Skip to main content
SpringerLink
Log in

Clinical correlates of high signal lesions on magnetic resonance imaging in Alzheimer's disease

  • Original Communications
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Summary

The pathophysiology and clinical significance of high signal lesions, visualized on magnetic resonance imaging (MRI) in patients with Alzheimer's disease (AD), remain controversial. Since they are known to correlate with vascular disease and vascular risk factors, we reviewed the clinical correlates of periventricular high signal (PVH) and subcortical white matter lesions (WML) in a sample of 106 patients with probable AD, excluding persons with treated vascular risk factors or symptomatic cerebrovascular and cardiovascular disease. Grade 2 PVH were seen in 26 (25%) and scattered WML were identified in 29 (18%). PHV were associated with advancing age and gait disturbance. WML were associated with gait disturbance and incontinence. Neither radiologic finding was related to dementia severity. The findings suggest that these lesions are common in patients with AD even when those with evidence of cerebrovascular disease are excluded; their presence, therefore, should not preclude a diagnosis of AD. Additionally, the data suggest that HSL on MRI may be one of many risk factors associated with functional disability in persons with probable AD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Austrom MG, Thompson RF, Hendrie HC, et al (1990) Foci of increased T2 signal intensity in MR images of healthy elderly subjects. A follow-up study. J Am Geriatr Soc 38:1133–1138

    PubMed  Google Scholar 

  2. Awad IA, Johnson PC, Spetzler RF, et al (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations. Stroke 17:1090–1097

    PubMed  Google Scholar 

  3. Awad IA, Spetzler RF, Hodak JA, et al (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke 17:1084–1089

    PubMed  Google Scholar 

  4. Bennett DA, Wilson RS, Gilley DW, Fox JH (1990) Clinical diagnosis of Binswanger's disease. J Neurol Neurosurg Psychiatry 53:961–965

    PubMed  Google Scholar 

  5. Bennett DA, Charletta D, Gilley DW, Cochran E, Hayes K (1991) Clinical correlates of high signal lesions on MRI in pathologically proven Alzheimer's disease. Neurology 41[Suppl 1]:407

    Google Scholar 

  6. Bondareff W, Raval J, Woo B, et al (1990) Magnetic resonance imaging and the severity of dementia in older adults. Arch Gen Psychiatry 47:47–51

    PubMed  Google Scholar 

  7. Braffman BH, Zimmerman RA, Trojanowski JQ, et al (1988) Brain MR: pathologic correlation with gross and histopathology. 2. Hyperintense white-matter foci in the elderly. Am J Neuroradiology 9:629–636

    Google Scholar 

  8. Brun A, Englund E (1986) A white matter disorder in dementia of the Alzheimer type: a pathoanatomical study. Ann Neurol 19:253–262

    PubMed  Google Scholar 

  9. Cox DR (1970) Analysis of binary data. Methuen, London

    Google Scholar 

  10. De la Monte SM (1989) Quantitation of cerebral atrophy in preclinical and end-stage Alzheimer's disease. Ann Neurol 25:450–459

    PubMed  Google Scholar 

  11. Englund E, Brun A, Persson B (1987) Correlations between histopathologic white matter changes and proton MR relaxation times in dementia. Alzheimer Dis Assoc Disord 1:156–170

    PubMed  Google Scholar 

  12. Fazekas F, Chawluk JB, Alavi A, et al (1987) MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Am J Neuroradiology 8:421–426

    Google Scholar 

  13. Fazekas F, Niederkorn K, Schmidt R, et al (1988) White matter signal abnormalities in normal individuals: correlation with carotid ultrasonography, cerebral blood flow measurements, and cerebrovascular risk factors. Stroke 19:1285–1288

    PubMed  Google Scholar 

  14. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    PubMed  Google Scholar 

  15. Fox JH, Topel JL, Huckman MS (1975) Use of computerized tomography in senile dementia. J Neurol Neurosurg Psychiatry 38:948

    PubMed  Google Scholar 

  16. Fox JH, Penn R, Clasen R, et al (1985) Pathological diagnosis in clinically typical Alzheimer's disease. N Engl J Med 313:1419–1420

    Google Scholar 

  17. Galasko D, Klauber MR, Hofstetter R, et al (1990) The Mini-Mental State Examination in the early diagnosis of Alzheimer's disease. Arch Neurol 47:49–52

    PubMed  Google Scholar 

  18. Hachinski VC, Potter P, Merskey H (1987) Leukoaraiosis. Arch Neurol 44:21–23

    PubMed  Google Scholar 

  19. Hendrie HC, Farlow MR, Austrom MG, et al (1989) Foci of increased T2 signal intensity on brain MT scans of healthy elderly subjects. Am J Neuroradiol 10:703–707

    PubMed  Google Scholar 

  20. Janota I, Mirsen TR, Hachinski VC, et al (1989) Neuropathologic correlates of leuko-araiosis. Arch Neurol 46:1124–1128

    PubMed  Google Scholar 

  21. Johnson KA, Davis KR, Buonanno FS, et al (1987) Comparison of magnetic resonance and roentgen ray computed tomography in dementia. Arch Neurol 44:1075–1080

    PubMed  Google Scholar 

  22. Jungreis CA, Kanal E, Flirsch WL, et al (1988) Normal perivascular spaces mimicking lacunar infarction: MR imaging. Radiology 169:101–104

