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Additive effect of cerebral atrophy on cognition in dementia-free elderly with cerebrovascular disease

Xin Xu, April Phua, Simon L Collinson, Saima Hilal, Mohammad Kamran Ikram, Tien Yin Wong, Ching Yu Cheng, Narayanaswamy Venketasubramanian, Christopher Chen
DOI: 10.1136/svn-2018-000202 Published 20 June 2019
Xin Xu
1Department of Pharmacology, National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
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April Phua
2Department of Psychological Medicine, National University Hospital, Singapore, Singapore
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Simon L Collinson
3Department of Psychology, National University of Singapore, Singapore, Singapore
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Saima Hilal
1Department of Pharmacology, National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
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Mohammad Kamran Ikram
4Departments of Epidemiology and Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Tien Yin Wong
5Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
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Ching Yu Cheng
5Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
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Narayanaswamy Venketasubramanian
6Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
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Christopher Chen
7Clinical Research Centre, Department of Pharmacology, National University Health System, Singapore, Singapore
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    Figure 1

    Global cognitive z-score in different atrophy groups stratified by CeVD burden severity. Values are mean (SE). No atrophy, defined by the absence of significant atrophy (CA and MTA); CA, defined by the presence of significant CA and the absence of MTA; CA+MTA, defined by the presence of significant CA and MTA. CA, cortical atrophy; CeVD, cerebrovascular disease; MTA, medial temporal atrophy.

Tables

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  • Table 1

    Characteristics of the study population

    No atrophy
    (n=471)
    CA
    (n=265)
    CA+MTA
    (n=83)
    P value
    Age, mean±SD67.7±5.572.2±6.174.9±6.5<0.001
    Education0.019
     ≤6 years, n (%)278 (59.0)177 (66.8)60 (72.3)
    Gender<0.001
     Female, n (%)274 (58.2)127 (47.9)25 (30.1)
    Race0.045
     Chinese, n (%)157 (33.3)85 (32.1)34 (41.0)
     Malay, n (%)155 (32.9)84 (31.7)34 (41.0)
     Indian, n (%)159 (33.8)96 (36.2)15 (18.1)
    Hypertension, n (%)354 (75.2)229 (86.4)76 (91.6)<0.001
    Hyperlipidemia, n (%)356 (75.6)198 (74.7)61 (73.5)NS
    Diabetes mellitus, n (%)154 (32.7)113 (42.6)37 (44.6)0.009
    History of stroke, n (%)10 (2.1)22 (8.3)10 (12.0)<0.001
    Ischaemic heart disease, n (%)26 (5.5)26 (9.8)8 (9.6)NS
    Smoking history, n (%)108 (22.9)78 (29.4)35 (42.2)0.001
    CI status, n (%)<0.001
     NCI175 (37.2)68 (25.6)10 (12.0)
     CIND mild171 (36.3)85 (32.1)19 (22.9)
     CIND moderate125 (26.5)112 (42.3)54 (65.1)
    • CA+MTA, cortical atrophy and medial temporal atrophy; CI, cognitive impairment; CIND, cognitive impairment-no dementia; NCI, no cognitive impairment; NS, not significant.

  • Table 2

    Domain-specific cognitive z-scores in no atrophy, CA and CA+MTA groups in different CeVD groups

    Groups
    Cognitive scoresNone-mild CeVDModerate-severe CeVDP
    (for trend)
    No atrophy (n=362)CA (n=133)CA+MTA (n=25)No atrophy (n=109)CA (n=132)CA+MTA (n=58)
    Executive function0.27
    (0.18, 0.36)
    0.23
    (0.10, 0.37)
    −0.21
    (−0.53,0.11)
    0.19
    (0.03, 0.34)*
    0.07
    (−0.10, 0.23)†
    −0.33
    (−0.64,–0.02)*†
    0.002
    Attention0.28
    (0.19, 0.36)
    0.22
    (0.08, 0.36)
    −0.04
    (−0.37, 0.28)
    0.16
    (0.01, 0.32)
    −0.20
    (−0.37,–0.03)
    −0.35
    (−0.66,–0.04)
    0.001
    Language0.28
    (0.19, 0.36)
    0.22
    (0.08, 0.36)
    −0.04
    (−0.37, 0.28)
    0.16
    (0.01, 0.32)
    −0.20
    (−0.37,–0.04)
    −0.35
    (−0.66,–0.04)
    <0.001
    Verbal memory0.35
    (0.26, 0.44)
    0.23
    (0.09, 0.38)
    −0.19
    (−0.52, 0.14)
    0.08
    (−0.08, 0.24)
    0.01
    (−0.16, 0.18)
    −0.25
    (−0.56,0.07)
    <0.001
    Visual memory0.33
    (0.25, 0.41)
    0.27
    (0.14, 0.40)
    −0.23
    (−0.53, 0.07)
    0.19
    (0.04, 0.33)*
    −0.12
    (−0.27, 0.03)
    −0.39
    (−0.67,–0.11)*
    <0.001
    Visuoconstruction0.30
    (0.21, 0.38)
    0.24
    (0.10, 0.38)
    −0.30
    (−0.63, 0.02)
    0.09
    (−0.06, 0.25)
    0.04
    (−0.12, 0.21)
    −0.09
    (−0.39, 0.22)
    0.002
    Visuomotor speed0.31
    (0.23, 0.39)
    0.18
    (0.05, 0.30)
    −0.29
    (−0.57, 0.003)
    0.11
    (−0.03, 0.24)*
    0.09
    (−0.05, 0.24)†
    −0.22
    (−0.49, 0.06)†
    <0.001
    • Values are adjusted means (95% CI). CeVD, Cerebrovascular Disease. The model controlled for age, education, gender and cognitive impairment status.

    • *Significant difference between no atrophy and CA+MTA groups.

    • †Significant difference between CA and CA+MTA groups.

Supplementary Materials

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    [svn-2018-000202supp001.pdf]

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Additive effect of cerebral atrophy on cognition in dementia-free elderly with cerebrovascular disease
Xin Xu, April Phua, Simon L Collinson, Saima Hilal, Mohammad Kamran Ikram, Tien Yin Wong, Ching Yu Cheng, Narayanaswamy Venketasubramanian, Christopher Chen
Stroke and Vascular Neurology Jun 2019, svn-2018-000202; DOI: 10.1136/svn-2018-000202

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Additive effect of cerebral atrophy on cognition in dementia-free elderly with cerebrovascular disease
Xin Xu, April Phua, Simon L Collinson, Saima Hilal, Mohammad Kamran Ikram, Tien Yin Wong, Ching Yu Cheng, Narayanaswamy Venketasubramanian, Christopher Chen
Stroke and Vascular Neurology Jun 2019, svn-2018-000202; DOI: 10.1136/svn-2018-000202
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Additive effect of cerebral atrophy on cognition in dementia-free elderly with cerebrovascular disease
Xin Xu, April Phua, Simon L Collinson, Saima Hilal, Mohammad Kamran Ikram, Tien Yin Wong, Ching Yu Cheng, Narayanaswamy Venketasubramanian, Christopher Chen
Stroke and Vascular Neurology Jun 2019, svn-2018-000202; DOI: 10.1136/svn-2018-000202
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