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Lacunar lesions are independently associated with disability and cognitive impairment in CADASIL

A Viswanathan1, A Gschwendtner, J-P Guichard

  • 1Departments of Neurology, Centre Hospitalier Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, France.

Neurology
|July 11, 2007
PubMed

Insights

Lacunar lesions, not white matter lesions or microhemorrhages, significantly impact cognitive function and disability in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Focusing on lacunar lesion reduction may improve patient outcomes.

Area of Science:

  • Neurology
  • Radiology
  • Genetics

Background:

  • Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary arteriopathy linked to Notch3 gene mutations.
  • CADASIL is characterized by white matter lesions, lacunar lesions, and cerebral microhemorrhages (CMs) on MRI.
  • The clinical significance of lacunar lesions in CADASIL has been understudied compared to white matter lesions.

Purpose of the Study:

  • To investigate the influence of MRI-visible markers, specifically lacunar lesions, on cognitive impairment and disability in CADASIL patients.
  • To differentiate the impact of lacunar lesions from white matter hyperintensities (WMHs) and CMs on disease progression.

Main Methods:

  • A prospective cohort study included 147 consecutive CADASIL patients.
  • Clinical data, including disability (modified Rankin scale, Barthel index) and cognitive function (Mattis Dementia Rating Scale, Mini-Mental Status Examination), were collected.
  • MRI (1.5-T) assessed the volume and location of lacunar lesions, WMHs, and CMs.

Main Results:

  • Lacunar lesion volume was significantly and independently associated with global cognitive function in multivariable analysis.
  • WMHs and CMs did not show an independent influence on cognitive function.
  • Disability was associated with lacunar lesion volume, CMs, systolic blood pressure, and age, but not WMHs.

Conclusions:

  • The overall burden of lacunar lesions significantly impacts cognitive function and disability in CADASIL.
  • Preventive strategies targeting lacunar lesion reduction may mitigate disease-related impairment.
  • Lacunar lesions may also be crucial in the disability and cognitive impairment seen in more common small-vessel diseases.
Abstract

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