Strategic lacunes and their relationship to cognitive impairment in cerebral small vessel disease

被引：69

作者：

Benjamin, Philip ^{[1
]}

Lawrence, Andrew J. ^{[4
]}

Lambert, Christian ^{[1
]}

Patel, Bhavini ^{[1
]}

Chung, Ai Wern ^{[1
]}

MacKinnon, Andrew D. ^{[2
]}

Morris, Robin G. ^{[3
]}

Barrick, Thomas R. ^{[1
]}

Markus, Hugh S. ^{[4
]}

机构：

[1] St Georges Univ London, Neurosci Res Ctr, London SW17 0RE, England

[2] St Georges NHS Healthcare Trust, Atkinson Morley Reg Neurosci Ctr, London, England

[3] Kings Coll London, Inst Psychiat, London WC2R 2LS, England

[4] Univ Cambridge, Dept Clin Neurosci, Cambridge, England

来源：

NEUROIMAGE-CLINICAL | 2014年 / 4卷

基金：

英国惠康基金;

关键词：

Small vessel disease; Lacunes; Cognitive Impairment; PREFRONTAL CORTEX; BASAL GANGLIA; MRI; INFARCTS; CONNECTIONS; SEGMENTATION; ORGANIZATION; VALIDATION; DEPRESSION; THALAMUS;

D O I：

10.1016/j.nicl.2014.05.009

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Objectives: Lacunes are an important disease feature of cerebral small vessel disease (SVD) but their relationship to cognitive impairment is not fully understood. To investigate this we determined (1) the relationship between lacune count and total lacune volume with cognition, (2) the spatial distribution of lacunes and the cognitive impact of lacune location, and (3) the whole brain anatomical covariance associated with these strategically located regions of lacune damage. Methods: One hundred and twenty one patients with symptomatic lacunar stroke and radiological leukoaraiosis were recruited and multimodal MRI and neuropsychological data acquired. Lacunes were mapped semiautomatically and their volume calculated. Lacune location was automatically determined by projection onto atlases, including an atlas which segments the thalamus based on its connectivity to the cortex. Lacune locations were correlated with neuropsychological results. Voxel based morphometry was used to create anatomical covariance maps for these 'strategic ' regions. Results: Lacune number and lacune volume were positively associated with worse executive function (number p < 0.001; volume p < 0.001) and processing speed (number p < 0.001; volume p < 0.001). Thalamic lacunes, particularly those in regions with connectivity to the prefrontal cortex, were associated with impaired processing speed (Bonferroni corrected p = 0.016). Regions of associated anatomical covariance included the medial prefrontal, orbitofrontal, anterior insular cortex and the striatum. Conclusion: Lacunes are important predictors of cognitive impairment in SVD. We highlight the importance of spatial distribution, particularly of anteromedial thalamic lacunes which are associated with impaired information processing speed and may mediate cognitive impairment via disruption of connectivity to the prefrontal cortex. (C) 2014 Published by Elsevier Inc. This is an open access article under the CC BY license.

引用

页码：828 / 837

页数：10