Cerebral Small Vessel Disease and Motoric Cognitive Risk Syndrome: Results from the Kerala-Einstein Study

Article type: Research Article

Authors: Wang, Nan^a | Allali, Gilles^a | Kesavadas, Chandrasekharan^c | Noone, Mohan L.^d | Pradeep, Vayyattu G.^d | Blumen, Helena M.^{a; b} | Verghese, Joe^{a; b; *}

Affiliations: [a] Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA | [b] Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA | [c] Department of Imaging Science and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India | [d] Department of Neurology, Baby Memorial Hospital, Kozhikode, Kerala, India

Correspondence: [*] Correspondence to: Joe Verghese, MBBS, Division of Cognitive & Motor Aging, Saul R Korey Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Rousso 301, Bronx, New York 10461, USA. Tel.: +1 718 430 3808; Fax: +1 718 430 3829; E-mail: [email protected].

Abstract: Background:The contribution of cerebral small vessel disease to cognitive decline, especially in non-Caucasian populations, is not well established. Objective:We examined the relationship between cerebral small vessel disease and motoric cognitive risk syndrome (MCR), a recently described pre-dementia syndrome, in Indian seniors. Methods:139 participants (mean age 66.6 ± 5.4 y, 33.1% female) participating in the Kerala-Einstein study in Southern India were examined in a cross-sectional study. The presence of cerebral small vessel disease (lacunar infarcts and cerebral microbleeds (CMB)) and white matter hyperintensities on MRI was ascertained by raters blinded to clinical information. MCR was defined by the presence of cognitive complaints and slow gait in older adults without dementia or mobility disability. Results:Thirty-eight (27.3% ) participants met MCR criteria. The overall prevalence of lacunar infarcts and CMB was 49.6% and 9.4% , respectively. Lacunar infarcts in the frontal lobe, but no other brain regions, were associated with MCR even after adjusting for vascular risk factors and presence of white matter hyperintensities (adjusted Odds Ratio (aOR): 4.67, 95% CI: 1.69–12.94). Frontal lacunar infarcts were associated with slow gait (aOR: 3.98, 95% CI: 1.46–10.79) and poor performance on memory test (β: –1.24, 95% CI: –2.42 to –0.05), but not with cognitive complaints or non-memory tests. No association of CMB was found with MCR, individual MCR criterion or cognitive tests. Conclusions:Frontal lacunar infarcts are associated with MCR in Indian seniors, perhaps, by contributing to slow gait and poor memory function.

Keywords: Aging, cerebral small vessel diseases, cognition, frontal lobe, gait, lacunar infarct, magnetic resonance imaging, memory

DOI: 10.3233/JAD-150523

Journal: Journal of Alzheimer's Disease, vol. 50, no. 3, pp. 699-707, 2016