American Journal of Epidemiology Advance Access originally published online on September 25, 2009
American Journal of Epidemiology 2009 170(9):1147-1155; doi:10.1093/aje/kwp256
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ORIGINAL CONTRIBUTIONS |
Association of White Matter Lesions and Lacunar Infarcts With Executive Functioning
The SMART-MR Study
Correspondence to Dr. Mirjam I. Geerlings, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care (Str.6.131), P.O. Box 85500, 3508 GA Utrecht, the Netherlands (e-mail: m.geerlings{at}umcutrecht.nl).
Received for publication January 14, 2009. Accepted for publication July 24, 2009.
The authors investigated the association of white matter lesions and lacunar infarcts with cognitive performance and whether brain atrophy mediates these associations. Within the Second Manifestations of Arterial Disease-Magnetic Resonance study (2001–2005, the Netherlands), cross-sectional analyses of 522 patients were performed (mean age, 57 years (standard deviation, 10); 76% male). Brain segmentation was used to quantify volumes of brain tissue, cerebrospinal fluid, and white matter lesions. Infarcts were rated visually. Brain volume, ventricular volume, and gray matter volume were divided by intracranial volume to obtain indicators of brain atrophy. Neuropsychological tests assessing executive functioning and memory were performed, and scores were transformed into z scores. The authors used linear regression analyses, adjusted for age, sex, education, intelligence, and vascular risk factors, to investigate the association of white matter lesions and number of lacunar infarcts with cognitive performance. A 1-standard-deviation higher volume of white matter lesions (β = –0.12, 95% confidence interval: –0.20, –0.04) and the presence of 
2 lacunar infarcts (β = –0.48, 95% confidence interval: –0.87, –0.09) were associated with worse executive functioning. These associations remained after adjusting for brain atrophy. Both were not associated with worse memory. Results suggest that subcortical ischemic vascular lesions are associated with decreased executive functioning, but not with memory functioning, independent of brain atrophy.
brain infarction; cognition; leukoaraiosis; magnetic resonance imaging
Abbreviations: CI, confidence interval; LI, lacunar infarcts; MRI, magnetic resonance imaging; SMART-MR, Second Manifestations of ARTerial disease-Magnetic Resonance; WML, white matter lesions
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