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Executive dysfunction in subcortical ischaemic vascular disease
  1. J H Kramer1,
  2. B R Reed2,
  3. D Mungas2,
  4. M W Weiner3,
  5. H C Chui4
  1. 1San Francisco Medical Center, University of California, 401 Parnassus Avenue, San Francisco, CA 94143, USA
  2. 2Davis Medical Center, University of California, 150 Muir Rd, Martinez, CA94553, USA
  3. 3Veterans' Administration Medical Center, 4150 Clement St, San Francisco, CA 94121, USA
  4. 4University of Southern California, 7601 East Imperial Highway, Downey, CA 90242, USA
  1. Correspondence to:
    Dr J Kramer, University of California, San Francisco Campus, Box 0984-PAC, 401 Parnassus Avenue, San Francisco, CA 94143, USA;


Background: Executive dysfunction has been reported in patients with subcortical-frontal pathology, even in the absence of dementia.

Objective: This study was undertaken to determine if impairments in executive functioning could be found in non-demented patients with subcortical lacunes.

Methods: Cross sectional comparison between older control subjects (n=27) and non-demented patients with one or more subcortical lacunes (n=12). All participants were administered a neuropsychological test battery incorporating three measures of executive functioning, the Stroop interference test, California card sorting test, and the initiation-perseveration subtest of the Mattis dementia rating scale.

Results: No group differences were found on measures of recent verbal memory, language, or spatial ability. Normal controls performed better than patients with lacunes in visual memory. On the Stroop interference test, patients with lacunes performed as well as controls on the colour naming condition but slower on the interference condition. Patients with lacunes also generated fewer correct sorts on the California card sort test and achieved lower scores on the initiation-perseveration subtest. Executive measures were correlated with extent of white matter signal hyperintensity but not number of lacunes.

Conclusion: Subcortical ischaemic vascular disease is associated with subtle declines in executive functioning and visual memory, even in non-demented patients. The pattern of cognitive impairment after subcortical lacunes is consistent with models of subcortical-frontal circuits.

  • executive functions
  • subcortical lacunes
  • subcortical-frontal systems
  • white matter
  • CDR, clinical dementia rating scale
  • DSE, double spin echo
  • PVS, perivascular spaces
  • SIVD, subcortical ischaemic vascular disease
  • MAS, memory assessment scale list learning
  • CADASIL, cerebral autosomal dominant arterriopathy with subcortical infarcts and leucoencephalopathy

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