Brain White Matter Hyperintensity Changes Associated with Vascular Cognitive Impairment and Dementia, Alzheimer's Dementia and Normal Aging

Abstract

Aim: The aim of this study was to analyze the relationship between the distribution and grading of white matter hyperintensity (WMH) obtained by brain magnetic resonance imaging and cognitive impairment associated with vascular cognitive impairment and dementia (VCID), Alzheimer's dementia (AD) and normal aging in individuals aged 65 years and older. Material and Methods: Retrospective analysis was performed on a total of 372 patients, who met the criteria for AD, VCID and normal aging. The basic clinical criteria of DSM-V and NIA-AA were considered for AD. The DSM-V and NINDS-AIREN diagnostic criteria were used for VCID and probable vascular dementia (VaD). WMHs were graded according to the Fazekas criteria. Results: Normal aging was detected in 58.3% (n=217) of the patients, AD in 24.7% (n=92) and VCID in 16.9% (n=63). The relationship between WMH and dementia was significant. (p<0.001). Periventricular hyperintensity was detected as 76.2% (n=70) in AD, 95.2% (n=60) in VCID, 40.6% (n=88) in normal aging, and deep white matter hyperintensity was detected as 63.0% (n=58) in AD, 74.5% (n=47) in VCID, 44.2% (n=96) in normal aging. In the VCID group, 52.4% (n=33) had basal ganglia lesions and 60.3% (n=38) had classical infarct areas. No relationship was found between the presence of cortical lesion and cognition. Conclusion: This study is important in terms of showing that it would be better to focus on markers of brain damage and dementia, such as WMH rather than focusing on clinical diagnoses with mixed-type pathologies such as Alzheimer's disease or vascular cognitive impairment.

Keywords

• Alzheimer dementia
• vascular cognitive impairment
• brain MRI
• white matter hyperintensity

Vasküler Kognitif Bozukluk ve Demans, Alzheimer Demans ve Normal Yaşlanma ile İlişkili Beyin Beyaz Cevher Hiperintensite Değişiklikleri

Abstract

Amaç: Bu çalışmanın amacı, 65 yaş ve üstü bireylerde, beyin manyetik rezonans görüntüleme (MRG) ile elde edilen beyaz madde hiperintensitesinin (white matter hyperintensity, WMH) dağılımı ve derecelendirmesi ile vasküler kognitif bozukluk ve demans (VCID), Alzheimer demans (AD) ve normal yaşlanma ile ilişkili kognitif etkilenme arasındaki ilişkiyi analiz etmektir. Gereç ve Yöntemler: AD, VCID ve normal yaşlanma kriterlerine uygun toplam 372 hasta ile geriye dönük analiz yapıldı. AD için DSM-V ve 2011 NIA-AA temel klinik kriterleri dikkate alındı. VCID ve olası vasküler demans (VaD) için DSM-V ve NINDS-AIREN tanı kriterleri kullanıldı. WMH'ler Fazekas kriterlerine göre derecelendirildi. Bulgular: Katılımcıların %58,3’ünde (n=217) normal yaşlanma, %24,7’sinde (n=92) AD ve %16,9’unda (n=63) VCID tespit edildi. WMH ile demans arasındaki ilişki anlamlı idi (p<0.001). Periventriküler hiperintensite AD’de %76,2 (n=70), VCID’de %95,2 (n=60), normal yaşlanmada %40,6 (n=88) olarak tespit edildi ve derin beyaz madde hiperintensitesi ise AD’de %63,0 (n=58), VCID’de %74,5 (n=47), normal yaşlanmada %44,2 (n=96) olarak saptandı. VCID grubunda %52,4 (n=33) ile bazal ganglion lezyonları ve %60,3 (n=38) ile klasik enfarkt alanları mevcuttu. Kortikal lezyon varlığı ile kognisyon arasındaki ilişki tespit edilmedi. Sonuç: Bu çalışma Alzheimer hastalığı veya vasküler bilişsel bozukluk gibi mix tip patolojileri olan klinik tanılara odaklanmak yerine, belki de WMH gibi beyin hasarı ve demans belirteçlerine odaklanmanın daha iyi olacağını göstermesi açısından önemlidir.

Keywords

• Alzheimer demans
• vasküler kognitif bozulma
• beyin MRG
• white matter hiperintensite

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