title: Microstructural integrity of the cingulum is related to verbal memory performance in elderly with cerebral small vessel disease: the RUN DMC study.
abstract: BACKGROUND
  Cerebral small vessel disease (SVD) is related to verbal memory failures. It is suggested that early white matter damage, is located, among others, in the (posterior) cingulum at an early stage in neurodegeneration. Changes in the microstructural integrity of the cingulum assessed with diffusion tensor imaging (DTI), beyond detection with conventional MRI, may precede macrostructural changes and be related to verbal memory failures.
  
  
  OBJECTIVE
  To investigate the relation between cingular microstructural integrity and verbal memory performance in 503 non-demented elderly with cerebral SVD.
  
  
  METHODS
  The RUN DMC study is a prospective cohort study in elderly (50-85 years) with cerebral SVD. All participants underwent T1 MPRAGE, FLAIR and DTI scanning and the Rey Auditory Verbal Learning Test. Mean diffusivity (MD) and fractional anisotropy (FA) were assessed in six different cingular regions of interests (ROIs). Linear regression analysis was used to assess the relation between verbal memory performance and cingular DTI parameters, with appropriate adjustments. Furthermore a TBSS analysis of the whole brain was performed to investigate the specificity of our findings.
  
  
  RESULTS
  Both our ROI-based and TBSS analysis showed that FA was positively related to immediate memory, delayed recall, delayed recognition and overall verbal memory performance of the cingulum, independent of confounders. A similar distribution was seen for the inverse association with MD and verbal memory performance with TBSS analysis. No significant relations were found with psychomotor speed, visuospatial memory and MMSE. When stratified on hippocampal integrity, the MD and FA values of the cingular ROIs differed significantly between participants with a good and poor hippocampal integrity.
  
  
  CONCLUSIONS
  Microstructural integrity of the cingulum, assessed by DTI, is specifically related to verbal memory performance, in elderly with SVD. Furthermore we found that when the integrity of the hippocampus is disrupted, the cingulum integrity is impaired as well.
authors.affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: van der Holst
authors.forename: A M
authors.initials: AM
authors.lastname: Tuladhar
authors.forename: A G W
authors.initials: AG
authors.lastname: van Norden
authors.forename: K F
authors.initials: KF
authors.lastname: de Laat
authors.forename: I W M
authors.initials: IW
authors.lastname: van Uden
authors.forename: L J B
authors.initials: LJ
authors.lastname: van Oudheusden
authors.forename: M P
authors.initials: MP
authors.lastname: Zwiers
authors.forename: D G
authors.initials: DG
authors.lastname: Norris
authors.forename: R P C
authors.initials: RP
authors.lastname: Kessels
authors.forename: F E
authors.initials: FE
authors.lastname: de Leeuw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059345:Cerebral Small Vessel Diseases / Q000150:complications / Q000473:pathology*; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006179:Gyrus Cinguli / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008568:Memory; D008569:Memory Disorders / Q000150:complications / Q000473:pathology*; D008875:Middle Aged; D009483:Neuropsychological Tests