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Relevance of brain lesion location for cognition in vascular mild cognitive impairment
Antonio Giorgio1, Ilaria Di Donato1, Alessandro De Leucio1
1Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Background:
Vascular mild cognitive impairment (VMCI) is a potentially transitional state between normal aging and vascular dementia. The presence of macroscopic white matter lesions (WML) of moderate or severe extension on brain MRI is the hallmark of the VMCI.
Objective:
To assess the clinical relevance of the frequency of WML in patients with VMCI independently of total lesion volume (LV).
Methods:
In this multicenter study, we included 110 patients with VMCI (age: 74.3 ± 6.6 years; sex: 60 women). Cognitive assessment was performed with the VMCI-Tuscany Neuropsychological Battery, which allowed to identify four VMCI groups: amnestic single (n = 9) and multi-domain (n = 76), non-amnestic single- (n = 10) and multi-domain (n = 15). Distribution and frequency of WML on MRI FLAIR images were evaluated with lesion probability map (LPM). Voxelwise statistics was performed with nonparametric permutation tests, controlling for age, sex, slice thickness, center, magnetic field strength, total LV and head size (p < .01, family-wise error-corrected for multiple comparisons across space).
Results:
LPM of the WML had a fairly symmetric and widespread distribution across brain. A higher frequency of WML along association tracts of the WM such as inferior longitudinal fascicle, inferior fronto-occipital fascicle and superior longitudinal fascicle, was correlated with worst cognitive scores at the Trail Making Test Part A and Copy of the Rey-Osterrieth Complex Figure. The non-amnestic groups showed a higher frequency of WML in the anterior cingulum and superior longitudinal fascicle close to the frontal gyrus.
Conclusions:
Our study showed that in patients with VMCI, independently of total LV, the higher frequency of lesions along association tracts of the WM, which mediate intrahemispheric long-range connectivity, is related with psychomotor speed and constructional praxis. Moreover, a prevalence of lesions in the frontal WM seems to characterize VMCI patients with involvement of non-amnestic domains.
Insights
In vascular mild cognitive impairment (VMCI), white matter lesion (WML) frequency in specific brain tracts, not just volume, impacts cognitive function. Lesion location is key to understanding VMCI subtypes and their cognitive deficits.
Area of Science:
- Neurology
- Neuroimaging
- Cognitive Science
Background:
- Vascular mild cognitive impairment (VMCI) represents a transitional stage between normal aging and vascular dementia.
- Macroscopic white matter lesions (WML) of moderate to severe extent on brain MRI are characteristic of VMCI.
Purpose of the Study:
- To investigate the clinical relevance of WML frequency in VMCI patients, independent of total lesion volume (LV).
- To correlate WML distribution with specific cognitive deficits in VMCI.
Main Methods:
- 110 VMCI patients underwent cognitive assessment and brain MRI with FLAIR sequences.
- Lesion probability maps (LPM) analyzed WML distribution and frequency.
- Voxelwise statistics controlled for demographic and imaging variables.
Main Results:
- WML distribution was widespread, with higher frequency along association tracts.
- Increased WML frequency in specific tracts correlated with poorer performance on Trail Making Test Part A and Rey-Osterrieth Complex Figure.
- Non-amnestic VMCI groups showed higher WML frequency in the anterior cingulum and superior longitudinal fascicle.
Conclusions:
- In VMCI, WML frequency along association tracts, impacting long-range connectivity, relates to psychomotor speed and constructional praxis, independent of total LV.
- Frontal white matter WML prevalence may characterize non-amnestic VMCI.
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