Imaging Techniques and Neuropsychological Testing in Dementia with Severe White Matter Changes

  • C. DeCarli
  • C. L. Grady
  • C. M. Clark
  • G. Gouras
  • J. V. Haxby
  • J. A. Salerno
  • S. I. Rapoport
  • M. B. Schapiro
Conference paper


Multi-infarct dementia (MID), as originally described by Hachinski [21] is thought to be the consequence of repeated, clinically apparent cerebrovascular infarctions. The Hachinski Ischemic Scale [21] is used to separate vascular from nonvascular dementias, according to this operational definition. Not all cerebral infarctions are clinically apparent, however. Recent reports suggest that 11%–30% of all cerebral infarctions are asymptomatic [8,37]. Moreover, the concept of cerebrovascular dementia has evolved to include patients with subcortical arteriosclerotic dementias (SAD) where clinical stroke is inapparent [9,35]. Patients with SAD form a subgroup of slowly progressive dementing illnesses which differ pathophysiological from the dementia of Alzheimer type (DAT) and MID groups, by virtue of having predominantly small vessel cerebrovascular disease and central white matter demyelination [33,35]. The cognitive deficits, however, bear no unique characteristics that reliably distinguish them from DAT or MID [7,9,33,35,36].


Cerebral Amyloid Angiopathy White Matter Hyperintensities Adult Intelligence Scale Subcortical Nucleus Cerebral Glucose Utilization 
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  1. 1.
    Awad IA, Johnson PC, Spetzler RF, Hodak JA (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations. Stroke 17:1090–1097PubMedCrossRefGoogle Scholar
  2. 2.
    Awad IA, Spetzler RF, Hodak JA, Awad CA, Carey R (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke 17:1084–1089PubMedCrossRefGoogle Scholar
  3. 3.
    Baron JC, D’Antona R, Pantano P, Serdaru M, Samson Y, Bousser MG (1986) Effects of thalamic stroke on energy metabolism of the cerebral cortex. Brain 109:1243–1259PubMedCrossRefGoogle Scholar
  4. 4.
    Benton AL, Van Allen MW, Hamsher K, Levin HS (1975) Test of Facial Recognition. Form SL, Revised Manual. University of Iowa, Iowa City of Iowa (Neurosensory Center Publication 338)Google Scholar
  5. 5.
    Braffman BH, Zimmerman RA, Trojanowski JQ, Gonatas NK, Hickey WF, Schlaepfer WW (1988) Brain MR: pathologic correlation with gross and histopathology. 2. Hyper-intence white-matter foci in the elderly. AJNR 9:629–636Google Scholar
  6. 6.
    Brooks RA (1982) Alternative formula for glucose utilization using labeled deoxyglucose. J Nucl Med 23:538–539PubMedGoogle Scholar
  7. 7.
    Chimowitz MI, Awad IA, Furlan AJ (1989) Preiventricular lesions on MRI: Facts and theories. Stroke 20:963–967PubMedCrossRefGoogle Scholar
  8. 8.
    Chodosh EH, Foulkes MA, Kase CS et al. (1988) Silent stroke in the NINCDS stroke data bank. Neurology 38:1674–1679PubMedGoogle Scholar
  9. 9.
    Chui HC (1989) Dementia: a review emphasizing clinicopathologic correlation and brain-behavior relationships. Arch Neurol 46:806–814PubMedCrossRefGoogle Scholar
  10. 10.
    Creasey H, Schwartz M, Frederickson H, Haxby JV, Rapoport SI (1986) Quantitative computed tomography in dementia of the Alzheimer type. Neurology 36:1563–1568PubMedGoogle Scholar
  11. 11.
    DeWitt LD, Kistler JP, Miller DC, Richardson EP Jr, Buonanno FS (1987) NMR-neuropathologic correlation in stroke. Stroke 18:342–351PubMedCrossRefGoogle Scholar
  12. 12.
    Duara R, Grady CL, Haxby JV et al. (1986) Positron emission tomography in Alzheimer’s disease. Neurology 36:879–887PubMedGoogle Scholar
  13. 13.
    Duara R, Margolin RA, Robertson-Tchabo EA et al. (1983) Cerebral glucose utilization, as measured with positron emission tomography in 21 resting healthy men between the ages of 21 and 83 years. Brain 106:761–775PubMedCrossRefGoogle Scholar
  14. 14.
    Eycleshymer AC, Schoemaker DM (1911) A cross-section anatomy. Appleton, New York, pp 2–55Google Scholar
  15. 15.
    Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA (1987) MRI signal abnormalities at 1.5T in Alzheimer’s dementia and normal aging. AJNR 8:416–421Google Scholar
  16. 16.
    Fazekas F, Niederkorn K, Schmidt R et al. (1988) White matter signal abnormalities in normal individuals: correlation with carotid ultrasonography, cerebral blood flow measurements and cerebrovascular risk factors. Stroke 19:1285–1288PubMedCrossRefGoogle Scholar
  17. 17.
    Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. J Psychiatr Res 12:189–198PubMedCrossRefGoogle Scholar
  18. 18.
