How Do Different Forms of Vascular Brain Injury Relate to Cognition in a Memory Clinic Population: The TRACE-VCI Study

Article type: Research Article

Authors: Boomsma, Jooske M.F.^{a; e} | Exalto, Lieza G.^a | Barkhof, Frederik^{c; h; i} | van den Berg, Esther^{a; f} | de Bresser, Jeroen^{d; j} | Heinen, Rutger^a | Leeuwis, Anna E.^b | Prins, Niels D.^b | Scheltens, Philip^b | Weinstein, Henry C.^e | van der Flier, Wiesje M. ^{b; g} | Biessels, Geert Jan^{a; *} | behalf of the TRACE-VCI study group

Correspondence: [*] Correspondence to: Prof. Dr. Geert Jan Biessels, Department of Neurology, University Medical Center Utrecht, G03.232, PO Box 85500, 3508 GA Utrecht, The Netherlands. Tel.: +31 88 7556866; Fax: +31 30 2542100; E-mail: [email protected].

Abstract: Background:Memory clinic patients frequently present with different forms of vascular brain injury due to different etiologies, often co-occurring with Alzheimer’s disease (AD) pathology. Objective:We studied how cognition was affected by different forms of vascular brain injury, possibly in interplay with AD pathology. Methods:We included 860 memory clinic patients with vascular brain injury on magnetic resonance imaging (MRI), receiving a standardized evaluation including cerebrospinal fluid (CSF) biomarker analyses (n = 541). The cognitive profile of patients with different forms of vascular brain injury on MRI (moderate/severe white matter hyperintensities (WMH) (n = 398), microbleeds (n = 368), lacunar (n = 188) and non-lacunar (n = 96) infarct(s), macrobleeds (n = 16)) was assessed by: 1) comparison of all these different forms of vascular brain injury with a reference group (patients with only mild WMH (n = 205) without other forms of vascular brain injury), using linear regression analyses also stratified for CSF biomarker AD profile and 2) multivariate linear regression analysis. Results:The cognitive profile was remarkably similar across groups. Compared to the reference group effect sizes on all domains were <0.2 with narrow 95% confidence intervals, except for non-lacunar infarcts on information processing speed (age, sex, and education adjusted mean difference from reference group (β: – 0.26, p = 0.05). Results were similar in the presence (n = 300) or absence (n = 241) of biomarker co-occurring AD pathology. In multivariate linear regression analysis, higher WMH burden was related to a slightly worse performance on attention and executive functioning (β: – 0.08, p = 0.02) and working memory (β: – 0.08, p = 0.04). Conclusion:Although different forms of vascular brain injury have different etiologies and different patterns of cerebral damage, they show a largely similar cognitive profile in memory clinic patients regardless of co-occurring AD pathology.

Keywords: Cerebral small vessel diseases, cerebrovascular disorders, cognitive disorders, neuropsychological test

DOI: 10.3233/JAD-180696

Journal: Journal of Alzheimer's Disease, vol. 68, no. 3, pp. 1273-1286, 2019