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(Stroke. 2008;39:800.)
© 2008 American Heart Association, Inc.

Original Contributions

White Matter Hyperintensities and Subclinical Infarction

Associations With Psychomotor Speed and Cognitive Flexibility

Clinton B. Wright, MD, MS; Joanne R. Festa, PhD; Myunghee C. Paik, PhD; Alexis Schmiedigen, BA; Truman R. Brown, PhD; Mitsuhiro Yoshita, MD, PhD; Charles DeCarli, MD; Ralph Sacco, MD, MS Yaakov Stern, PhD

From the Division of Stroke and Critical Care (C.B.W., J.R.F., A.S.), Department of Neurology, College of Physicians and Surgeons of Columbia University, New York; the Department of Biostatistics (M.C.P.), Mailman School of Public Health, Columbia University, New York; the Department of Radiology (T.R.B.), Columbia University, New York; the Gertrude H. Sergievsky Center (R.S., Y.S.), College of Physicians and Surgeons of Columbia University, New York; the Department of Neurology and Center for Neuroscience (M.Y., C.D.), University of California-Davis, Sacramento, Calif; and the Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fla.

Correspondence to Clinton Wright, MD, MS, Division of Stroke and Critical Care, College of Physicians and Surgeons of Columbia University, NI-Room 640, 710 W168th Street, New York, NY 10032. E-mail cbw7{at}columbia.edu

Background and Purpose— We examined white matter hyperintensity volume (WMHV) and subclinical infarction (no history of clinical stroke; SI) in relation to performance on tests of sequencing, cognitive flexibility, and sensorimotor ability.

Methods— The Northern Manhattan Study includes a stroke-free community-based sample of Hispanic, Black, and White participants. A subsample (n=656) has undergone measurement of WMHV, SI, and neuropsychological testing. Linear regression was used to examine WMHV and SI in relation to performance on tests of sequencing as measured by Color Trails 1, cognitive flexibility as measured by Color Trails 2, and sensorimotor ability as measured by Grooved Pegboard, using generalized estimating equations (GEE) to account for the correlation among the cognitive tests and other covariates.

Results— Considering performance on the tests of sequencing, cognitive flexibility, and sensorimotor ability simultaneously using GEE, WMHV and subclinical infarction were each associated with worse cognitive performance globally. There was a threshold effect for WMHV with those in the upper quartile performing significantly worse on the tests of cognitive flexibility and sensorimotor ability. Those with frontal SI performed worse on the test of cognitive flexibility and those with deep SI, worse on the test of sequencing.

Conclusions— Both SI and WMHV were associated with globally worse cognitive performance. Participants with WMH affecting more than 0.75% of cranial volume had significantly slower performance on a task of cognitive flexibility and sensorimotor ability than those in the lowest quartile. The effects of SI on cognitive performance varied by location.

Key Words: leukoaraiosis • silent stroke • vascular cognitive impairment

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