The impact of single and combined effects of subcortical white matter lesions (WMLs) and magnetic resonance imaging (MRI)—defined brain infarct on activities of daily living (ADL), depression, and health status perception was analyzed in community-dwelling elderly individuals. The study included 268 participants from the Memory and Morbidity in Augsburg Elderly (MEMO) project, a population-based study on individuals aged 65 to 83 years, conducted in Augsburg, Germany. Cerebral MRI was performed, and 2 geriatric performance tests, scales to assess ADL, depressive symptoms, and self-perceived health status were assessed. The prevalence of large (>10 mm) subcortical WML was 37.7% and of MRI-defined infarct-like lesions was 15.3%. Both vascular lesion types combined were found in 9% of the participants. Large WMLs were associated with significantly more impairments in basic ADL, inferior results in the performance tests, and a worse self-perceived health status compared to those without large WML. Magnetic resonance imaging—defined brain infarct was associated with impairments in performance tests. Participants with both lesion types were limited in all domains and were 2 to 3 times more likely to have impairments in all examined functions. Their risk of impairment in a specific function was considerably higher than the sum of the single risks associated with each lesion type alone. This study suggests that the single and especially the combined occurrence of common vascular brain lesions are associated with functional impairment. Identifying individuals with severe WML combined with MRI-defined brain infarct can help better understand the development of marked impairments in old age.
Scheltens P. , Barkhof F., Valk J., et al. White matter lesions on magnetic resonance imaging in clinically diagnosed Alzheimer’s disease. Evidence for heterogeneity . Brain. 1992;115(pt 3):735-748.
2.
de Leeuw FE, de Groot JC, Achten E., et al. Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study. J Neurol Neurosurg Psychiatry. 2001;70(1):9-14.
3.
van Swieten JC, Staal S., Kappelle LJ, Derix MM, van Gijn J.Are white matter lesions directly associated with cognitive impairment in patients with lacunar infarcts? J Neurol. 1996;243(2):196-200.
4.
Ylikoski A., Erkinjuntti T., Raininko R., Sarna S., Sulkava R., Tilvis R.White matter hyperintensities on MRI in the neurologically nondiseased elderly. Analysis of cohorts of consecutive subjects aged 55 to 85 years living at home. Stroke. 1995;26(7):1171-1177.
5.
Pantoni L., Garcia JHPathogenesis of leukoaraiosis: a review. Stroke. 1997;28(3):652-659.
6.
Longstreth WT Jr, Manolio TA, Arnold A., et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke. 1996;27(8):1274-1282.
7.
van Zagten M. , Lodder J., Kessels F.Gait disorder and parkinsonian signs in patients with stroke related to small deep infarcts and white matter lesions. Mov Disord. 1998;13(1):89-95.
8.
Whitman GT, Tang Y., Lin A., Baloh RWA prospective study of cerebral white matter abnormalities in older people with gait dysfunction. Neurology. 2001; 57(6): 990-994.
9.
Tell GS, Lefkowitz DS, Diehr P., Elster ADRelationship between balance and abnormalities in cerebral magnetic resonance imaging in older adults. Arch Neurol. 1998 ; 55(1):73-79.
10.
Hickie I., Naismith S., Ward PB, et al. Vascular risk and low serum B12 predict white matter lesions in patients with major depression. J Affect Disord. 2005; 85(3): 327-332.
11.
de Groot JC , de Leeuw FE, Oudkerk M., Hofman A., Jolles J., Breteler MMCerebral white matter lesions and subjective cognitive dysfunction: the Rotterdam Scan Study. Neurology . 2001;56(11):1539-1545.
12.
Guo X., Skoog I., Matousek M., et al. A population-based study on motor performance and white matter lesions in older women. J Am Geriatr Soc. 2000;48(8):967-970.
13.
Launer LJEpidemiology of white matter lesions. Top Magn Reson Imaging . 2004;15(6):365-367.
14.
van Dijk EJ , Breteler MM, Schmidt R., et al. for the CASCADE Consortium.The association between blood pressure, hypertension, and cerebral white matter lesions: cardiovascular determinants of dementia study. Hypertension. 2004;44(5):625-630.
15.
Liao D., Cooper L., Cai J., et al. Presence and severity of cerebral white matter lesions and hypertension, its treatment, and its control. The ARIC Study. Atherosclerosis Risk in Communities Study. Stroke. 1996;27(12):2262-2270.
16.
Bots ML, van Swieten JC, Breteler MM, et al. Cerebral white matter lesions and atherosclerosis in the Rotterdam Study. Lancet. 1993;341(8855):1232-1237.
17.
Kurata M., Okura T., Watanabe S., Higaki J.Association between carotid hemodynamics and asymptomatic white and gray matter lesions in patients with essential hypertension. Hypertens Res. 2005;28(10):797-803.
18.
DeCarli C.Prevention of white-matter lesions through control of cerebrovascular risk factors. Int Psychogeriatr. 2003;15(suppl 1):147-151.
19.
Sierra C., Coca A.White matter lesions and cognitive impairment as silent cerebral disease in hypertension. ScientificWorldJournal. 2006 ;6:494-501.
20.
Desmond DWCognition and white matter lesions. Cerebrovasc Dis.2002;13(suppl 2):53-57.
