Vol. 38, No. 1, 2012
Issue release date: January 2012
Free Access
Neuroepidemiology 2012;38:41–47
(DOI:10.1159/000334438)
Original Paper
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Characteristics of MR Infarcts Associated with Dementia and Cognitive Function in the Elderly

Aggarwal N.T.a · Schneider J.A.a · Wilson R.S.a · Beck T.L.a · Evans D.A.a · De Carli C.b
aRush University Medical Center, Chicago, Ill., and bUniversity of California at Davis, Sacramento, Calif., USA
email Corresponding Author


 goto top of outline Key Words

  • Stroke
  • Dementia
  • Cognitive function
  • Biracial population sample
  • Magnetic resonance imaging

 goto top of outline Abstract

Background: Little information exists on the simultaneous effects of magnetic resonance (MR) infarct characteristics, that may increase the likelihood of dementia or lower cognitive function in community populations. Methods: Participants were 580 community-dwelling individuals from the Chicago Health and Aging Project (CHAP) who underwent detailed clinical evaluation and MR imaging. The association of MR infarct characteristics (region, number, side, and size) with dementia, global cognition and cognition in five separate cognitive domains was examined using logistic and linear regression analyses controlling for age, sex, race, education and time elapsed between clinical evaluation and MRI. Results: A total of 156 persons had MR infarcts: 108 with 1 infarct and 48 with multiple. Poorer cognitive function and, in particular, slower perceptual speed, were associated with infarcts characterized as cortical, multiple, bilateral or large (all p < 0.05). Multiple infarcts in multiple regions were associated with poor performance in all cognitive domains except visuospatial ability (p < 0.05). Race did not modify any of these associations. Conclusions: In this community sample, cortical and multiple infarcts in multiple regions were associated with dementia; cortical, multiple, large and bilateral infarcts were associated with lower cognition, particularly lower memory function and perceptual speed. These effects were not modified by race.

Copyright © 2011 S. Karger AG, Basel


 goto top of outline References
  1. Pohjasvaara T, Erkinjuntti T, Ylikoski R, Hietanen M, Vataja R, Kaste M: Clinical determinants of poststroke dementia. Stroke 1998;29:75–81.
  2. Pohjasvaara T, Mantyla R, Salonen O, Aronen HJ, Ylikoski R, Hietanen M, Kaste M, Erkinjuntti T: How complex interactions of ischemic brain infarcts, white matter lesions, and atrophy relate to poststroke dementia. Arch Neurol 2000;57:1295–1300.
  3. Kuller LH, Lopez OL, Newman A, Beauchamp NJ, Burke G, Dulberg C, Fitzpatrick A, Fried L, Haan MN: Risk factors for dementia in the cardiovascular health cognition study. Neuroepidemiology 2003;22:13–22.
  4. Pohjasvaara T, Mantyla R, Salonen O, Aronen HJ, Ylikoski R, Hietanen M, Kaste M, Erkinjuntti T: MRI correlates of dementia after first clinical ischemic stroke. J Neurol Sci 2000;181:111–117.
  5. Kuller LH, Lopez OL, Jagust WJ, Becker JT, DeKosky ST, Lyketsos C, Kawas C, Breitner JC, Fitzpatrick A, Dulberg C: Determinants of vascular dementia in the Cardiovascular Health Cognition Study. Neurology 2005;64:1548–1552.
  6. Desmond DW, Moroney JT, Paik MC, Sano M, Mohr JP, Aboumatar S, Tseng CL, Chan S, Williams JB, Remien RH, Hauser WA, Stern Y: Frequency and clinical determinants of dementia after ischemic stroke. Neurology 2000;54:1124–1131.
  7. Tatemichi TK, Desmond DW, Paik M, Figueroa M, Gropen TI, Stern Y, Sano M, Remien R, Williams JB, Mohr JP, et al: Clinical determinants of dementia related to stroke. Ann Neurol 1993;33:568–575.
  8. Sachdev PS, Brodaty H, Valenzuela MJ, Lorentz L, Looi JC, Berman K, Ross A, Wen W, Zagami AS: Clinical determinants of dementia and mild cognitive impairment following ischaemic stroke: the Sydney Stroke Study. Dement Geriatr Cogn Disord 2006;21:275–283.
  9. Mungas D, Jagust WJ, Reed BR, Kramer JH, Weiner MW, Schuff N, Norman D, Mack WJ, Willis L, Chui HC: MRI predictors of cognition in subcortical ischemic vascular disease and Alzheimer’s disease. Neurology 2001;57:2229–2235.
  10. Longstreth WT Jr, Dulberg C, Manolio TA, Lewis MR, Beauchamp NJ Jr, O’Leary D, Carr J, Furberg CD: Incidence, manifestations, and predictors of brain infarcts defined by serial cranial magnetic resonance imaging in the elderly: the Cardiovascular Health Study. Stroke 2002;33:2376–2382.
  11. Prins ND, van Dijk EJ, den Heijer T, Vermeer SE, Jolles J, Koudstaal PJ, Hofman A, Breteler MM: Cerebral small-vessel disease and decline in information processing speed, executive function and memory. Brain 2005;128:2034–2041.
  12. Nyenhuis DL, Gorelick PB: Vascular dementia: a contemporary review of epidemiology, diagnosis, prevention, and treatment. J Am Geriatr Soc 1998;46:1437–1448.
  13. Bienias JL, Beckett LA, Bennett DA, Wilson RS, Evans DA: Design of the Chicago Health and Aging Project (CHAP). J Alzheimers Dis 2003;5:349–355.

