Association of White Matter Lesions and Lacunar Infarcts With Executive Functioning: The SMART-MR Study

• Published in: American journal of epidemiology 2009-11, Vol.170 (9), p.1147-1155
• Main Authors: GEERLINGS, Mirjam I, APPELMAN, Auke P. A, VINCKEN, Koen L, MALI, Willem P. T. M, VAN DER GRAAF, Yolanda
• Format: Article
• Language: English
• Subjects: Aged; Analysis. Health state; Atrophy; Biological and medical sciences; Brain - pathology; Brain diseases; Brain Infarction - cerebrospinal fluid; Brain Infarction - complications; Brain Infarction - pathology; Cognition & reasoning; Cognition Disorders - cerebrospinal fluid; Cognition Disorders - etiology; Cognition Disorders - pathology; Cross-Sectional Studies; Epidemiology; Female; General aspects; Humans; Injuries; Linear Models; Magnetic Resonance Imaging; Male; Medical sciences; Memory; Middle Aged; Neurology; Neuropsychological Tests; NMR; Nuclear magnetic resonance; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kwp256

The authors investigated the association of white matter lesions and lacunar infarcts with cognitive performance and whether brain atrophy mediates these associations. Within the Second Manifestations of Arterial Disease-Magnetic Resonance study (2001-2005, the Netherlands), cross-sectional analyses of 522 patients were performed (mean age, 57 years (standard deviation, 10); 76% male). Brain segmentation was used to quantify volumes of brain tissue, cerebrospinal fluid, and white matter lesions. Infarcts were rated visually. Brain volume, ventricular volume, and gray matter volume were divided by intracranial volume to obtain indicators of brain atrophy. Neuropsychological tests assessing executive functioning and memory were performed, and scores were transformed into z scores. The authors used linear regression analyses, adjusted for age, sex, education, intelligence, and vascular risk factors, to investigate the association of white matter lesions and number of lacunar infarcts with cognitive performance. A 1-standard-deviation higher volume of white matter lesions (beta = -0.12, 95% confidence interval: -0.20, -0.04) and the presence of >or=2 lacunar infarcts (beta = -0.48, 95% confidence interval: -0.87, -0.09) were associated with worse executive functioning. These associations remained after adjusting for brain atrophy. Both were not associated with worse memory. Results suggest that subcortical ischemic vascular lesions are associated with decreased executive functioning, but not with memory functioning, independent of brain atrophy.