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Lacunar lesions are independently associated with disability and cognitive impairment in CADASIL.
Neurology. 2007 Jul 10; 69(2):172-9.Neur

Abstract

OBJECTIVE

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary arteriopathy caused by mutations of the Notch3 gene. The disease is characterized by T2-hyperintense lesions (subcortical white matter lesions), T1-hypointense lesions (lacunar lesions), and T2*-weighted gradient-echo (GE) lesions (cerebral microhemorrhages [CMs]) visualized on clinical MRI sequences and is considered as a model of "pure" subcortical ischemic vascular dementia. Although numerous studies have investigated the impact of white matter lesions in patients with CADASIL, the clinical importance of lacunar lesions remains unknown. Our purpose was to examine the influence of the visible MRI markers in the disease, including the load of lacunar lesions on cognitive impairment and disability in CADASIL.

METHODS

We collected clinical data from 147 consecutive patients enrolled in an ongoing two-center prospective cohort study. Degree of disability was assessed by modified Rankin scale and Barthel index. Degree of cognitive impairment was assessed by Mattis Dementia Rating Scale and Mini-Mental Status Examination. T1-weighted, fluid-attenuated inversion recovery, and GE images were obtained on a 1.5-T MRI. Volume and location of lacunar lesions, white matter hyperintensities (WMHs), and CMs were assessed.

RESULTS

There was a significant independent association between age, volume of lacunar lesions, and global cognitive function scales when analyzed in a multivariable model. In contrast, WMHs and CMs had no independent influence on cognitive function. Disability in this cohort was associated with volume of lacunar lesions, CMs, systolic blood pressure, and age but not with WMHs.

CONCLUSIONS

Among the lesions observed on conventional MRI in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the overall lacunar lesion burden seems to have the most important impact on cognitive function and disability. These findings suggest that preventive strategies to decrease the risk of lacunar lesions as observed on MRI may reduce disease-related impairment in CADASIL. These results suggest that lacunar lesions may also play a key role in disability and cognitive impairment in more common forms of small-vessel disease.

Authors+Show Affiliations

Departments of Neurology, Centre Hospitalier Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17620550

Citation

Viswanathan, A, et al. "Lacunar Lesions Are Independently Associated With Disability and Cognitive Impairment in CADASIL." Neurology, vol. 69, no. 2, 2007, pp. 172-9.
Viswanathan A, Gschwendtner A, Guichard JP, et al. Lacunar lesions are independently associated with disability and cognitive impairment in CADASIL. Neurology. 2007;69(2):172-9.
Viswanathan, A., Gschwendtner, A., Guichard, J. P., Buffon, F., Cumurciuc, R., O'Sullivan, M., Holtmannspötter, M., Pachai, C., Bousser, M. G., Dichgans, M., & Chabriat, H. (2007). Lacunar lesions are independently associated with disability and cognitive impairment in CADASIL. Neurology, 69(2), 172-9.
Viswanathan A, et al. Lacunar Lesions Are Independently Associated With Disability and Cognitive Impairment in CADASIL. Neurology. 2007 Jul 10;69(2):172-9. PubMed PMID: 17620550.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lacunar lesions are independently associated with disability and cognitive impairment in CADASIL. AU - Viswanathan,A, AU - Gschwendtner,A, AU - Guichard,J-P, AU - Buffon,F, AU - Cumurciuc,R, AU - O'Sullivan,M, AU - Holtmannspötter,M, AU - Pachai,C, AU - Bousser,M-G, AU - Dichgans,M, AU - Chabriat,H, PY - 2007/7/11/pubmed PY - 2007/8/19/medline PY - 2007/7/11/entrez SP - 172 EP - 9 JF - Neurology JO - Neurology VL - 69 IS - 2 N2 - OBJECTIVE: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary arteriopathy caused by mutations of the Notch3 gene. The disease is characterized by T2-hyperintense lesions (subcortical white matter lesions), T1-hypointense lesions (lacunar lesions), and T2*-weighted gradient-echo (GE) lesions (cerebral microhemorrhages [CMs]) visualized on clinical MRI sequences and is considered as a model of "pure" subcortical ischemic vascular dementia. Although numerous studies have investigated the impact of white matter lesions in patients with CADASIL, the clinical importance of lacunar lesions remains unknown. Our purpose was to examine the influence of the visible MRI markers in the disease, including the load of lacunar lesions on cognitive impairment and disability in CADASIL. METHODS: We collected clinical data from 147 consecutive patients enrolled in an ongoing two-center prospective cohort study. Degree of disability was assessed by modified Rankin scale and Barthel index. Degree of cognitive impairment was assessed by Mattis Dementia Rating Scale and Mini-Mental Status Examination. T1-weighted, fluid-attenuated inversion recovery, and GE images were obtained on a 1.5-T MRI. Volume and location of lacunar lesions, white matter hyperintensities (WMHs), and CMs were assessed. RESULTS: There was a significant independent association between age, volume of lacunar lesions, and global cognitive function scales when analyzed in a multivariable model. In contrast, WMHs and CMs had no independent influence on cognitive function. Disability in this cohort was associated with volume of lacunar lesions, CMs, systolic blood pressure, and age but not with WMHs. CONCLUSIONS: Among the lesions observed on conventional MRI in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the overall lacunar lesion burden seems to have the most important impact on cognitive function and disability. These findings suggest that preventive strategies to decrease the risk of lacunar lesions as observed on MRI may reduce disease-related impairment in CADASIL. These results suggest that lacunar lesions may also play a key role in disability and cognitive impairment in more common forms of small-vessel disease. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/17620550/Lacunar_lesions_are_independently_associated_with_disability_and_cognitive_impairment_in_CADASIL_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=17620550 DB - PRIME DP - Unbound Medicine ER -