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

Philip Benjamin*, Andrew J. Lawrence, Christian Lambert, Bhavini Patel, Ai Wern Chung, Andrew D. MacKinnon, Robin G. Morris, Thomas R. Barrick, Hugh S. Markus

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

70 Citations (Scopus)
221 Downloads (Pure)

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.ConclusionLacunes 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.
Original languageEnglish
Pages (from-to)828-837
Number of pages10
JournalNeuroImage: Clinical
Volume4
Early online date21 May 2014
DOIs
Publication statusPublished - 2014

Keywords

  • Cognitive Impairment
  • Lacunes
  • Small vessel disease

Fingerprint

Dive into the research topics of 'Strategic lacunes and their relationship to cognitive impairment in cerebral small vessel disease'. Together they form a unique fingerprint.

Cite this