Correlation of MRI brain findings with executive dysfunction and vascular risk factors in elderly patients with cognitive impairment

Objectives: The primary objective of the present study was to investigate the relationship between gray matter changes, white matter changes and executive function among older Indian adults with vascular risk factors. Methods: This hospital based observational analytical study was conducted in a tertiary care health facility located in the north-western region of India for a duration of one year between October 2021 and September 2022 among patients between 60 and 90 years of age presenting to the outpatient sections of Department of Neurology with executive dysfunction. We assessed the vascular risk factors, evaluated executive function, and then the patients underwent brain MRI on a 1.5T MRI scanner. Results: The proportion of patients with dorsolateral atrophy was significantly higher (p<0.001) among patients with executive dysfunction (83.10%). Hypertension significantly contributed to predict the atrophy of temporal lobe and parietal lobe (p<0.05). Hyperintensity of periventricular area was found significantly higher among executive dysfunction patients (85.92%). Elevated HbA1c levels and smoking significantly contributed to predict the white matter hyperintensity of basal ganglia (p<0.05). The present study also found that hypertension and alcohol use significantly predicted white matter hyperintensity in the frontal area (p<0.05). Conclusion: Specific white matter hyperintensity loci and grey matter volume loss were closely associated with executive dysfunction in elderly. It is understood that modifying and treating vascular risk factors can prevent progression of executive dysfunction and these findings emphasize the complex nature of the relationship between vascular risk factors, cognitive impairment, and brain structure.