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Differential impact of cerebral white matter changes, diabetes, hypertension and stroke on cognitive performance among non-disabled elderly. The LADIS study

¹ Neurology Department, Centro de Estudos Egas Moniz, Santa Maria Hospital, Lisbon, Portugal
² Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
³ Department of Neurology, Hôpital Lariboisière, Paris, France
⁴ Memory Research Unit, Department of Clinical Neurosciences, Helsinki University, Helsinki, Finland
⁵ Department of Neurology and MRI Institute, Karl Franzens University Graz, Graz, Austria
⁶ Department of Neurology, University of Heidelberg, Klinikum Mannheim, Mannheim, Germany
⁷ Institute for Ageing and Health, University of Newcastle, Newcastle-upon-Tyne, UK
⁸ Department of Neurology, VU Medical Centre, Amsterdam, the Netherlands
⁹ Karolinska Institute, Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Huddinge, Sweden
¹⁰ Memory Disorders Research Unit, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
¹¹ Institute of Clinical Neuroscience, Göteborg University, Göteborg, Sweden

Correspondence to:
Dr Ana Verdelho, Department of Neurosciences, Hospital Santa Maria, 1649-035 Lisbon, Portugal; averdelho{at}netcabo.pt

Methods: Independent subjects, aged 65–84 years, with any degree of ARWMC were assessed using a comprehensive neuropsychological battery including the Mini-Mental State Examination (MMSE), VADAS-Cog (Alzheimer’s disease assessment scale) and the Stroop and Trail Making test. Vascular risk factors were recorded and ARWMC (measured by MRI) were graded into three classes. The impact of vascular risk factors and ARWMC on neuropsychological performance was assessed by linear regression analyses, with adjustment for age and education.

Results: 638 patients (74.1 (5) years old, 55% women) were included. Patients with severe ARWMC performed significantly worse on global tests of cognition, executive functions, speed and motor control, attention, naming and visuoconstructional praxis. Diabetes interfered with tests of executive function, attention, speed and motor control, memory and naming. Arterial hypertension and stroke influenced executive functions and attention. The effect of these vascular risk factors was independent of the severity of ARWMC, age and education.

Conclusion: ARWMC is related to worse performance in executive function, attention and speed. Diabetes, hypertension and previous stroke influenced neuropsychological performance, independently of the severity of ARWMC, stressing the need to control vascular risk factors in order to prevent cognitive decline in the elderly.

Abbreviations: ADAS, Alzheimer’s Disease Assessment Scale; ARWMC, age related white matter changes; LADIS study, Leukoaraiosis and Disability study; MMSE, Mini-Mental State Examination; TM, Trail Making

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