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Cognitive profile of subcortical ischaemic vascular disease
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  1. H Jokinen1,2,
  2. H Kalska1,
  3. R Mäntylä3,
  4. T Pohjasvaara4,5,
  5. R Ylikoski2,
  6. M Hietanen2,
  7. O Salonen3,
  8. M Kaste6,
  9. T Erkinjuntti5
  1. 1Department of Psychology, University of Helsinki, Helsinki, Finland
  2. 2Unit of Neuropsychology, Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
  3. 3Helsinki Medical Imaging Center, Helsinki, Finland
  4. 4Department of Neurology, Lohja Hospital, Helsinki, Finland
  5. 5Memory Research Unit, Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
  6. 6Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
  1. Correspondence to:
 Hanna Jokinen
 Department of Neurology, Helsinki University Central Hospital, PO Box 302, FIN-00029 HUS, Helsinki, Finland; hanna.jokinen{at}helsinki.fi

Abstract

Objectives: Subcortical ischaemic vascular disease (SIVD) is a subtype of vascular cognitive impairment characterised by extensive white matter lesions and multiple lacunar infarcts. Radiologically defined diagnostic criteria for SIVD have been introduced, but only a few studies have presented empirical data on its clinical and cognitive features. The aim of this study is to describe in detail the neuropsychological characteristics of patients with SIVD from a large well defined stroke cohort.

Methods: A sample of 323 consecutive patients with ischaemic stroke, aged 55–85 years, was investigated using neuropsychological examination and magnetic resonance imaging (MRI). Patients fulfilling the MRI criteria of SIVD (n = 85) were compared to the other stroke patients (n = 238) and to normal control subjects (n = 38).

Results: Cognitive performance of the SIVD group was inferior to that of the normal control group throughout all domains. As compared to the other stroke patients, the SIVD group performed significantly worse in tests measuring executive functions and delayed memory recall. Adjusting for depression had no effect on these results. Instead, after controlling for medial temporal lobe atrophy, the differences disappeared for delayed memory but remained significant for executive functions.

Conclusion: Executive deficits are the most prominent cognitive characteristic associated with SIVD. Patients with SIVD also exhibit subtle deficits in delayed memory, which is explained in part by medial temporal lobe atrophy. Cognitive and mood changes seem to be parallel but independent processes related to SIVD. The results support the concept of SIVD as a separate clinical entity.

  • B*, significant result after Bonferroni correction
  • ηp2, partial eta squared
  • DSM-III-R, Diagnostic and Statistical Manual for Mental Disorders-Revised
  • DWMH, deep white matter hyperintensities
  • FOME, Fuld Object Memory Evaluation
  • MANCOVA, multivariate analysis of covariance
  • MRI, magnetic resonance imaging
  • MTA, medial temporal lobe atrophy
  • NC, normal control subjects
  • OS, other stroke
  • PVH, periventricular white matter hyperintensities
  • SD, standard deviation
  • SIVD, subcortical ischaemic vascular disease
  • WAIS-R, Wechsler Adult Intelligence Scale-Revised
  • WCST, Modified Wisconsin Card Sorting Test
  • WMS, Wechsler Memory Scale
  • WMS-R, Wechsler Memory Scale-Revised
  • ageing
  • cognition
  • executive functions
  • stroke
  • subcortical ischaemic vascular disease

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Supplementary materials

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Footnotes

  • This study was financially supported by the Finnish Graduate School of Psychology

  • Competing interests: none declared

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