London, United Kingdom 2013 11 Brain imaging B 16:40 - 16:50 Loss of white matter integrity in small vessel disease is related to cognition A.M. Tuladhar1, A.G.W. van Norden2, K.F. de Laat3, D.G. Norris4, M.P. Zwiers5, E.J. van Dijk6, F.E. de Leeuw7 UMCN St Radboud, Nijmegen, THE NETHERLANDS1,Amphia Ziekenhuis, Breda, THE NETHERLANDS2, HagaLanden, Den Haag, THE NETHERLANDS3, Donders Centre, Nijme-gen, THE NETHERLANDS4, Donders Centre, Nijmegen, THE NETHERLANDS5, UMCN St Radboud, Nijmegen, THE NETHERLANDS6, UMCN St Radboud, Nijmegen, THE NETHER-LANDS7 Background: Cerebral small vessel disease, including white matter lesions and lacunar infarcts, is common in elderly people and is related to cognitive impairment and dementia. The loss of microstructural integrity in the normal appearing white matter (NAWM) may also play a role in the cause of cognitive disturbances. In this study, we used diffusion tensor imaging (DTI) to ex-amine the relation between the white matter integrity and cognitive function. Methods: The RUN DMC study is a prospective study among 503 independently living, non-demented elderly with cerebral small vessel disease, aged between 50 and 85 years. All subjects underwent magnetic resonance imaging and DTI scanning and an extensive neuropsy-chological assessment. Tract-based spatial statistic was conducted to assess the relationship be-tween cognitive performance and diffusion parameters. Results: Loss of white matter integrity was related to cognitive performance, reflected by lower fractional anisotropy and higher mean diffusivity with lower performance (figure 1). This rela-tion was found in numerous regions, mostly in the NAWM. The microstructural integrity in the genu and splenium of the corpus callosum showed the highest significant relation with global cognitive function, in the cingulum bundle with verbal memory performance and in the frontal white matter with psychomotor speed. Associations between DTI-parameters and most cogni-tive domains remained present after adjustment for white matter lesion volume and lacunar in-farctions. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 67 Conclusion: Cognitive disturbances in subjects with cerebral small vessel disease are attribut-able to loss of microstructural integrity of multiple white matter fibers connecting different cor-tical and subcortical regions. DTI could be of added value to conventional magnetic resonance imaging parameters in investigating the pathophysiology of cognitive impairment in subjects with cerebral small vessel disease. 16:30-18:00 Oral Session Room 2,3,4 Brain imaging B Chairs: H. Chabriat, France and A. Gass, Germany 10 Brain imaging B 16:30 - 16:40 Cerebral small vessel disease and microstructural integrity of the white matter predict progression of gait impairment. The RUN DMC Study H.M. van der Holst1, I.W.M. van Uden2, A.M. Tuladhar3, K.F. de Laat4, A.G.W van Norden5, D.G. Norris6, M.P. Zwiers7, E.J. van Dijk8, F.E. de Leeuw9 Radboud University Nijmegen Medical Centre, Department of Neurology, Nijmegen, THE NETHERLANDS1,Radboud University Nijmegen Medical Centre, Department of Neu-rology, Nijmegen, THE NETHERLANDS2, Radboud University Nijmegen Medical Centre, Department of Neurology, Nijmegen, THE NETHERLANDS3, HagaZiekenhuis, Den Haag, THE NETHERLANDS4, Amphia Ziekenhuis, Breda, THE NETHERLANDS5, Centre for Neu-roimaging, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, THE NETHER-LANDS6, Centre for Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Ni-jmegen, THE NETHERLANDS7, Radboud University Nijmegen Medical Centre, Department of Neurology, Nijmegen, THE NETHERLANDS8, Radboud University Nijmegen Medical Centre, Department of Neurology, Nijmegen, THE NETHERLANDS9 Background: Cerebral small vessel disease (cSVD) is related to gait disturbances. However the role of cSVD in gait disability progression is unknown. This study investigates the rela-tion between cSVD and the microstructural integrity of the white matter (WM), WM lesions (WML) and normal appearing WM (NAWM) and progression of gait impairment prospec-tively. Methods: The RUN DMC study is a prospective study among 503 elderly with cSVD with baseline assessment in 2006. Follow-up has been performed in 2012 with 398 subjects who underwent repeated gait assessment (Tinneti Test and Timed-Up-and-Go (TUG) test) and MRI investigation. 49 subjects had died, 2 were lost to follow-up and 54 did not visit our re-search center, however clinical endpoints were obtained. Mean follow-up time was 5.2 years. Subjects with territorial infarcts were excluded, yielding a subgroup of 332. Linear regression analysis was used to assess the relation between change of these gait parameters at baseline and follow-up and WML volume, number of lacunar infarcts and DTI-parameters at baseline. Adjustments were made for age, sex, height, normalized total brain volume, WML volume and lacunar infarcts. Results: Mean age at follow-up was 69.9 yrs (SD8.6) and 56.3% was male. WML volume at baseline was positively related to the increase of number of steps needed during TUG test (β=.16,p=.01), as well as to the duration of the test(β=.23,p<.0005). Lacu-nar infarcts were not related to both tests. Decline of the Tinneti test was negatively related to WML volume(β=-.14,p=.02). Significant relations were found between mean diffusivity val-ues of total WM, NAWM and WML at baseline and decline of the Tinneti test(β-.18,p=.01; β=-.24,p<.0005; β=-.15,p=.04). No significant relations with fractional anisotropy values were found. Conclusion: This is the first prospective study showing that cSVD, especially WML vol-ume, and microstructural integrity of the WM, WML and NAWM is related to progression of gait impairment.
Karger_ESC London_2013
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