21.
Schmidt WP, Roesler A., Kretzschmar K., Ladwig KH, Junker R., Berger K.Functional and cognitive consequences of silent stroke discovered using brain magnetic resonance imaging in an elderly population. J Am Geriatr Soc. 2004;52(7):1045-1050.
22.
Keil U., Filipiak B., Döring A., et al, and the Centers for Disease Control (CDC).Monitoring trends and determinants in cardiovascular disease in Germany: results of the MONICA Project Augsburg, 1985-1990. MMWR Morb Mortal Wkly Rep.1992;41(suppl):171-179.
23.
Launer LJ, Oudkerk M., Nilsson LG, et al. CASCADE: a European collaborative study on vascular determinants of brain lesions. Study design and objectives. Neuroepidemiology . 2000;19(3):113-120.
24.
Berger K., Kase CS, Buring JEInterobserver agreement in the classification of stroke in the physicians’ health study. Stroke. 1996;27(2):238-242.
25.
Atiya M., Kurth T., Berger K., Buring JE, Kase CS, and the Women’s Health Group.Interobserver agreement in the classification of stroke in the Women’s Health Study. Stroke. 2003;34(2):565-567.
26.
Hautzinger M., Bailer M.Allgemeine Depressionskala (ADS).Die deutsche Version des CES-D. Weinheim: Beltz ; 1991.
27.
Radloff LSThe CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385-401.
28.
Lawton MP, Brody EMAssessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179-186.
29.
Ware JE Jr , Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care . 1992;30(6):473-483.
30.
Tarlov AR, Ware JE Jr, Greenfield S., Nelson EC, Perrin E., Zubkoff M.The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA. 181989;262(7):925-930.
31.
Keil U., Stieber J., Döring A., et al. The cardiovascular risk factor profile in the study area Augsburg. Results from the first MONICA survey 1984/85. Acta Med Scand Suppl.1988;728:119-128.
32.
Achten E., Breteler M., De Leeuw F.Rating scale for age related brain changes. Imaging Decision MRI. 2000;4:10-19.
33.
Scheltens P. , Erkinjunti T., Leys D., et al. White matter changes on CT and MRI: an overview of visual rating scales. European Task Force on Age-Related White Matter Changes. Eur Neurol. 1998;39(2):80-89.
34.
Videbech P. , Ravnkilde B., Gammelgaard L., et al. The Danish PET/depression project: performance on Stroop’s test linked to white matter lesions in the brain . Psychiatry Res. 2004;130(2):117-130.
35.
Piguet O., Ridley L., Grayson DA, et al. Are MRI white matter lesions clinically significant in the ‘old-old’? Evidence from the Sydney Older Persons Study. Dement Geriatr Cogn Disord. 2003;15(3):143-150.
36.
Wong TY, Klein R., Sharrett AR, et al. for the ARIC Investigators.Atheroslerosis Risk in Communities Study. Cerebral white matter lesions, retinopathy, and incident clinical stroke. JAMA. 2002;288(1):67-74.
37.
Yamauchi H. , Fukuda H., Oyanagi C.Significance of white matter high intensity lesions as a predictor of stroke from arteriolosclerosis. J Neurol Neurosurg Psychiatry. 2002;72(5):576-582.
38.
Meguro K., Ueda M., Kobayashi I., et al. Sleep disturbance in elderly patients with cognitive impairment, decreased daily activity and periventricular white matter lesions. Sleep. 1995;18(2):109-114.
39.
Seno H., Ishino H., Inagaki T., Yamamori C., Miyaoaka T.Comparison between multiple lacunar infarcted patients with and without dementia in nursing homes in shimane prefecture, Japan. Dement Geriatr Cogn Disord. 2000; 11(3):161-165.
40.
Steffens DC , Bosworth HB, Provenzale JM, MacFall JRSubcortical white matter lesions and functional impairment in geriatric depression. Depress Anxiety. 2002; 15(1):23-28.
41.
Pantoni L., Poggesi A., Basile AM, et al, for the LADIS Study Group.Leukoaraiosis predicts hidden global functioning impairment in nondisabled older people: the LADIS (Leukoaraiosis and Disability in the Elderly) Study . J Am Geriatr Soc.2006;54(7):1095-1101.
42.
Krishnan MS , O’Brien JT, Firbank MJ, et al, and the LADIS Group.Relationship between periventricular and deep white matter lesions and depressive symptoms in older people. The LADIS Study. Int J Geriatr Psychiatry.2006;21(10):983-989.
43.
Versluis CE , van der Mast RC, van Buchem MA, et al. Progression of cerebral white matter lesions is not associated with development of depressive symptoms in elderly subjects at risk of cardiovascular disease: The PROSPER Study. Int J Geriatr Psychiatry. 2006;21(4): 375-381.
44.
Chen PS, McQuoid DR, Payne ME, Steffens DCWhite matter and subcortical gray matter lesion volume changes and late-life depression outcome: a 4-year magnetic resonance imaging study. Int Psychogeriatr.2006; 18(3):445-456.
45.
Firbank MJ, O’Brien JT, Pakrasi S., et al. White matter hyperintensities and depression-preliminary results from the LADIS study. Int J Geriatr Psychiatry.2005; 20(7):674-679.