    External Resources

  14. Evans DA, Bennett DA, Wilson RS, Bienias JL, Morris MC, Scherr PA, Hebert LE, Aggarwal N, Beckett LA, Joglekar R, Berry-Kravis E, Schneider J: Incidence of Alzheimer disease in a biracial urban community: relation to apolipoprotein E allele status. Arch Neurol 2003;60:185–189.
  15. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
  16. Roman GD, Tatemichi TTK: Report on the NINCDS International Workshop. Neurology 1993;43:250–260.
  17. Goldstein LB: Interrater reliability of the NIH Stroke Scale. Arch Neurol 1989;46:660–662.
  18. Foulkes MA, Wolf PH, Price TR: The Stroke Data Bank: design, methods, and baseline characteristics. Stroke 1988;19:547–554.
  19. Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C: The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 1989;39:1159–1165.
  20. Albert M, Smith LA, Scherr PA, Taylor JO, Evans DA, Funkenstein HH: Use of brief cognitive tests to identify individuals in the community with clinically diagnosed Alzheimer’s disease. Int J Neurosci 1991;57:167–178.
  21. Wechsler Memory Scale-Revised: Manual. New York, Psychological Corporation, 1987.
  22. Kaplan E, Goodglass H, Weintraub S: The Boston Naming Test. Philadelphia, Lea & Febiger, 1983.
  23. Nelsen HE: National Adult Reading Test (NART) test manual. Windsor, NFER-Nelson Publishing Company, 1982.
  24. Cooper JA, Sagar HJ: Incidental and intentional recall in Parkinson’s disease: an account based on diminished attentional resources. J Clin Exp Neuropsychol 1993;15:713–731.
  25. Ekstrom RB, French JQW, Harman H, Dermen D: Manual for kit of factor-referenced cognitive tests. Princeton, Educational Testing Service 1976.
  26. Smith A: Symbol Digit Modalities Test Manual-Revised. Los Angeles, Western Psychological, 1984.
  27. Benton AL, Varney NR, Hamsher KD: Visuospatial judgment: a clinical test. Arch Neurol 1978;35:364–367.
  28. Raven JC, Court JH, Raven J: Standard progressive matrices; in Raven Manual, Oxford, Oxford Psychologists Press, 1992.
  29. Wilson RS, Bienias JL, Evans DA, Bennett DA: Religious Orders Study: overview and change in cognitive and motor speed. Aging Neuropsychol Cogn 2004;11:280–303.

    External Resources

  30. Bennett DA, Schneider JA, Buchman AS, Mendes de Leon C, Bienias JL, Wilson RS: The Rush Memory and Aging Project: study design and baseline characteristics of the study cohort. Neuroepidemiology 2005;25:163–175.
  31. Wilson RS, Aggarwal NT, Barnes LL, Bienias JL, Mendes de Leon C, Evans DA: Biracial Population Study of Mortality in Mild Cognitive Impairment and AD. Arch Neurol 2009;66:667–672.
  32. Rand WM: Objective criteria for the evaluation of clustering methods. J Am Statist Assoc 1971;66:847–850.

