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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Influence of histopathologic type of hippocampal sclerosis on neuropsychological profile
Nhan Le Thanh1, Marion Houot2,3,4, Marie Mere5
1Rehabilitation Unit, Assistance publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
Insights
Hippocampal sclerosis (HS) subtype impacts cognitive function in mesial temporal lobe epilepsy (MTLE). HS-ILAE type 1 is linked to poorer language and visuoconstructive skills compared to other types.
Area of Science:
- Neurology
- Neuroscience
- Epilepsy Research
Background:
- Hippocampal sclerosis (HS) is a common finding in drug-resistant mesial temporal lobe epilepsy (MTLE).
- The International League Against Epilepsy (ILAE) classified HS into three types (HS-ILAE type 1, 2, and 3) in 2013.
- Understanding HS subtypes is crucial for predicting surgical outcomes in MTLE patients.
Purpose of the Study:
- To investigate the association between different HS-ILAE types and cognitive profiles in MTLE patients.
- To compare cognitive performance across HS-ILAE types and patients without HS.
Main Methods:
- Retrospective analysis of 302 patients with MTLE, including 253 with HS (classified into types 1, 2, and 3) and 49 without HS.
- Assessment of multiple cognitive domains: general cognition, memory, language, executive functions, and visuoconstructive abilities.
- Comparison of demographic, clinical, and cognitive data between HS-ILAE type 1, HS-ILAE type 2, and non-HS groups.
Main Results:
- No association found between HS pattern and age at onset, precipitating events, or surgical outcome.
- Patients with HS-ILAE type 1 showed significantly worse performance in language and visuoconstructive tasks compared to HS-ILAE type 2 and non-HS groups.
- No significant differences were noted in episodic memory, short-term memory, executive functions, or perceptual-motor speed between the groups.
Conclusions:
- HS-ILAE subtype influences cognitive outcomes, particularly language and visuoconstructive functions, in MTLE patients.
- Cognitive impairment in MTLE-HS may result from a combination of pathological processes, including specific hippocampal subfield neuronal loss.
- Further research with targeted neuropsychological assessments is recommended to understand the functional impact of distinct hippocampal subregions.
Objective:
Hippocampal sclerosis (HS) is the most common histopathological abnormality in adults with drug-resistant mesial temporal lobe epilepsy (MTLE) who are candidates for surgery. In 2013, the International League Against Epilepsy (ILAE) Task Force subdivided HS into three types: HS-ILAE type 1 (severe neuronal loss and gliosis predominantly in CA1 and CA4), HS-ILAE type 2 (CA1-predominant), and HS-ILAE type 3 (CA4-predominant). The aim of this study was to assess the association between HS-ILAE types and cognitive profiles of MTLE-HS patients.
Methods:
A total of 302 patients were retrospectively included, comprised of 253 MTLE-HS patients with a postoperative ILAE classification of HS as follows: 194 HS-ILAE type 1, 57 HS-ILAE type 2, and two HS-ILAE type 3; and 49 MTLE patients without HS. Demographic variables, clinical characteristics, postoperative outcome, and cognitive performance were compared between patients with HS-ILAE type 1, with HS-ILAE type 2, and without HS, who served as internal controls. Height cognitive domains were examined: general cognition, verbal and nonverbal episodic memory, language, executive functions, short-term and working memory, perceptual-motor speed, and visuoconstructive abilities.
Results:
The pattern of hippocampal neuronal loss was not associated with age at epilepsy onset, the presence of specific initial precipitating events, other clinical characteristics, or postoperative outcome. Patients with HS-ILAE type 1 demonstrated significantly poorer performance in visuoconstructive and language tasks compared with those with HS-ILAE type 2 or patients without HS. No significant differences were observed between groups in verbal and nonverbal episodic memory, short-term memory, executive functions, or perceptual-motor speed.
Significance:
HS-ILAE subtype has a modest yet differential impact on patient performance, with HS-ILAE type 1 patients demonstrating overall poorer outcomes across two cognitive domains: language and visuoconstructive function. These findings suggest that cognitive impairment in MTLE-HS likely reflects a complex interplay among multiple pathological processes, including, in part, neuronal loss within specific hippocampal subfields. More targeted neuropsychological assessments focusing on the functional integrity of distinct hippocampal subregions are warranted.
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