    PubMed  Google Scholar 

  23. Kaszniak AW, Garron DC, Fox JH, et al (1979) Cerebral atrophy, EEG slowing, age, education, and cognitive functioning in suspected dementia. Neurology 29:1273–1279

    PubMed  Google Scholar 

  24. Kemper T (1984) Neuroanatomical and neuropathological changes in normal aging and in dementia. In: Albert ML (ed) Clinical neurology of aging. Oxford University Press, Oxford, pp 9–52

    Google Scholar 

  25. Khachaturian ZS (1985) Diagnosis of Alzheimer's disease. Arch Neurol 42:1097–1104

    PubMed  Google Scholar 

  26. Kinkel WR, Jacobs L, Polachini I, et al (1989) Subcortical arteriosclerotic encephalopathy (Binswanger's disease): computed tomographic, nuclear magnetic resonance and clinical correlations. Arch Neurol 42:951–959

    Google Scholar 

  27. Koller WC, Wilson RS, Glatt SL, Huckman MS, Fox JH (1983) Senile gait: correlation with computed tomographic scans. Ann Neurol 13:343–344

    PubMed  Google Scholar 

  28. Koller WC, Glatt SL, Fox JH (1985) Senile gait: a distinct neurologic entity. In: Radebaugh TS, Hadley E, Suzman R (eds) Falls in the elderly: biologic and behavioral aspects. Saunders, Philadelphia, p 661

    Google Scholar 

  29. Kozachuk WE, DeCarli C, Horwitz B, et al (1990) White matter hyperintensities in dementia of the Alzheimer type and in healthy subjects without cerebrovascular risk factors: a MRI study. Arch Neurol 47:1306–1310

    PubMed  Google Scholar 

  30. Lawton MP, Brody E (1969) Assessment of older people: self maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    PubMed  Google Scholar 

  31. Leys D, Soetaert G, Petit H, et al (1990) Periventricular and white matter magnetic resonance imaging hyperintensities do not differ between Alzheimer's disease and normal aging. Arch Neurol 47:524–527

    PubMed  Google Scholar 

  32. Leys D, Pruvo JP, Parent M, et al (1991) Could Wallerian degeneration contribute to “leuko-araiosis” in subjects free from any vascular disorder? J Neurol Neurosurg Psychiatry 54:46–50

    PubMed  Google Scholar 

  33. Lieberman A, Dziatolowski M, Gopinathan G, et al (1980) Evaluation of Parkinson's disease. In: Goldstein M, Calne DB, Lieberman A, Thorner MO (eds) Ergot compounds and brain function: neuroendocrine and neuropsychiatric aspects. Raven Press, New York, p 277

    Google Scholar 

  34. Masdau JC, Wolfson L, Lantos G, et al (1989) Brain white-matter changes in the elderly prone to falling. Arch Neurol 46:1292–1296

    PubMed  Google Scholar 

  35. McKhann G, Drachman D, Folstein M, et al (1984) Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 34:939–944

    PubMed  Google Scholar 

  36. Morris JC, Heyman A, Mohs RC, et al (1989) The consortium to establish a registry for Alzheimer's disease (CERAD). 1. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 39:1159–1165

    PubMed  Google Scholar 

  37. Rao SM, Mittenberg W, Bernardin L, et al (1989) Neuropsychological test findings in subjects with leukoaraiosis. Arch Neurol 46:40–44

    PubMed  Google Scholar 

  38. Resnick NM, Yalla SV, Laurino E (1989) The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med 320:1–7

    PubMed  Google Scholar 

  39. Roman GC (1987) Senile dementia of the Binswanger type: a vascular form of dementia in the elderly. JAMA 258:1782–1788

    PubMed  Google Scholar 

  40. Salmon DP, Thal LJ, Butters N, Heindel WC (1990) Longitudinal evaluation of dementia of the Alzheimer type: a comparison of 34 standardized mental status examinations. Neurology 40:1225–1230

    PubMed  Google Scholar 

  41. Steingart A, Hachinski VC, Lau C, et al (1987) Cognitive and neurologic findings in subjects with diffuse white matter lucencies on computed tomographic scan (leukoaraiosis). Arch Neurol 44:32–35

    PubMed  Google Scholar 

  42. Sudarsky L, Ronthal M (1983) Gait disorders among elderly patients. A survey study of 50 patients. Arch Neurol 40:740–743

    PubMed  Google Scholar 

  43. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707

    PubMed  Google Scholar 

  44. Williams ME, Pannill FC (1982) Urinary incontinence in the elderly. Physiology, pathophysiology, diagnosis and treatment. Ann Intern Med 97:895–907

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rush Alzheimer's Disease Center, Rush-Presbyterian-St. Luke's Medical Center, 710 S. Paulina, 8 North - JRB, 60612-3864, Chicago, IL, Illinois, USA

    David A. Bennett, David W. Gilley, Robert S. Wilson & Jacob H. Fox

  2. Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA

    David A. Bennett & Jacob H. Fox

  3. Department of Psychology and Social Sciences, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA

    David W. Gilley & Robert S. Wilson

  4. Department of Radiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA

    Michael S. Huckman

Authors
  1. David A. Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David W. Gilley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert S. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael S. Huckman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacob H. Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bennett, D.A., Gilley, D.W., Wilson, R.S. et al. Clinical correlates of high signal lesions on magnetic resonance imaging in Alzheimer's disease. J Neurol 239, 186–190 (1992). https://doi.org/10.1007/BF00839137

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00839137

Key words

Search

Navigation