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Differential impact of cerebral white matter changes, diabetes, hypertension and stroke on cognitive performance among non disabled elderly. The LADIS study
  1. Ana Verdelho (averdelho{at}netcabo.pt)
  1. Neurology Department, Centro de Estudos Egas Moniz, Santa Maria Hospital, Lisbon, Portugal, Portugal
    1. Sofia Madureira
    1. Neurology Department, Centro de Estudos Egas Moniz, Santa Maria Hospital, Lisbon, Portugal, Portugal
      1. José M Ferro
      1. Neurology Department, Centro de Estudos Egas Moniz, Santa Maria Hospital, Lisbon, Portugal, Portugal
        1. Anna-Maria Basile
        1. Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy, Italy
          1. Hugues Chabriat Chabriat
          1. Department of Neurology, Hôpital Lariboisière,Paris, France, France
            1. Timo Erkinjuntti
            1. Memory Research Unit, Department of Clinical Neurosciences, Helsinki UniversityHelsinki, Finland, Finland
              1. Franz Fazekas
              1. Department of Neurology and MRI Institute, Karl Franzens University Graz, Graz, Austria, Austria
                1. Michael MD Hennerici
                1. Department of Neurology, University of Heidelberg, Klinikum Mannheim, Mannheim, Germany, Germany
                  1. John O’Brien
                  1. Institute for Ageing and Health, University of Newcastle, Newcastle-upon-Tyne, UK, United Kingdom
                    1. Leonardo Pantoni
                    1. Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy, Italy
                      1. Emilia Salvadori
                      1. Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy, Italy
                        1. Philip Scheltens
                        1. Department of Neurology, VU Medical Center, Amsterdam, The Netherlands, Netherlands
                          1. Marieke C. Visser
                          1. Department of Neurology, VU Medical Center, Amsterdam, The Netherlands, Netherlands
                            1. Lars-Olof Wahlund
                            1. Karolinska Institute, Department of Clinical Neuroscience and Family Medicine, Huddinge University, Sweden
                              1. Gunhild Gunhild Waldemar
                              1. Memory Disorders Research Unit, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
                                1. Anders Wallin
                                1. Institute of Clinical Neuroscience, Göteborg University, Göteborg, Sweden, Sweden
                                  1. Domenico Inzitari
                                  1. Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy, Italy

                                    Abstract

                                    Background and Purpose: Age-related white matter changes (ARWMC) are frequent in non-demented old subjects and are associated with impaired cognitive function. We aim to study the influence of vascular risk factors and ARWMC on the neuropsychological performance of an independent elderly population, namely if vascular risk factors impair cognition in addition to the effect of ARWMC.

                                    Methods: Independent subjects with 65 to 84 years old with any degree of ARWMC were assessed using a comprehensive neuropsychological battery that included MMSE, VADAS-Cog, Stroop and Trail Making test. Vascular risk factors were registered and ARWMC (measured by MRI) were graded in three classes. The impact of vascular risk factors and ARWMC on neuropsychological performance was assessed through linear regression analyses, with adjustment for age and education.

                                    Results: 638 patients (74.1 +/- 5 years old, 55% women) were included. Patients with severe ARWMC performed significantly worse on global tests of cognition, executive functions, speed and motor control, attention, naming and visuoconstructional praxis. Diabetes interfered with tests of executive functions, attention, speed and motor control, memory and naming. Arterial hypertension and stroke influenced executive functions and attention. The effect of these vascular risk factors was independent of the severity of ARWMC, age and education.

                                    Conclusion: ARWMC is related with worse performance in executive function, attention and speed. Diabetes, hypertension and previous stroke influenced neuropsychological performance independently of the severity of ARWMC, stressing the need to control vascular risk factors, in order to prevent cognitive decline in the elderly.

                                    • aging
                                    • diabetes
                                    • magnetic resonance imaging
                                    • vascular cognitive impairment
                                    • white matter

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