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Strategic lacunes and their relationship to cognitive impairment in cerebral small vessel disease

Benjamin, P; Lawrence, AJ; Lambert, C; Patel, B; Chung, AW; MacKinnon, AD; Morris, RG; ... Markus, HS; + view all (2014) Strategic lacunes and their relationship to cognitive impairment in cerebral small vessel disease. NeuroImage: Clinical , 4 pp. 828-837. 10.1016/j.nicl.2014.05.009. Green open access

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Abstract

OBJECTIVES: Lacunes are an important disease feature of cerebral small vessel disease (SVD) but their relationship to cognitive impairment is not fully understood. To investigate this we determined (1) the relationship between lacune count and total lacune volume with cognition, (2) the spatial distribution of lacunes and the cognitive impact of lacune location, and (3) the whole brain anatomical covariance associated with these strategically located regions of lacune damage. METHODS: One hundred and twenty one patients with symptomatic lacunar stroke and radiological leukoaraiosis were recruited and multimodal MRI and neuropsychological data acquired. Lacunes were mapped semi-automatically and their volume calculated. Lacune location was automatically determined by projection onto atlases, including an atlas which segments the thalamus based on its connectivity to the cortex. Lacune locations were correlated with neuropsychological results. Voxel based morphometry was used to create anatomical covariance maps for these ‘strategic’ regions. RESULTS: Lacune number and lacune volume were positively associated with worse executive function (number p < 0.001; volume p < 0.001) and processing speed (number p < 0.001; volume p < 0.001). Thalamic lacunes, particularly those in regions with connectivity to the prefrontal cortex, were associated with impaired processing speed (Bonferroni corrected p = 0.016). Regions of associated anatomical covariance included the medial prefrontal, orbitofrontal, anterior insular cortex and the striatum. CONCLUSION: Lacunes are important predictors of cognitive impairment in SVD. We highlight the importance of spatial distribution, particularly of anteromedial thalamic lacunes which are associated with impaired information processing speed and may mediate cognitive impairment via disruption of connectivity to the prefrontal cortex.

Type: Article
Title: Strategic lacunes and their relationship to cognitive impairment in cerebral small vessel disease
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.nicl.2014.05.009
Publisher version: http://dx.doi.org/10.1016/j.nicl.2014.05.009
Language: English
Additional information: © 2014 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
Keywords: Science & Technology, Life Sciences & Biomedicine, Neuroimaging, Neurosciences & Neurology, Small vessel disease, Lacunes, Cognitive Impairment, HUMAN THALAMUS, BASAL GANGLIA, DIFFUSION TRACTOGRAPHY, PREFRONTAL CORTEX, MRI, INFARCTS, CONNECTIONS, CADASIL, REGISTRATION, ORGANIZATION
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Imaging Neuroscience
URI: https://discovery.ucl.ac.uk/id/eprint/10044847
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