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Improved recognition of leukoaraiosis and cognitive impairment in Alzheimer's disease
J F Diaz1, H Merskey, V C Hachinski
1Department of Psychiatry, University of Western Ontario, London, Canada.
Insights
Leukoaraiosis, a brain imaging finding, is more common in women with Alzheimer's disease (AD) and is linked to greater cognitive decline. This finding highlights potential sex differences in AD progression.
Area of Science:
- Neurology
- Neuroimaging
- Gerontology
Background:
- Alzheimer's disease (AD) is a progressive neurodegenerative disorder.
- Leukoaraiosis, characterized by white matter changes on brain imaging, is frequently observed in older adults and may impact cognitive function.
Purpose of the Study:
- To investigate the prevalence of leukoaraiosis in patients with uncomplicated Alzheimer's disease.
- To determine the association between leukoaraiosis and cognitive impairment in AD patients.
- To explore potential sex differences in leukoaraiosis prevalence and its impact on cognition.
Main Methods:
- Longitudinal study of 85 Alzheimer's disease patients.
- Computed tomography (CT) scans and psychometric testing (Extended Scale for Dementia) within 6 months of study entry.
- Statistical analyses including analysis of covariance and multiple regression.
Main Results:
- Leukoaraiosis was present in 40% of patients, disproportionately affecting females (62% vs. 15% in males).
- Leukoaraiosis was associated with reduced cognitive scores on the Extended Scale for Dementia, even after adjusting for age, sex, education, and illness duration.
- Leukoaraiosis explained 11.6% of the variance in cognitive scores, and combined with illness duration, accounted for 18.2%.
Conclusions:
- Leukoaraiosis is a significant finding in Alzheimer's disease patients, particularly women.
- The presence of leukoaraiosis is independently associated with greater cognitive impairment in Alzheimer's disease.
- Leukoaraiosis may represent a distinct pathological process contributing to cognitive decline in AD.
Abstract:
We identified 85 patients in a longitudinal study of dementia who had uncomplicated Alzheimer's disease and in whom computed tomography of the head and psychometric testing were conducted within a 6-month period following their entry into the study. Thirty-four patients (40%) had leukoaraiosis, which was disproportionately common in female patients (62% vs 15% in male patients). Analysis of covariance demonstrated a relative reduction of scores on the Extended Scale for Dementia in those patients who had leukoaraiosis, after adjusting for the confounding effects of age, sex, educational level, and duration of illness. Leukoaraiosis was also much more common in women, even after adjusting for the possible confounding effects of age, duration of illness, Extended Scale for Dementia score, and hypertension. Multiple regression analysis showed that leukoaraiosis accounted for 11.6% of the variance of the Extended Scale for Dementia scores. Leukoaraiosis, together with duration of illness, accounted for 18.2% of the variance. Leukoaraiosis is associated with a greater degree of cognitive impairment in patients with Alzheimer's disease.