White matter microstructural damage in small vessel disease is associated with Montreal cognitive assessment but not with mini mental state examination performances: vascular mild cognitive impairment Tuscany study.
OBJECTIVE
Montreal Cognitive Assessment (MoCA) has been proposed as a screening tool in vascular cognitive impairment. Diffusion tensor imaging is sensitive to white matter microstructural damage. We investigated if diffusion tensor imaging-derived indices are more strongly associated with performances on MoCA or on the widely used mini mental state examination in patients with mild cognitive impairment and small vessel disease.


METHODS
Mild cognitive impairment patients with moderate/severe degrees of white matter hyperintensities on MRI were enrolled. Lacunar infarcts, cortical atrophy, medial temporal lobe atrophy and median values of mean diffusivity and fractional anisotropy of the cerebral white matter were studied and correlated with cognitive tests performances.


RESULTS
Seventy-six patients (mean age 75.1±6.8 years, mean years of education 8.0±4.3) were assessed. In univariate analyses, a significant association of both MoCA and mini mental state examination scores with age, education, cortical atrophy, and medial temporal lobe atrophy was found, whereas mean diffusivity and fractional anisotropy were associated with MoCA. In partial correlation analyses, adjusting for all demographic and neuroimaging variables, both mean diffusivity and fractional anisotropy were associated only with MoCA (mean diffusivity: r= -0.275, P=0.023; fractional anisotropy: r=0.246, P=0.043).


CONCLUSIONS
In patients with mild cognitive impairment and small vessel disease, diffusion tensor imaging-measured white matter microstructural damage is more related to MoCA than mini mental state examination performances. MoCA is suited for the cognitive screening of patients with small vessel disease.
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Marco
M
Pasi
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Emilia
E
Salvadori
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Anna
A
Poggesi
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Laura
L
Ciolli
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Alessandra
A
Del Bene
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Sandro
S
Marini
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Serena
S
Nannucci
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Francesca
F
Pescini
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Raffaella
R
Valenti
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Andrea
A
Ginestroni
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Nicola
N
Toschi
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Stefano
S
Diciotti
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Mario
M
Mascalchi
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.).
Domenico
D
Inzitari
From the Department of NEUROFARBA, Neuroscience Section, University of Florence, Italy (M.P., E.S., A.P., L.C., A.D.B., S.M., S.N., F.P., R.V., D.I.); "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (A.G., M.M.); Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy (N.T.); Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy (S.D.); and Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (L.P.). pantoni@unifi.it.
Leonardo
L
Pantoni
D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D002540:Cerebral Cortex / Q000473:pathology*; D059345:Cerebral Small Vessel Diseases / Q000473:pathology* / Q000523:psychology; D060825:Cognitive Dysfunction / Q000473:pathology* / Q000523:psychology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D013702:Temporal Lobe / Q000473:pathology; D066127:White Matter / Q000473:pathology*
cerebral small vessel disease; diffusion tensor imaging