Simple versus complex assessment of white matter hyperintensities in relation to physical performance and cognition: the LADIS study

Abstract

Background

White matter hyperintensities (WMH) on MRI are associated with disorders of gait and balance and with cognitive impairment. The most suitable method to assess WMH in relation to the clinical evaluation of disturbances in these areas has not yet been established.

Aim

To compare a simple visual rating scale, a detailed visual rating scale and volumetric assessment of WMH with respect to their associations with clinical measures of physical performance and cognition.

Methods

Data were drawn from the multicentre, multinational LADIS study. Data of 574 subjects were available. MRI analysis included assessment of WMH using the simple Fazekas scale, the more complex Scheltens scale and a semi-automated volumetric method. Disturbances of gait and balance and general cognitive function were assessed using the Short Physical Performance Battery (SPPB) and the Mini Mental State Examination (MMSE), respectively.

Results

Irrespective of the method of measuring WMH, subjects with disturbances of gait and balance (SPPB≤10) had more WMH than subjects with normal physical performance. Subjects with mild cognitive deficits (MMSE≤25) had more WMH than subjects with normal cognition. Correlations between clinical measures and WMH were equal across methods of WMH measurement (SPPB: Spearman r=−0.22, −0.25, −0.26, all p<0.001; MMSE: Spearman r=−0.11, −0.10, −0.09, all p<0.05, for Fazekas scale, Scheltens scale and volumetry, respectively). These associations remained significant and comparable after correcting for age, gender and education in multivariate linear regression analyses.

Conclusion

Simple and complex measures of WMH yield comparable associations with measures of physical performance and cognition. This suggests that a simple visual rating scale may be sufficient, when analyzing relationships between clinical parameters and WMH in a clinical setting.

Appendix

List op participating centres and personnel. Helsinki, Finland (Memory Research Unit, Department of Clinical Neurosciences, Helsinki University): Timo Erkinjuntti, MD, PhD, Tarja Pohjasvaara, MD, PhD, Pia Pihanen, MD, Raija Ylikoski, PhD, Hanna Jokinen, LPsych, Meija-Marjut Somerkoski, Mpsych, Riitta Mäntylä, MD,PhD; Graz, Austria (Department of Neurology and MRI Institute, Medical University): Franz Fazekas, MD, Reinhold Schmidt, MD, Stefan Ropele, PhD, Alexandra Seewann, MD, Katja Petrovic, MagPsychol, Ulrike Garmehi; Lisboa, Portugal (Serviço de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria): José M. Ferro, MD, PhD, Ana Verdelho, MD, Sofia Madureira, PsyD; Amsterdam, The Netherlands (Department of Neurology, VU Medical Center): Philip Scheltens, MD, PhD, Ilse van Straaten, MD, Wiesje van der Flier, PhD, Alida Gouw, MD, Frederik Barkhof, MD, PhD; Goteborg, Sweden (Institute of Clinical Neuroscience, Goteborg University): Anders Wallin, MD, PhD, Michael Jonsson, MD, Karin Lind, MD, Arto Nordlund, PsyD, Sindre Rolstad, PsyD, Kerstin Gustavsson, RN; Huddinge, Sweden (Neurotec department, Section of Clinical Geriatrics, Karolinska Universitetssjukhuset): Lars-Olof Wahlund, MD, PhD, Militta Crisby, MD, PhD, Anna Pettersson, physiotherapist, Kaarina Amberla, PsyD; Paris, France (Department of Neurology, Hopital Lariboisiere): Hugues Chabriat, MD, PhD, Ludovic Benoit, MD, Karen Hernandez, Solene Pointeau, Annie Kurtz, Daniel Reizine, MD; Mannheim, Germany (Department of Neurology, University of Heidelberg, Klinikum Mannheim): Michael Hennerici, MD, Christian Blahak, MD, Hansjorg Baezner, MD, Martin Wiarda, PsyD, Susanne Seip, RN; Copenhagen, Denmark (Memory Disorders Research Unit, Department of Neurology, and Danish Research Center for Magnetic Resonance, Copenhagen University Hospital): Gunhild Waldemar, MD, DMSc, Egill Rostrup, MD, MSc; Charlotte Ryberg, MSc, Tim Dyrby MSc, Olaf B. Paulson, MD, DMSc; Newcastle-upon-Tyne, UK (Institute for Ageing and Health, University of Newcastle): John O’Brien, DM, Sanjeet Pakrasi, MRCPsych, Thais Minnet, PhD, Michael Firbank, PhD, Jenny Dean, PhD, Pascale Harrison, BSc, Philip English, DCR. The Coordinating centre is in Florence, Italy (Department of Neurological and Psychiatric Sciences, University of Florence): Domenico Inzitari, MD (Study Coordinator); Leonardo Pantoni, MD, PhD, Anna Maria Basile, MD, Michela Simoni, MD, Giovanni Pracucci, MD, Monica Martini, MD, Luciano Bartolini, PhD, Emilia Salvadori, PhD, Marco Moretti, MD, Mario Mascalchi, MD, PhD.

The LADIS Steering Committee is formed by Domenico Inzitari, MD (study coordinator), Timo Erkinjuntti, Md, PhD, Philip Scheltens, MD, PhD, Marieke Visser, MD, PhD, and Kjell Asplund, MD, PhD.