Selective neuronal damage and Wisconsin Card Sorting Test performance in atherosclerotic occlusive disease of the major cerebral artery.
BACKGROUND
In atherosclerotic internal carotid artery (ICA) or middle cerebral artery (MCA) disease, selective neuronal damage can be detected as a decrease in central benzodiazepine receptors (BZRs) in the normal-appearing cerebral cortex. This study aimed to determine whether a decrease in the BZRs in the non-infarcted cerebral cortex is associated with poor performance on the Wisconsin Card Sorting Test (WCST), which assesses executive functions.


METHODS
The authors measured the BZRs using positron emission tomography and (11)C-flumazenil in 60 non-disabled patients with unilateral atherosclerotic ICA or MCA disease and no cortical infarction. Using three-dimensional stereotactic surface projections, the abnormally decreased BZR index (extent (%) of pixels with Z score >2 compared with controls × average Z score in those pixels) in the cerebral cortex of the anterior cerebral artery (ACA) or MCA territory was calculated and found to be correlated with the patient's score on the WCST.


RESULTS
On the basis of the WCST results, 39 patients were considered abnormal (low categories achieved) for their age. The BZR index of the ACA territory in the hemisphere affected by arterial disease was significantly higher in abnormal patients than in normal patients. The BZR index of the MCA territory differed significantly between the two groups when patients with left arterial disease (n=28) were analysed separately.


CONCLUSIONS
In atherosclerotic ICA or MCA disease, selective neuronal damage that is manifested as a decrease in BZRs in the non-infarcted cerebral cortex may contribute to the development of executive dysfunction.
Yamauchi
Hiroshi
H
Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan. yamauchi@kuhp.kyoto-u.ac.jp
Nishii
Ryuichi
R
Higashi
Tatsuya
T
Kagawa
Shinya
S
Fukuyama
Hidenao
H
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology*; D001923:Brain Chemistry / Q000502:physiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003627:Data Interpretation, Statistical; D056344:Executive Function / Q000502:physiology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000473:pathology*; D009483:Neuropsychological Tests; D010101:Oxygen Consumption / Q000502:physiology; D049268:Positron-Emission Tomography; D011963:Receptors, GABA-A / Q000378:metabolism; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology
D011963:Receptors, GABA-A
Ann Nucl Med. 2003 Jun;17(4):289-95
12932111
Stroke. 1997 Jan;28(1):124-32
8996500
J Comput Assist Tomogr. 1980 Dec;4(6):727-36
6971299
J Neurol Neurosurg Psychiatry. 2000 Mar;68(3):317-22
10675213
J Cereb Blood Flow Metab. 2001 Jul;21(7):793-803
11435791
J Comput Assist Tomogr. 2004 May-Jun;28(3):428-35
15100552
Stroke. 2006 Nov;37(11):2713-9
17023671
Brain. 1996 Oct;119 ( Pt 5):1667-75
8931588
Stroke. 1995 Dec;26(12):2267-71
7491648
Arch Neurol. 1996 Nov;53(11):1103-9
8912483
Stroke. 2003 Jun;34(6):1419-24
12714708
Science. 2004 Oct 15;306(5695):443-7
15486290
J Cereb Blood Flow Metab. 1983 Dec;3(4):416-24
6630313
Alzheimer Dis Assoc Disord. 1999 Oct-Dec;13 Suppl 3:S69-80
10609685
Stroke. 1986 Sep-Oct;17(5):817-30
3532434
Surg Neurol. 2003 Jun;59(6):455-60; discussion 460-3
12826338
Brain. 2008 Oct;131(Pt 10):2666-78
18678564
Neuropsychologia. 2000;38(4):388-402
10683390
J Cereb Blood Flow Metab. 1996 Sep;16(5):834-40
8784228
N Engl J Med. 1991 Aug 15;325(7):445-53
1852179
Science. 2009 Jul 3;325(5936):52-8
19574382
Stroke. 1993 Dec;24(12):2046-57; discussion 2057-8
8248987
J Nucl Med. 2005 Dec;46(12):1973-9
16330559
Stroke. 2009 Feb;40(2):448-53
19074482
Hum Brain Mapp. 2005 May;25(1):35-45
15846821
Ann Neurol. 1991 Mar;29(3):231-40
2042939
J Nucl Med. 1995 Jul;36(7):1238-48
7790950
Stroke. 1998 Feb;29(2):454-61
9472889
J Neurol Neurosurg Psychiatry. 1995 May;58(5):633-6
7745417
J Nucl Med. 1995 Dec;36(12):2154-61
8523097
Cortex. 1976 Dec;12(4):313-24
1009768
Ann Neurol. 2007 May;61(5):454-65
17380523
Neuroimage. 2006 Apr 15;30(3):1038-49
16414280
J Neuropsychiatry Clin Neurosci. 2002 Fall;14(4):377-405
12426407
Stroke. 2009 Dec;40(12):3730-5
19797182
AJNR Am J Neuroradiol. 2008 Nov;29(10):1841-6
18653680
AJNR Am J Neuroradiol. 2000 Apr;21(4):643-6
10782772
J Nucl Med. 1998 Aug;39(8):1348-53
9708504