title: White matter correlates of cognitive impairment in essential tremor.
abstract: OBJECTIVE
  Impairment of cognitive functions occurs in essential tremor, though the mechanism is largely unknown. The aim of this study was to find microstructural correlates of cognitive dysfunction seen in essential tremor by using DTI and neuropsychological assessment.
  
  
  METHODS
  Fifty-five patients with essential tremor and 55 matched healthy controls were evaluated. Essential tremor was diagnosed by using the National Institutes of Health criteria. Subjects were assessed by using a structured neuropsychological battery. DTI data were acquired by using 3T MR imaging and were analyzed by using tract-based spatial statistics. Fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity were analyzed.
  
  
  RESULTS
  Patients were considered cognitively impaired when the test score was 1.5 SDs below or above the mean of healthy controls (depending on the type of test) in ≥3 neuropsychological tests. Patients with cognitive impairment had significantly higher mean diffusivity, radial diffusivity, and axial diffusivity values in the bilateral frontoparietal regions. In patients with cognitive impairment, mean diffusivity, radial diffusivity, and axial diffusivity showed correlations with various neuropsychological test scores. Executive function correlated with DTI measures of the frontal white matter, cingulum, inferior superior longitudinal and uncinate fasciculi, anterior thalamic radiations, and posterior lobe of the cerebellum. Visuospatial function correlated with the right parieto-occipital lobe, whereas visual-verbal memories correlated with the anterior thalamic radiations, inferior longitudinal and uncinate fasciculi, and the posterior lobe of the cerebellum. No significant correlations were found between fractional anisotropy and any of the neuropsychological test scores.
  
  
  CONCLUSIONS
  The present study demonstrates a correlation between neuropsychological test scores and DTI measures, suggesting a neuroanatomic basis for cognitive impairment seen in patients with essential tremor.
authors.affiliation: From the Departments of Neurology (K.S.B., R.Y., P.K.P.).
authors.forename: K S
authors.initials: KS
authors.lastname: Bhalsing
authors.affiliation: Clinical Psychology (K.J.K.).
authors.forename: K J
authors.initials: KJ
authors.lastname: Kumar
authors.affiliation: Neuroimaging and Interventional Radiology (J.S., A.K.G.), National Institute of Mental Health and Neurosciences, Karnataka, India.
authors.forename: J
authors.initials: J
authors.lastname: Saini
authors.affiliation: From the Departments of Neurology (K.S.B., R.Y., P.K.P.).
authors.forename: R
authors.initials: R
authors.lastname: Yadav
authors.affiliation: Neuroimaging and Interventional Radiology (J.S., A.K.G.), National Institute of Mental Health and Neurosciences, Karnataka, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: From the Departments of Neurology (K.S.B., R.Y., P.K.P.) pal.pramod@rediffmail.com.
authors.forename: P K
authors.initials: PK
authors.lastname: Pal
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D020329:Essential Tremor / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D014481:United States; D066127:White Matter / Q000473:pathology*