The Impact of Strategic White Matter Hyperintensity Lesion Location on Language

• Published in: The American journal of geriatric psychiatry 2021-02, Vol.29 (2), p.156-165
• Main Authors: Hilal, Saima, Biesbroek, J. Matthijs, Vrooman, Henri, Chong, Eddie, Kuijf, Hugo J., Venketasubramanian, Narayanaswamy, Cheng, Ching-Yu, Wong, Tien Yin, Biessels, Geert Jan, Chen, Christopher
• Format: Article
• Language: English
• Subjects: Asian people; Cerebral small vessel disease; Cognition & reasoning; Cognitive ability; cortical; Language; Older people; population-based; white matter hyperintensities
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2020.06.009

•Is there an association between white matter hyperintensities lesion location and language?•In this cross-sectional analysis of a population-based study that included 819 persons, the left cingulum of the cingulate gyrus was identified as a strategic white matter tract for the Modified Boston Naming Test.•The language performance is sensitive to ischemic damage in a larger subcortical network than was previously thought. The impact of white matter hyperintensities (WMH) on language possibly depends on lesion location through disturbance of strategic white matter tracts. We examined the impact of WMH location on language in elderly Asians. Cross-sectional. Population-based. Eight-hundred nineteen residents of Singapore, ages (≥65 years). Clinical, cognitive and 3T magnetic resonance imaging assessments were performed on all participants. Language was assessed using the Modified Boston Naming Test (MBNT) and Verbal Fluency (VF). Hypothesis-free region-of-interest-based (ROI) analyses based on major white matter tracts were used to determine the association between WMH location and language. Conditional dependencies between the regional WMH volumes and language were examined using Bayesian-network analysis. ROI-based analyses showed that WMH located within the anterior thalamic radiation (mean difference: −0.12, 95% confidence interval [CI]: −0.22; −0.02, p = 0.019) and uncinate fasciculus (mean difference: −0.09, 95% CI: −0.18; −0.01, p = 0.022) in the left hemisphere were significantly associated with worse VF but did not survive multiple testing. Conversely, WMH volume in the left cingulum of cingulate gyrus was significantly associated with MBNT performance (mean difference: −0.09, 95% CI: −0.17; −0.02, p = 0.016). Bayesian-network analyses confirmed the left cingulum of cingulate gyrus as a direct determinant of MBNT performance. Our findings identify the left cingulum of cingulate gyrus as a strategic white matter tract for MBNT, suggesting that language – is sensitive to subcortical ischemic damage. Future studies on the role of sporadic ischemic lesions and vascular cognitive impairment should not only focus on total WMH volume but should also take WMH lesion location into account when addressing language.