Cerebral microinfarcts (CMIs) are small ischemic lesions that are a common neuropathological finding in patients with stroke or dementia. CMIs in the cortex can now be detected in vivo on 3 Tesla MRI.
Objective:
To determine the occurrence of CMIs and associated clinical features in patients with possible vascular cognitive impairment (VCI).
Method:
182 memory-clinic patients (mean age 71.4±10.6, 55% male) with vascular injury on brain MRI (i.e., possible VCI) underwent a standardized work-up including 3 Tesla MRI and cognitive assessment. A control group consisted of 70 cognitively normal subjects (mean age 70.6±4.7, 60% male). Cortical CMIs and other neuroimaging markers of vascular brain injury were rated according to established criteria.
Result:
Occurrence of CMIs was higher (20%) in patients compared to controls (10%). Among patients, the presence of CMIs was associated with male sex, history of stroke, infarcts, and white matter hyperintensities. CMI presence was also associated with a diagnosis of vascular dementia and reduced performance in multiple cognitive domains.
Conclusion:
CMIs on 3 Tesla MRI are common in patients with possible VCI and co-occur with imaging markers of small and large vessel disease, likely reflecting a heterogeneous etiology. CMIs are associated with worse cognitive performance, independent of other markers of vascular brain injury.
Van VeluwSJ, ZwanenburgJJM, Engelen-LeeJ, SplietWGM, HendrikseJ, LuijtenPR, BiesselsGJ (2013) In vivo detection of cerebral cortical microinfarcts with high-resolution 7T MRI. J Cereb Blood Flow Metab33, 322–329.
3.
Van VeluwSJ, HilalS, KuijfHJ, IkramMK, XuX, TanBY, VenketasubramanianN, BiesselsGJ, ChenC (2015) Cortical microinfarcts on 3T MRI: Clinical correlates in memory-clinic patients. Alzheimers Dement11, 1500–1509.
4.
HilalS, SikkingE, ShaikMA, ChanQL, van VeluwSJ, VroomanH, ChengC-Y, SabanayagamC, CheungCY, WongTY, VenketasubramanianN, BiesselsGJ, ChenC, IkramMK (2016) Cortical cerebral microinfarcts on 3T MRI: A novel marker of cerebrovascular disease. Neurology87, 1583–1590.
5.
BoomsmaJMF, ExaltoLG, BarkhofF, van den BergE, de BresserJ, HeinenR, KoekHL, PrinsND, ScheltensP, WeinsteinHC, van der FlierWM, BiesselsGJ (2017) Vascular cognitive impairment in a memory clinic population: Rationale and design of the “Utrecht-Amsterdam Clinical Features and Prognosis in Vascular Cognitive Impairment” (TRACE-VCI) study. JMIR Res Protoc6, e60.
6.
FazekasF, ChawlukJ, AlaviA, HurtigH, ZimmermanR (1987) MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. Am J Roentgenol149, 351–356.
7.
ReijmerYD, BrundelM, De BresserJ, KappelleLJ, LeemansA, BiesselsGJ (2013) Microstructural white matter abnormalities and cognitive functioning in type 2 diabetes: A diffusion tensor imaging study. Diabetes Care36, 137–144.
LindeboomJ, SchmandB, TulnerL, WalstraG, JonkerC (2002) Visual association test to detect early dementia of the Alzheimer type. J Neurol Neurosurg Psychiatry73, 126–133.
15.
Van der ElstW, van BoxtelMPJ, van BreukelenGJP, JollesJ (2005) Rey’s verbal learning test: Normative data for 1855 healthy participants aged 24-81 years and the influence of age, sex, education, and mode of presentation. J Int Neuropsychol Soc11, 290–302.
16.
CorriganJD, HinkeldeyNS (1987) Relationships between parts A and B of the Trail Making Test. J Clin Psychol43, 402–409.
17.
StroopJR (1935) Stroop color word test. J Exp Physiol643–662.
18.
DeelmanBG, LiebrandWB, Koning-HaanstraM, van den BurgW (1980) Measurements of aphasic disorders. A brief description of the SAN-battery (Dutch). Gerontologie11, 17–21.
19.
VerhageF (1964) Intelligentie en leeftijd: Onderzoek bij Nederlanders van twaalf tot zevenenzeventig jaar.
20.
GorelickPB, ScuteriA, BlackSE, DecarliC, GreenbergSM, IadecolaC, LaunerLJ, LaurentS, LopezOL, NyenhuisD, PetersenRC, SchneiderJA, TzourioC, ArnettDK, BennettDA, ChuiHC, HigashidaRT, LindquistR, NilssonPM, RomanGC, SellkeFW, SeshadriS (2011) Vascular contributions to cognitive impairment and dementia: A statement for healthcare professionals from the american heart association/american stroke association. Stroke42, 2672–713.
21.
McKhannG, DrachmanD, FolsteinM, KatzmanR, PriceD, StadlanEM (1984) Clinical diagnosis of Alzheimer’sdisease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology34, 939–944.
22.
RománGC, TatemichiTK, ErkinjunttiT, CummingsJL, MasdeuJC, GarciaJH, AmaducciL, OrgogozoJM, BrunA, HofmanA (1993) Vascular dementia: Diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology43, 250–260.
23.
UedaY, SatohM, TabeiK, KidaH, IiY, AsahiM, MaedaM, SakumaH, TomimotoH (2016) neuropsychological features of microbleeds and cortical microinfarct detected by high resolution magnetic resonance imaging. J Alzheimers Dis53, 315–325.
24.
FuR, WangY, WangY, LiuL, ZhaoX, WangDZ, PanY, PuY, ZhangC (2015) The development of cortical microinfarcts is associated with intracranial atherosclerosis: Data from the Chinese Intracranial Atherosclerosis Study. J Stroke Cerebrovasc Dis24, 2447–2454.
25.
WangZ, van VeluwSJ, WongA, LiuW, ShiL, YangJ, XiongY, LauA, BiesselsGJ, MokVC (2016) Risk factors and cognitive relevance of cortical cerebral microinfarcts in patients with ischemic stroke or transient ischemic attack. Stroke47, 2450–2455.
26.
Van DalenJW, ScuricEEM, van VeluwSJ, CaanMWA, NederveenAJ, BiesselsGJ, van GoolWA, RichardE (2015) Cortical microinfarcts detected in vivo on 3 Tesla MRI: Clinical and radiological correlates. Stroke46, 255–257.
27.
BrundelM, de BresserJ, van DillenJJ, KappelleLJ, BiesselsGJ (2012) Cerebral microinfarcts: A systematic review of neuropathological studies. J Cereb Blood Flow Metab32, 425–436.
De RotteAAJ, KoningW, den HartogAG, BovensSM, ZwanenburgJJM, KlompDWJ, PasterkampG, MollFL, LuijtenPR, de BorstGJ, HendrikseJ (2014) 7.0 T MRI detection of cerebral microinfarcts in patients with a symptomatic high-grade carotid artery stenosis. J Cereb Blood Flow Metab34, 1–5.
30.
IiY, MaedaM, KidaH, MatsuoK, ShindoA, TaniguchiA, TomimotoH (2013) In vivo detection of cortical microinfarcts on ultrahigh-field MRI. J Neuroimaging23, 28–32.
31.
KovariE, HerrmannFR, GoldG, HofPR, CharidimouA (2017) Association of cortical microinfarcts and cerebral small vessel pathology in the ageing brain. Neuropathol Appl Neurobiol43, 505–513.
