Leukoaraiosis and mobility decline: a high resolution magnetic resonance imaging study in older people with mild cognitive impairment

doi:10.1016/j.neulet.2003.10.072

Neuroscience Letters

Volume 355, Issue 3, 30 January 2004, Pages 185-188

https://doi.org/10.1016/j.neulet.2003.10.072 Get rights and content

Abstract

Patterns of leukoaraiosis were analyzed on both T2-weighted fast fluid-attenuated inversion-recovery and 3D T1-weighted sequences in 23 community-dwelling older subjects with mild cognitive impairment. Mobility assessment had allowed their classification into higher and lower mobility groups (P<0.0001). Lower mobility appeared correlated with frontal subependymal lesions (P=0.0005). The absence of marked ventriculomegaly, any thick caps, deep white matter lesions curved along the ventricles bodies, large deep white matter lesions, deep grey matter leukoaraiosis was an hallmark of the higher mobility group (P<0.0001). High resolution MRI demonstrated regular patterns of the subependymal lesions and detected perivascular distribution in other forms of leukoaraiosis. It suggests that the underlying mechanism of mobility decline in the elderly may be impairment of cerebrospinal fluid dynamics with cerebral small vessel disease.

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Acknowledgements

The authors wish to acknowledge the financial support of the Programme Hospitalier de Recherche Clinique (French Ministry of Health) #AOM98007 and #AOM98053.

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Citation Excerpt :
Periventricular leukoaraiosis in MRI was clinically predicted by poorer performance of the ‘up and go test’ (TUG) in patients with MCI [65]. It was, therefore, concluded that vascular extrapyramidal dysfunction may be the cause of mobility dysfunction in MCI [65,66]. However, these parameters only represent MR correlates of vascular pathology, while parameters of subtle cortical dysfunction or atrophy may not be assessable by common MRI routines and may therefore be missed.
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Citation Excerpt :
The imaging protocol included a coronal T2-weighted fast FLAIR sequence, (time inversion TI = 2200 ms, TR = 10,000 ms, effective TE = 148 ms, echo train length 8, FOV 220 mm matrix 256 × 192, NEX 1, 24 × 5 mm contiguous slices) and a 3D T1-weighted coronal fast spoiled gradient recalled echo acquisition sequence (SPGR) sequence (TR = 22 ms TE = 6 ms flip angle 35°, NEX 1, FOV 240 mm, matrix 256 × 256). A detailed MR analysis was performed by a single rater (MCHF), blinded to clinical data and using previously described rating scales of high reproducibility (Onen et al., 2004; Henry-Feugeas et al., 2005, 2008). Both T1 and T2 sequences were used to identify white matter changes around the frontal horns characterized by ventricular systematisation and thickness of more than 5 mm, that best correlated with motor decline in our previous pilot study (Onen et al., 2004).
Mobility dysfunction of unknown origin predicts dementia in the elderly and is associated with periventricular leukoaraiosis (LA), another predictor of dementia of still controversial pathogenesis, in the elderly with mild cognitive impairment (MCI). Thus, this study examined which gait and balance parameters best correlate with periventricular LA to better understand the pathogenesis of mobility decline in MCI. High resolution MRI and detailed mobility assessment were performed in 61 subjects (72 years ± 5) with MCI. Cognitive assessment included Free and Cued Selective Reminding Test (FCSRT) and the Trail Making test part B (TMB). Mobility assessment included reports of falls in the previous 6-month period, the walking while talking test, the timed “up and go test” (TUG), measurement of fast gait speed, the standing test and the one-leg standing test. There was an association between marked periventricular LA and slow postural changes, slow gait (TUG and gait speed), altered balance (standing test and one-leg standing test), altered walking while talking test. But after adjusting for age and ventriculomegaly on a logistic multiple regression model, performance on the TUG test was the only clinical predictor of periventricular LA (> 10 s, P = 0.002). Poorer TUG performances were more frequent with vascular than Alzheimer's disease-like profiles on the FCSRT and TMB tests (P = 0.01). In conclusion, the clinical profile of patients demonstrating a main MR brain correlate of mobility dysfunction supports a main pathomechanism of subtle vascular extrapyramidal dysfunction in MCI.

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Leukoaraiosis and mobility decline: a high resolution magnetic resonance imaging study in older people with mild cognitive impairment

Abstract

Section snippets

Acknowledgements

Magn. Reson. Imaging

Lancet

Neurobiol. Aging

J. Neurol. Sci.

British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Fall prevention. Guidelines for the prevention of falls in older persons

J. Am. Geriatr. Soc.

Older people with impaired mobility have specific loci of periventricular abnormality on MR

Neurology

Cerebral white matter changes (leukoaraiosis), stroke, and gait disturbance

J. Am. Geriatr. Soc.

Magnetic resonance imaging in dementia. A study of brain white matter changes

Acta Radiol. Suppl.

Age-related brain changes associated with motor function in healthy older people

J. Am. Geriatr. Soc.

Neuropathological assessment of the lesions of significance in vascular dementia

J. Neurol. Neurosurg. Psychiatry