Prognostische Aussagekraft von White Matter Lesions auf den kognitiven Verlauf bei Patienten mit zerebraler Mikroangiopathie

Prognostic value of white matter lesions with change in cognitive decline in patients with cerebral small vessel disease

by Friderike Resech
Doctoral thesis
Date of Examination:2014-11-18
Date of issue:2014-11-03
Advisor:Prof. Dr. Inga Zerr
Referee:PD Dr. Peter Dechent
Referee:Prof. Dr. Martin Oppermann
Persistent Address: http://dx.doi.org/10.53846/goediss-4747

 

 

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Abstract

English

White matter lesions (WML) of the brain are a frequent finding in magnetic resonance imaging (MRI) and their significance remains a controversy. The aim of the study was to identify prognostic value of WML and other risk factors of cognitive decline in patients with cerebral small vessel disease. In this study, 71 patients with WML were included and categorized by total MMSE score with a cut-off of 27 points in the cognitive healthy group 1 and patients with cognitive impairment group 2. At baseline all subjects underwent a cranial MRI or cranial CT, a detailed neuropsychological exam, neurological examination, lumbar puncture and blood analysis. After 3 years 18 patients were examined again. The decline in cognitive function was defined by 1 point decline in total MMSE score (“MMSE stable” vs. “MMSE decline”). In a second part, the subjects were stratified for WML severity into two new groups using the cut-off point of 9 of sum score of Age Related White Matter Changes rating scale by Wahlund (ARWMC scale). The follow-up-population (n=18), 9 patients were assigned to group 1 (total MMSE ≥27points) and 9 to group 2 (total MMSE <27 points). After 3 years 4 patients of group 1 were stable, but just one had a total MMSE score lower 27. In group 2, 7 patients decreased in total MMSE score and 1 patient had a total MMSE score above 26 points. Patients with “stable MMSE” and patients with “MMSE decline” did not differ in the total WML scores of the Scheltens scale and the ARWMC scale at baseline. In the group with mild WML (total sum score of ARWMC lower <9), the total MMSE score declines at a greater rate than in the group with severe WML (sum score of ARWMC >9). Patients with “MMSE decline” had a significant lower Aß1-42 at baseline. As expected, decreased total MMSE score at baseline was significant associated with decline in cognitive function. The Barthel Index was significant lower in patients with cognitive decline. In summary, low MMSE score, decreased Aß1-42 and decreased Barthel index at baseline are predictive factors for decline in global cognitive functions in patients with incident findings of WML in MRI scans. WML alone are not a unique predictive marker for development of dementia over a period of 3 years.
Keywords: white matter lesions, small vessel disease, vascular dementia, alzheimer's disease, cognitive decline
 
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