Hippocampal volume is an independent predictor of cognitive performance in CADASIL.
Recent evidence suggests that hippocampal changes are present in vascular cognitive impairment but their importance and relationship with ischaemic mechanisms remain controversial. To investigate these issues we performed MRI and cognitive assessment in a large cohort (n=144) of patients with CADASIL, a hereditary small vessel disease and model of pure vascular cognitive impairment. Dementia status was ascribed according to DSM-IV and global cognitive function assessed with the Minimental State Examination (MMSE) and Mattis Dementia Rating Scale (MDRS). Hippocampal volume (HV) correlated with age (r=-0.33, p<0.001), brain volume (r=0.39, p<0.001) and lacunar lesion volume (r=-0.23, p=0.008), but not white matter lesions or microhaemorrhages. HV was reduced in dementia (2272+/-333 mm(3) versus 2642+/-349 mm(3), p<0.001) in the whole cohort and the subgroup progressing to dementia before age 60. HV correlated with MMSE (r=0.30, p<0.001), MDRS (r=0.40, p<0.001) and in a multivariate model predicted cognition independent of typical vascular lesions and whole brain atrophy. These findings strengthen the view that hippocampal atrophy is an important pathway of cognitive impairment in vascular as well as degenerative disease.
O'Sullivan
Mike
M
Neurologische Klinik, Klinikum Grosshadern, Ludwig Maximilians University, Marchioninstrasse 15, 81377 Munich, Germany. michael.osullivan@med.uni-muenchen.de
Ngo
Elmar
E
Viswanathan
Anand
A
Jouvent
Eric
E
Gschwendtner
Andreas
A
Saemann
Philipp G
PG
Duering
Marco
M
Pachai
Chahin
C
Bousser
Marie-Germaine
MG
Chabriat
Hugues
H
Dichgans
Martin
M
D046589:CADASIL / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic