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Original article
Additive effect of cerebral atrophy on cognition in dementia-free elderly with cerebrovascular disease
  1. Xin Xu1,
  2. April Phua2,
  3. Simon L Collinson3,
  4. Saima Hilal1,
  5. Mohammad Kamran Ikram4,
  6. Tien Yin Wong5,
  7. Ching Yu Cheng5,
  8. Narayanaswamy Venketasubramanian6,
  9. Christopher Chen7
  1. 1 Department of Pharmacology, National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
  2. 2 Department of Psychological Medicine, National University Hospital, Singapore, Singapore
  3. 3 Department of Psychology, National University of Singapore, Singapore, Singapore
  4. 4 Departments of Epidemiology and Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
  5. 5 Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
  6. 6 Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
  7. 7 Clinical Research Centre, Department of Pharmacology, National University Health System, Singapore, Singapore
  1. Correspondence to Dr Xin Xu; summer.xu{at}nus.edu.sg

Abstract

Objective To explore the additive effect of neurodegenerative diseases, measured by atrophy, on neurocognitive function in Asian dementia-free elderly with cerebrovascular disease (CeVD).

Methods The present study employed a cross-sectional design and was conducted between 2010 and 2015 among community-dwelling elderly participants recruited into the study. Eligible participants were evaluated with an extensive neuropsychological battery and neuroimaging. The weighted CeVD burden scale comprising markers of both small- and large-vessel diseases was applied, with a score of ≥2, indicating significant CeVD burden. Cortical atrophy (CA) and medial temporal atrophy (MTA) were graded using the global cortical atrophy scale and Schelten’s scale, respectively. Global and domain-specific (attention, executive function, language, visuomotor speed, visuoconstruction, visual memory, and verbal memory) neurocognitive performance was measured using a locally validated neuropsychological battery (Vascular Dementia Battery, VDB).

Results A total of 819 dementia-free participants were included in the analysis. Among none-mild CeVD subjects, there was no significant difference in the global cognitive performance across atrophy groups (no atrophy, CA, and CA+MTA). However, in moderate-severe CeVD subjects, CA+MTA showed significantly worse global cognitive performance compared with those with CA alone (mean difference=−0.35, 95% CI −0.60 to −0.11, p=0.002) and those without atrophy (mean difference=−0.46, 95% CI −0.74 to −0.19, p<0.001, p<0.001). In domain-specific cognitive performance, subjects with CA+MTA performed worse than other groups in visual memory (p=0.005), executive function (p=0.001) and visuomotor speed (p<0.001) in moderate-severe CeVD but not in none-mild CeVD.

Conclusions and relevance Atrophy and moderate-severe CeVD burden showed an additive effect on global and domain-specific cognitive performance. This study highlights the importance of investigating the mechanisms of clinico-pathological interactions between neurodegenerative processes and vascular damage, particularly in the pre-dementia stage.

  • cerebrovascular disease
  • atrophy
  • cognition
  • dementia

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2018-000202

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    Footnotes

    • Contributors XX was responsible for study concept and design, acquisition of data, analysis and interpretation of data, and critical revision of the manuscript. AKSP and SH were responsible for acquisition of data and critical revision of the manuscript for intellectual content. SLC and MKI were responsible for critical revision of the manuscript for intellectual content. TYW, CYC and NV were responsible for study design and critical revision of the manuscript for intellectual content. CLHC was responsible for study concept and design, supervision of analysis and interpretation of data, and critical revision of the manuscript for intellectual content.

    • Funding The Epidemiology of Dementia in Singapore study is supported by the NMRC Centre Grant - Memory Aging and Cognition Centre (MACC) - Theme 5 (NMRC/CG/NUHS/2010 - R-184-006-184-511); NUHS Bridging Fund (NUHSRO/2013/114/5+5 budget/01); NMRC Clinician Scientist Award (NMRC/CSA/038/2013); and NMRC Centre Grant - NUHS - Metabolic Medicine, Infectious Diseases, Neuroscience Enablers (MINE) (NMRC/CG/013/2013). The National University Hospital assisted in study participant recruitment. Research assistants and coordinators (Memory, Ageing and Cognition Centre) contributed to study participant recruitment and assessment.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.