title: Influence of vascular risk factors and neuropsychological profile on functional performances in CADASIL: results from the MIcrovascular LEukoencephalopathy Study (MILES).
abstract: OBJECTIVE
  Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral small vessel disease that may lead to disability and whose phenotype modulators are still unknown.
  
  
  METHODS
  In the MIcrovascular LEukoencephalopathy Study (MILES), we assessed the influence of vascular risk factors and the effect of different cognitive domains (memory, psychomotor speed and executive functions) performances on functional abilities in CADASIL in comparison with age-related leukoencephalopathy (ARL).
  
  
  RESULTS
  We evaluated 51 CADASIL patients (mean age 50.3 ± 13.8 years, 47.1% males) and 68 ARL patients (70.6 ± 7.4 years, 58.8% males). Considering vascular risk factors, after adjustment for age, CADASIL patients had higher mean BMI values than ARL patients. Stroke history frequency was similar in the two groups. After adjustment for age, more CADASIL patients were disabled (impaired on ≥ 2 items of the Instrumental Activities of Daily Living scale) in comparison with ARL patients, and CADASIL patients had worse functional performances evaluated with the Disability Assessment for Dementia (DAD) scale. In CADASIL patients, hypertension was related to both DAD score and disability. The cognitive profile of CADASIL and ARL patients was similar, but on a stepwise linear regression analysis functional performances were mainly associated with the memory index (β = -0.418, P < 0.003) in CADASIL patients and the executive function index (β = -0.321, P = 0.028) in ARL.
  
  
  CONCLUSIONS
  This study suggests that hypertension may contribute to functional impairment in CADASIL and that memory impairment has a large influence on functional decline in contrast with that observed in a sample of subjects with ARL.
authors.affiliation: NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Ciolli
authors.forename: F
authors.initials: F
authors.lastname: Pescini
authors.forename: E
authors.initials: E
authors.lastname: Salvadori
authors.forename: A
authors.initials: A
authors.lastname: Del Bene
authors.forename: G
authors.initials: G
authors.lastname: Pracucci
authors.forename: A
authors.initials: A
authors.lastname: Poggesi
authors.forename: S
authors.initials: S
authors.lastname: Nannucci
authors.forename: R
authors.initials: R
authors.lastname: Valenti
authors.forename: A M
authors.initials: AM
authors.lastname: Basile
authors.forename: F
authors.initials: F
authors.lastname: Squarzanti
authors.forename: S
authors.initials: S
authors.lastname: Bianchi
authors.forename: M T
authors.initials: MT
authors.lastname: Dotti
authors.forename: E
authors.initials: E
authors.lastname: Adriano
authors.forename: M
authors.initials: M
authors.lastname: Balestrino
authors.forename: A
authors.initials: A
authors.lastname: Federico
authors.forename: C
authors.initials: C
authors.lastname: Gandolfo
authors.forename: D
authors.initials: D
authors.lastname: Inzitari
authors.forename: L
authors.initials: L
authors.lastname: Pantoni
mesh_terms: D000368:Aged; D046589:CADASIL / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D056784:Leukoencephalopathies / Q000150:complications / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010641:Phenotype; D012307:Risk Factors
keywords: CADASIL; disability; functional impairment; leukoencephalopathy; neuropsychological evaluation; small vessel disease