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[Cerebral blood flow patterns in patients with leukoaraiosis and lacunar infarction]
N Ohsawa1, S Takahashi, H Yonezawa
1Department of Neurology, Iwate Medical University.
Insights
Atrial fibrillation was more common in lacunar infarction associated with leukoaraiosis (LACS) but not other risk factors. Demented patients with periventricular white matter lesions (PVWMLs) or LACS showed reduced cerebral blood flow, suggesting vascular dementia or Alzheimer type dementia.
Area of Science:
- Neurology
- Neuroimaging
- Cerebrovascular Disease
Background:
- Leukoaraiosis (LA) is a common finding on MRI, associated with cognitive impairment.
- Distinguishing between different patterns of white matter lesions is crucial for understanding underlying pathologies.
Purpose of the Study:
- To compare risk factors and cerebral blood flow in patients with lacunar infarction associated with leukoaraiosis in the centrum semiovale (LACS) versus periventricular white matter lesions (PVWMLs).
- To investigate the relationship between cerebral blood flow and dementia in these patient groups.
Main Methods:
- Retrospective comparison of risk factors (hypertension, diabetes, hyperlipidemia, hematocrit, atrial fibrillation) in LACS and PVWML patients.
- Single photon emission computed tomography (SPECT) using N-isopropyl-p-123I iodoamphetamine (IMP) to assess local cerebral blood flow.
- Correlation analysis between cerebral blood flow and dementia rating scales.
Main Results:
- Atrial fibrillation was more frequent in LACS (p < 0.05), but other risk factors did not differ.
- Demented patients were older in both groups.
- Demented patients with PVWMLs showed reduced blood flow in parietal and basal gray regions.
- Demented patients with LACS showed reduced blood flow in frontal and basal gray regions.
- Positive correlation between cerebral blood flow and dementia scores in specific brain areas for each group.
Conclusions:
- LACS patients may often have vascular dementia of Binswanger type.
- Some demented PVWML patients might have Alzheimer type dementia.
- Cerebral blood flow reduction is associated with cognitive decline in white matter lesion patients.
Abstract:
We compared the incidence of risk factors (such as hypertension, diabetes mellitus, hyperlipidemia, hematocrit, atrial fibrillation) and local cerebral blood flow between patients with lacunar infarction associated with leukoaraiosis (LA) in the centrum semiovale (LACS) and those with periventricular white matter lesions (PVWMLs) on magnetic resonance imagings (MRI). Only atrial fibrillation was more frequently seen in LACS (p < 0.05), but the incidence of other risk factors for cerebrovascular disease was not different between the two patient groups. Demented patients were older than those with preserved intelligence in both groups. Local cerebral blood flow was compared between patients with and without dementia by single photon emission computed tomography using N-isopropyl-p-123I iodoamphetamine (IMP). The cerebral: cerebellar IMP uptake ratio (%) was used as a measure of relative cerebral perfusion. Compared with normal controls the demented patients with PVWMLs showed a significant reduction in local cerebral blood flow in the parietal area (p < 0.05) and the basal gray region (p < 0.05), and those with LACS in the frontal area (p < 0.05) and the basal gray region (p < 0.05). A significant positive correlation was found between local cerebral blood flow and dementia rating scales in the temporal and parietal areas in PVWMLs, and in the frontal area in LACS. These results suggest that most patients with LACS may represent vascular dementia of Binswanger type, and some demented patients with PVWMLs may have Alzheimer type dementia.