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(Stroke. 1999;30:556-566.)
© 1999 American Heart Association, Inc.

Original Contributions

Neuropsychological Impairment Correlates With Hypoperfusion and Hypometabolism but Not With Severity of White Matter Lesions on MRI in Patients With Cerebral Microangiopathy

Osama Sabri, MD; Erich-Bernhard Ringelstein, MD; Dirk Hellwig, MD; Rolf Schneider, MD; Mathias Schreckenberger, MD; Hans-Jürgen Kaiser, PhD; Michael Mull, MD Udalrich Buell, MD

From the Departments of Nuclear Medicine (O.S., D.H., M.S., H-J.K., U.B.), Neurology (R.S.), and Neuroradiology (M.M.), Aachen University of Technology, and the Department of Neurology (E-B.R.), University of Münster (Germany).

Correspondence to Osama Sabri, MD, Department of Nuclear Medicine, University of Technology (RWTH), Pauwelsstrasse 30, D-52057 Aachen, Germany.

Background and Purpose—Cerebral microangiopathy, indicated on MRI by lacunar infarctions (LI) and deep white matter lesions (DWML), is said to lead to vascular dementia.

Methods—Fifty-seven patients with proven cerebral microangiopathy were assessed for changes in regional cerebral blood flow (rCBF) and glucose metabolism (rMRGlu) and compared with 19 age-matched controls. The findings were correlated with results of extensive neuropsychological testing, as well as with MRI findings. A special head holder ensured reproducibility of positioning during rCBF (single-photon emission CT [SPECT]), rMRGlu (positron emission tomography [PET]), and MR imaging. White matter and cortex were quantified with regions of interest defined on MRI and superimposed to corresponding PET/SPECT slices. LI and DWML were graded by number and extent.

Results—Even with severe DWML and multiple LI, rCBF and rMRGlu values were not reduced. ANOVAs identified brain atrophy and neuropsychological deficits as the main determinants for reduced rCBF and rMRGlu values in both cortex and white matter. Neuropsychological deficits correlated well with decreased rCBF and rMRGlu, whereas MRI patterns such as LI and DWML did not. Factor analysis revealed no correlation of LI and DWML with rCBF, rMRGlu, atrophy, and neuropsychological deficits, showing instead positive correlations between rCBF, rMRGlu, and neuropsychological performance and negative correlations of the latter 3 with brain atrophy.

Conclusions—From these data, we conclude that LI and DWML are epiphenomena that may morphologically characterize cerebral microangiopathy but do not in themselves indicate cognitive impairment. Dementia or neuropsychological deficits, by contrast, are reflected exclusively by functional imaging parameters (rCBF, rMRGlu) and cerebral atrophy.

Key Words: magnetic resonance imaging • microangiopathy • neuropsychological testing • tomography, emission computed • vascular dementia

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