Differential impact of cerebral white matter changes, diabetes, hypertension and stroke on cognitive performance among non-disabled elderly. The LADIS study.
OBJECTIVE
Age related white matter changes (ARWMC) are frequent in non-demented old subjects and are associated with impaired cognitive function. Our aim was to study the influence of vascular risk factors and ARWMC on the neuropsychological performance of an independent elderly population, to see if vascular risk factors impair cognition in addition to the effects of ARWMC.


METHODS
Independent subjects, aged 65-84 years, with any degree of ARWMC were assessed using a comprehensive neuropsychological battery including the Mini-Mental State Examination (MMSE), VADAS-Cog (Alzheimer's disease assessment scale) and the Stroop and Trail Making test. Vascular risk factors were recorded and ARWMC (measured by MRI) were graded into three classes. The impact of vascular risk factors and ARWMC on neuropsychological performance was assessed by linear regression analyses, with adjustment for age and education.


RESULTS
638 patients (74.1 (5) years old, 55% women) were included. Patients with severe ARWMC performed significantly worse on global tests of cognition, executive functions, speed and motor control, attention, naming and visuoconstructional praxis. Diabetes interfered with tests of executive function, attention, speed and motor control, memory and naming. Arterial hypertension and stroke influenced executive functions and attention. The effect of these vascular risk factors was independent of the severity of ARWMC, age and education.


CONCLUSIONS
ARWMC is related to worse performance in executive function, attention and speed. Diabetes, hypertension and previous stroke influenced neuropsychological performance, independently of the severity of ARWMC, stressing the need to control vascular risk factors in order to prevent cognitive decline in the elderly.
Verdelho
Ana
A
Neurology Department, Centro de Estudos Egas Moniz, Santa Maria Hospital, Lisbon, Portugal. averdelho@netcabo.pt
Madureira
Sofia
S
Ferro
José M
JM
Basile
Anna-Maria
AM
Chabriat
Hugues
H
Erkinjuntti
Timo
T
Fazekas
Franz
F
Hennerici
Michael
M
O'Brien
John
J
Pantoni
Leonardo
L
Salvadori
Emilia
E
Scheltens
Philip
P
Visser
Marieke C
MC
Wahlund
Lars-Olof
LO
Waldemar
Gunhild
G
Wallin
Anders
A
Inzitari
Domenico
D
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D001921:Brain / Q000098:blood supply / Q000473:pathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008403:Mass Screening / Q000379:methods; D009483:Neuropsychological Tests; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D011795:Surveys and Questionnaires; D014145:Trail Making Test
D001786:Blood Glucose; D007004:Hypoglycemic Agents