognitive Disorders, 520 Saisho-ko, Himeji 670-0981, Japan. E-mail hirono{at}hiabcd.go.jp
Background and Purpose—There have been conflicting results involving the clinical significance of white matter changes in patients with Alzheimer’s disease (AD). We studied the association between the volume of white matter hyperintensities (WMHs) on T2-weighted images and cognitive, neurological, and neuropsychiatric symptoms.
Methods—The subjects were 76 AD patients who had WMHs but no obvious cerebrovascular diseases. We quantified the volume of WMHs by using fast-fluid–attenuated inversion recovery images and whole brain atrophy by using 3D spoiled gradient-echo images. Effects of WMHs and brain atrophy on dementia severity, cognitive function, neuropsychiatric disturbances, and neurological findings were examined.
Results—Whole brain atrophy was significantly associated with dementia severity and cognitive disturbances, as well as with grasp reflex and some kinds of neuropsychiatric disturbances. After we controlled for the effects of brain atrophy, duration of symptoms, and demographic factors, we found that WMH volume was not associated with global cognitive disturbances or dementia severity but was significantly associated with urinary incontinence, grasp reflex, and aberrant motor behaviors. Brain atrophy and WMH volume were not significantly correlated either before or after controlling for age, sex, education, and duration of symptoms. WMH volume was associated with hypertension, but brain atrophy was not positively correlated with any vascular risk factors.
Conclusions—Our results support the hypothesis that WMHs in AD patients are superimposed phenomena of vascular origin. WMHs contribute to specific neurological and neuropsychiatric manifestations but not to global cognitive impairment, which is more closely associated with brain atrophy.
Key Words: Alzheimer disease • atrophy • neurological deficits • risk factors • white matter
This article has been cited by other articles:
 |
|
 |
|
  R. Pettersen, Y. Haig, P. H. Nakstad, and T. B. Wyller Subtypes of urinary incontinence after stroke: relation to size and location of cerebrovascular damage Age Ageing, May 1, 2008; 37(3): 324 - 327. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Pantoni Leukoaraiosis: From an Ancient Term to an Actual Marker of Poor Prognosis Stroke, May 1, 2008; 39(5): 1401 - 1403. [Full Text] [PDF]
|
|
|
|
|
|
R. H. Swartz, D. T. Stuss, F. Gao, and S. E. Black Independent Cognitive Effects of Atrophy and Diffuse Subcortical and Thalamico-Cortical Cerebrovascular Disease in Dementia Stroke, March 1, 2008; 39(3): 822 - 830. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L BRONGE and L-O WAHLUND White matter changes in dementia: does radiology matter? Br. J. Radiol., December 1, 2007; 80(Special_Issue_2): S115 - S120. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Behl, C. Bocti, R. H. Swartz, F. Gao, D. J. Sahlas, K. L. Lanctot, D. L. Streiner, and S. E. Black Strategic Subcortical Hyperintensities in Cholinergic Pathways and Executive Function Decline in Treated Alzheimer Patients Arch Neurol, February 1, 2007; 64(2): 266 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Y. Lee, I. H. Choo, K. W. Kim, J. H. Jhoo, J. C. Youn, U. Y. Lee, and J. I. Woo White Matter Changes Associated With Psychotic Symptoms in Alzheimer's Disease Patients J Neuropsychiatry Clin Neurosci, May 1, 2006; 18(2): 191 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Fernandez, A. Turrero, P. Zuluaga, P. Gil, F. Maestu, P. Campo, and T. Ortiz Magnetoencephalographic Parietal {delta} Dipole Density in Mild Cognitive Impairment: Preliminary Results of a Method to Estimate the Risk of Developing Alzheimer Disease. Arch Neurol, March 1, 2006; 63(3): 427 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Au, J. M. Massaro, P. A. Wolf, M. E. Young, A. Beiser, S. Seshadri, R. B. D'Agostino, and C. DeCarli Association of White Matter Hyperintensity Volume With Decreased Cognitive Functioning: The Framingham Heart Study Arch Neurol, February 1, 2006; 63(2): 246 - 250. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Burns, J. A. Church, D. K. Johnson, C. Xiong, D. Marcus, A. F. Fotenos, A. Z. Snyder, J. C. Morris, and R. L. Buckner White Matter Lesions Are Prevalent but Differentially Related With Cognition in Aging and Early Alzheimer Disease Arch Neurol, December 1, 2005; 62(12): 1870 - 1876. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Burton, R. A. Kenny, J. O'Brien, S. Stephens, M. Bradbury, E. Rowan, R. Kalaria, M. Firbank, K. Wesnes, and C. Ballard White Matter Hyperintensities Are Associated With Impairment of Memory, Attention, and Global Cognitive Performance in Older Stroke Patients Stroke, June 1, 2004; 35(6): 1270 - 1275. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Love Contribution of cerebral amyloid angiopathy to Alzheimer's disease J. Neurol. Neurosurg. Psychiatry, January 1, 2004; 75(1): 1 - 4. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Dufouil, A. Alperovitch, and C. Tzourio Influence of education on the relationship between white matter lesions and cognition Neurology, March 11, 2003; 60(5): 831 - 836. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. M. van der Flier, D.M. J. van den Heuvel, A.W. E. Weverling-Rijnsburger, A. Spilt, E.L.E. M. Bollen, R.G. J. Westendorp, H.A. M. Middelkoop, and M. A. van Buchem Cognitive decline in AD and mild cognitive impairment is associated with global brain damage Neurology, September 24, 2002; 59(6): 874 - 879. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Mueggler, C. Sturchler-Pierrat, D. Baumann, M. Rausch, M. Staufenbiel, and M. Rudin Compromised Hemodynamic Response in Amyloid Precursor Protein Transgenic Mice J. Neurosci., August 15, 2002; 22(16): 7218 - 7224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Campbell III and C. E. Coffey Neuropsychiatric Significance of Subcortical Hyperintensity J Neuropsychiatry Clin Neurosci, May 1, 2001; 13(2): 261 - 288. [Full Text] [PDF]
|
|