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Subclinical cerebrovascular disease in mild cognitive impairment

From the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain (J.A.L., A.M.B., C.R., N.S., J.J.M., S.A.S., R.M.), Department of Neurology (J.A.L., A.M.B., C.R., J.J.M., S.A.S., R.M.), Gertrude H. Sergievsky Center (A.M.B., C.R., N.S., J.J.M., M.X.T., S.A.S., R.M.), Department of Psychiatry (N.S., R.M.), Department of Medicine (J.A.L.), and Department of Radiology (T.R.B.), College of Physicians and Surgeons, Departments of Epidemiology (J.A.L., N.S., R.M.) and Biostatistics (M.X.T.), Joseph P. Mailman School of Public Health, and Department of Biomedical Engineering (T.R.B.), Columbia University, New York, NY; Department of Neurology and Imaging of Dementia and Aging (IDeA) Laboratory (C.D.), Center for Neuroscience, University of California, Sacramento; and Department of Neurology (S.J.C.), Hallym University College of Medicine, Seoul, Korea.

Address correspondence and reprint requests to Dr. José A. Luchsinger, 630 West 168^th St., PH9E-105, New York, NY 10032 jal94{at}columbia.edu

Background: Cerebrovascular disease (CVD) may contribute to mild cognitive impairment (MCI). We sought to determine the relation of white matter hyperintensity (WMH) volume and infarcts in brain MRI to MCI in a community-based sample.

Methods: A total of 679 elderly persons without dementia underwent brain MRI. WMH and infarcts were quantified using research methods. WMH was adjusted for total cranial volume. The Petersen criteria were used to define MCI. MCI was further subclassified into amnestic and non-amnestic. We used logistic regression to relate WMH and infarcts to prevalent MCI.

Results: WMH were associated with amnestic MCI (odds ratio [OR] = 1.9; 95% confidence interval [CI] 1.1, 3.4) but not non-amnestic MCI (OR = 1.2; 95% CI 0.4, 1.6) after adjusting for age, gender, ethnic group, education, and APOE-4. Infarcts were more strongly associated with non-amnestic MCI (OR = 2.7; 95% CI 1.5, 4.8) than amnestic MCI (OR = 1.4; 95% CI 0.9, 2.3). In secondary analyses using continuous cognitive scores as outcomes, WMH, but not infarcts, were related to memory, while infarcts were more strongly related with non-amnestic domains.

Conclusion: White matter hyperintensity (WMH) is more strongly related to amnestic mild cognitive impairment (MCI). Infarcts are more strongly related to non-amnestic MCI. The nature of WMH in amnestic MCI requires further study.

Abbreviations: AD = Alzheimer disease; BDAE = Boston Diagnostic Aphasia Examination; BVRT = Benton Visual Retention Test; CAA = cerebral amyloid angiopathy; CI = confidence interval; CVD = cerebrovascular disease; FLAIR = fluid-attenuated inverse recovery; MCI = mild cognitive impairment; OR = odds ratio; SRT = Selective Reminding Test; WAIS-R = Wechsler Adult Intelligence Scale–Revised; WHICAP = Washington/Hamilton Heights–Inwood Columbia Aging Project; WMH = white matter hyperintensity.

Supplemental data at www.neurology.org

Supported by National Institutes of Health grants P01 AG07232 and AG029949.

Disclosure: Author disclosures are provided at the end of the article.

Received June 23, 2008. Accepted in final form May 1, 2009.