White Matter Changes and Cognitive Decline in a Ten-Year Follow-Up Period: A Pilot Study on a Single-Center Cohort from the Leukoaraiosis and Disability Study

Madureira, Sofia; Verdelho, Ana; Moleiro, Carla; Santos, Catarina; Scheltens, Philip; Gouw, Alida; Ferro, José · 2016 · Crossref

DOI: 10.1159/000447121

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Summary

This study investigates the long-term impact of white matter lesions (WMLs) on cognitive decline and identifies neuropsychological predictors of cognitive status over a ten-year period. Motivated by the scarcity of very long-term follow-up studies on initially non-dependent participants with WMLs, the research aimed to characterize the cognitive evolution of different clinical diagnostic groups and determine baseline factors that predict the maintenance of no cognitive impairment (NI). The authors re-evaluated the Lisbon subcohort of the Leukoaraiosis and Disability (LADIS) study, which originally enrolled 66 elderly participants with WMLs. Of the 41 survivors at the 10-year mark, 37 underwent clinical, functional, and neuropsychological assessments, while 32 also received MRI scans. Participants were classified into three groups: no impairment (NI), cognitive impairment but no dementia (CIND), and dementia (DEM). The assessment battery included the Mini-Mental State Examination (MMSE), Alzheimer’s Disease Assessment Scale–Cognition (ADAS-Cog), Vascular Dementia Assessment Scale (VADAS-Cog), and tests for executive function and memory. MRI scans were analyzed for WML progression using the modified Rotterdam Progression Scale. Statistical analyses included repeated measures ANOVA to track changes over time and logistic regression to identify predictors of NI. The results indicated that 41% of the cohort had dementia, 32% had CIND, and 27% remained without impairment at the 10-year follow-up. Cognitive performance declined significantly over time across all groups, with the dementia group showing the steepest decline in MMSE, ADAS-Cog, and VADAS-Cog scores. While WML progression was common, with 53% of participants showing severe progression, there were no significant differences in WML progression or new lacunae between those with NI and those with impairment. However, participants with NI had less severe WMLs at the 10-year mark compared to those with impairment. Crucially, logistic regression revealed that higher baseline MMSE scores were the only significant neuropsychological predictor of maintaining NI after 10 years (OR = 3.13). Baseline ADAS scores also predicted NI, but demographic factors like age and education did not. The study concludes that while WML progression is prevalent in this elderly cohort, baseline global cognitive performance, specifically MMSE scores, is a robust predictor of long-term cognitive stability. The findings suggest that individuals who maintain cognitive independence over a decade are distinguished primarily by their initial cognitive reserve rather than the absence of WML progression. This highlights the importance of early cognitive screening in identifying patients at risk for long-term decline, independent of vascular burden progression.

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• cognitive impairment