RT Journal Article
SR Electronic
T1 Additive effect of cerebral atrophy on cognition in dementia-free elderly with cerebrovascular disease
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP svn-2018-000202
DO 10.1136/svn-2018-000202
A1 Xu, Xin
A1 Phua, April
A1 Collinson, Simon L
A1 Hilal, Saima
A1 Ikram, Mohammad Kamran
A1 Wong, Tien Yin
A1 Cheng, Ching Yu
A1 Venketasubramanian, Narayanaswamy
A1 Chen, Christopher
YR 2019
UL http://svn.bmj.com/content/early/2019/06/19/svn-2018-000202.abstract
AB Objective To explore the additive effect of neurodegenerative diseases, measured by atrophy, on neurocognitive function in Asian dementia-free elderly with cerebrovascular disease (CeVD).Methods The present study employed a cross-sectional design and was conducted between 2010 and 2015 among community-dwelling elderly participants recruited into the study. Eligible participants were evaluated with an extensive neuropsychological battery and neuroimaging. The weighted CeVD burden scale comprising markers of both small- and large-vessel diseases was applied, with a score of ≥2, indicating significant CeVD burden. Cortical atrophy (CA) and medial temporal atrophy (MTA) were graded using the global cortical atrophy scale and Schelten’s scale, respectively. Global and domain-specific (attention, executive function, language, visuomotor speed, visuoconstruction, visual memory, and verbal memory) neurocognitive performance was measured using a locally validated neuropsychological battery (Vascular Dementia Battery, VDB).Results A total of 819 dementia-free participants were included in the analysis. Among none-mild CeVD subjects, there was no significant difference in the global cognitive performance across atrophy groups (no atrophy, CA, and CA+MTA). However, in moderate-severe CeVD subjects, CA+MTA showed significantly worse global cognitive performance compared with those with CA alone (mean difference=−0.35, 95% CI −0.60 to −0.11, p=0.002) and those without atrophy (mean difference=−0.46, 95% CI −0.74 to −0.19, p<0.001, p<0.001). In domain-specific cognitive performance, subjects with CA+MTA performed worse than other groups in visual memory (p=0.005), executive function (p=0.001) and visuomotor speed (p<0.001) in moderate-severe CeVD but not in none-mild CeVD.Conclusions and relevance Atrophy and moderate-severe CeVD burden showed an additive effect on global and domain-specific cognitive performance. This study highlights the importance of investigating the mechanisms of clinico-pathological interactions between neurodegenerative processes and vascular damage, particularly in the pre-dementia stage.