    External Resources

  33. Wilson RS, Aggarwal NT, Barnes LL, Mendes de Leon C, Hebert LE, Evans D: A cognitive decline in incident Alzheimer disease in a community population. Neurology 2010;74:951–955.
  34. DeCarli C, Massaro J, Harvey D, Hald J, Tullberg M, Au R, Beiser A, D’Agostino R, Wolf PA: Measures of brain morphology and infarction in the Framingham Heart Study: establishing what is normal. Neurobiol Aging 2005;26:491–510.
  35. Allison PD: Survival Analysis Using the SAS System: A Practical Guide. Cary, SAS Institute Inc., 1995.
  36. Saczynski JS, Sigurdsson S, Jonsdottir MK, Eiriksdottir G, Jonsson PV, Garcia ME, Kjartansson O, Lopez O, Van Buchem MA, Gudnason V, Launer LJ: Cerebral infarcts and cognitive performance: importance of location and number of infarcts. Stroke 2009;40:677–682.
  37. Vermeer SE, Longstreth WT Jr, Koudstaal PJ: Silent brain infarcts: a systematic review. Lancet Neurol 2007;6:611–619.
  38. Tomlinson BE, Blessed G, Roth M: Observations on the brains of demented old people. J Neurol Sci 1970;11:205–242.
  39. Knopman DS, Parisi JE, Boeve BF, Cha RH, Apaydin H, Salviati A, Edland SD, Rocca WA: Vascular dementia in a population-based autopsy study. Arch Neurol 2003;60:569–575.
  40. Tatemichi TK, Desmond DW, Prohovnik I: Strategic infarcts in vascular dementia. A clinical and brain imaging experience. Arzneimittelforschung 1995;45:371–385.
  41. Pohjasvaara T, Mantyla R, Aronen HJ, Leskela M, Salonen O, Kaste M, Erkinjuntti T: Clinical and radiological determinants of prestroke cognitive decline in a stroke cohort. J Neurol Neurosurg Psychiatry 1999;67:742–748.
  42. Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR: Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA 1997;277:813–817.
  43. Schneider JA, Wilson RS, Cochran EJ, Bienias JL, Arnold SE, Evans DA, Bennett DA: Relation of cerebral infarctions to dementia and cognitive function in older persons. Neurology 2003;60:1082–1088.
  44. Jellinger KA, Seppi K, Wenning GK, Poewe W: Impact of coexistent Alzheimer pathology on the natural history of Parkinson’s disease. J Neural Transm 2002;109:329–339.
  45. Jellinger KA, Mitter-Ferstl E: The impact of cerebrovascular lesions in Alzheimer disease – a comparative autopsy study. J Neurol 2003;250:1050–1055.
  46. Kramer JH, Reed BR, Mungas D, Weiner MW, Chui HC: Executive dysfunction in subcortical ischaemic vascular disease. J Neurol Neurosurg Psychiatry 2002;72:217–220.
  47. Price TR, Manolio TA, Kronmal RA, Kittner SJ, Yue NC, Robbins J, Anton-Culver H, O’Leary DH: Silent brain infarction on magnetic resonance imaging and neurological abnormalities in community-dwelling older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. Stroke 1997;28:1158–1164.
  48. Bowler JV, Hachinski V, Steenhuis R, Lee D: Vascular cognitive impairment: clinical, neuropsychological, and imaging findings in early vascular dementia. Lancet 1998;352(suppl 4):63.
  49. Cummings JL: Frontal-subcortical circuits and human behavior. Arch Neurol 1993;50:873–880.
  50. Roman GC, Erkinjuntti T, Wallin A, Pantoni L, Chui HC: Subcortical ischaemic vascular dementia. Lancet Neurol 2002;1:426–436.
  51. Schneider JA, Arvanitakis Z, Bang W, Bennett DA: Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology 2007;69:2197–2204.
  52. Schneider JA, Arvanitakis Z, Leurgans SE, Bennett DA: The neuropathology of probable Alzheimer disease and mild cognitive impairment. Ann Neurol 2009;66:200–208.
  53. Lopez OL, Jagust WJ, Dulberg C, Becker JT, DeKosky ST, Fitzpatrick A, Breitner J, Lyketsos C, Jones B, Kawas C, Carlson M, Kuller LH: Risk factors for mild cognitive impairment in the Cardiovascular Health Study Cognition Study: part 2. Arch Neurol 2003;60:1394–1399.
  54. Gurland BJ, Wilder DE, Lantigua R, Stern Y, Chen J, Killeffer EH, Mayeux R: Rates of dementia in three ethnoracial groups. Int J Geriatr Psychiatry 1999;14:481–493.
  55. White H, Boden-Albala B, Wang C, Elkind MS, Rundek T, Wright CB, Sacco RL: Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation 2005;111:1327–1331.
  56. Brickman AM, Schupf N, Manly JJ, Luchsinger JA, Andrews H, Tang MX, Reitz C, Small SA, Mayeux R, DeCarli C, Brown TR: Brain morphology in older African Americans, Caribbean Hispanics, and Whites from northern Manhattan. Arch Neurol 2008;65:1053–1061.
  57. Bryan RN, Cai J, Burke G, Hutchinson RG, Liao D, Toole JF, Dagher AP, Cooper L: Prevalence and anatomic characteristics of infarct-like lesions on MR images of middle-aged adults: the atherosclerosis risk in communities study. AJNR Am J Neuroradiol 1999;20:1273–1280.

 goto top of outline Author Contacts

Neelum T. Aggarwal, MD
Rush Alzheimer’s Disease Center
600 South Paulina Avenue, Suite 1038
Chicago, IL 60612 (USA)
Tel. +1 312 942 2338, E-Mail Neelum_T_Aggarwal@rush.edu


 goto top of outline Article Information

Received: May 18, 2011
Accepted: October 7, 2011
Published online: December 17, 2011
Number of Print Pages : 7
Number of Figures : 0, Number of Tables : 5, Number of References : 57


 goto top of outline Publication Details

Neuroepidemiology

Vol. 38, No. 1, Year 2012 (Cover Date: January 2012)

Journal Editor: Feigin V.L. (Auckland)
ISSN: 0251-5350 (Print), eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED


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