    Grady CL, Haxby JV, Horwitz B et al. (1988) Longitudinal study of the early neuropsychological and cerebral metabolic changes in dementia of the Alzheimer type. J Clin Exp Neuropsychol 10:576–596PubMedCrossRefGoogle Scholar
  19. 19.
    Grady CL, Haxby JV, Schapiro MB et al. (1990) Metabolic subgroups in dementia of the Alzheimer type identified using positron emission tomography. J Neuropsychiatr Clin Neurosci 2:373–384Google Scholar
  20. 20.
    Gray F, Dubas F, Roullet E, Escourolle R (1985) Leukoencephalopathy in diffuse hemorrhagic cerebral amyloid angiopathy. Ann Neurol 18:54–59PubMedCrossRefGoogle Scholar
  21. 21.
    Hachinski VC, Illiff LD, Zilhka E et al. (1975) Cerebral blood flow in dementia. Arch Neurol 32:632–637PubMedCrossRefGoogle Scholar
  22. 22.
    Haxby JV, Rapoport SI (1985) Relations between neuropsychological and cerebral metabolic asymmetries in early Alzheimer’s disease. J Cereb Blood Flow Metab 5:193–200PubMedCrossRefGoogle Scholar
  23. 23.
    Herholz K, Heindel W, Rackl A et al. (1990) Regional cerebral blood flow in patients with leuko-araiosis and atherosclerotic carotid artery disease. Arch Neurol 47:392–396PubMedCrossRefGoogle Scholar
  24. 24.
    Hojer-Pedersen E, Petersen OF (1989) Changes of blood flow in the cerebral cortex after subcortical ischemic infarction. Stroke 20:211–216PubMedCrossRefGoogle Scholar
  25. 25.
    Inzitari D, Diaz F, Fox A et al. (1987) Vascular risk factors and leuko-araiosis. Arch Neurol 44:42–47PubMedCrossRefGoogle Scholar
  26. 26.
    Jacobson HG (1988) Magnetic resonance imaging of the central nervous system. JAMA 259:1211–1222CrossRefGoogle Scholar
  27. 27.
    Janota I, Mirsen TR, Hachinski VC, Lee DH, Merskey H (1989) Neuropathologic correlates of leuko-araiosis. Arch Neurol 46:1124–1128PubMedCrossRefGoogle Scholar
  28. 28.
    Kinkel WR, Jacobs L, Polachini I, Bates V, Heffner R (1985) Subcortical arteriosclerotic encephalopathy (Binswanger’s disease). Computed tomographic, nuclear magnetic resonance, and clinical correlations. Arch Neurol 42:951–959PubMedCrossRefGoogle Scholar
  29. 29.
    Kirkpatrick JB, Hayman LA (1987) White-matter lesions in MR imaging of clinically healthy brains of elderly subjects: possible pathologic basis. Radiology 162:509–511PubMedGoogle Scholar
  30. 30.
    Kozachuk WE, DeCarli C, Schapiro MB, Rapoport SI, Horwitz B (1990) White matter hyperintensities in dementia of the Alzheimer’s type and in healthy subjects without cerebrovascular risk factors: an MRI study. Arch Neurol 47:1306–1310PubMedCrossRefGoogle Scholar
  31. 31.
    Kuhl DE, Metter J, Riege WH (1985) Patterns of cerebral glucose utilization in depression, multiple infarct dementia, and Alzheimer’s disease. In: Sokoloff L (ed) Brain imaging and brain function. Raven, New York, pp 211–226Google Scholar
  32. 32.
    Lechner H, Schmidt R, Gotz B, Justich E, Offenbacher H, Schneider G (1988) Nuclear magnetic resonance image white matter lesions and risk factors for stroke in normal individuals. Stroke 19:263–265PubMedCrossRefGoogle Scholar
  33. 33.
    Lotz PR, Ballinger WE Jr, Quisling RG (1986) Subcortical arteriosclerotic encephalopathy: CT spectrum and pathological correlation. AJNR 7:817–822Google Scholar
  34. 34.
    McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34:939–944PubMedGoogle Scholar
  35. 35.
    Roman GC (1987) Senile dementia of the Binswanger type. A vascular form of dementia in the elderly. JAMA 258:1782–1788PubMedCrossRefGoogle Scholar
  36. 36.
    Scheinberg P (1988) Dementia due to vascular disease — a multifactorial disorder. Stroke 19:1291–1299PubMedCrossRefGoogle Scholar
  37. 37.
    Sise MJ, Sedwitz MM, Rowley WR, Shackford SR (1989) Prospective analysis of carotid endarterectomy and silent cerebral infarction in 97 patients. Stroke 20:329–332PubMedCrossRefGoogle Scholar
  38. 38.
    Sokoloff L, Reivich M, Kennedy C et al. (1977) [14C]-deoxyglucose method for the measurement of local cerebral glucose utilization: theory, procedure, and normal values in the conscious and anesthetized albino rat. J Neurochem 28:897–916PubMedCrossRefGoogle Scholar
  39. 39.
    Statistical Analysis Systems (SAS) (1985) Version 5. SAS Institute Inc. Box 8000, 27511–8000, Cary, NC, USAGoogle Scholar
  40. 40.
    Steingart A, Hachinski VC, Lau C et al. (1987) Cognitive and neurologic findings in subjects with diffuse white matter lucencies on computed tomographic scan (Leuko-araiosis). Arch Neurol 44:32–35PubMedCrossRefGoogle Scholar
  41. 41.
    Wechsler D (1945) A standardized memory scale for clinical use. J Psychol 19:87–95CrossRefGoogle Scholar
  42. 42.
    Wechsler DA (1955) Wechsler Adult Intelligence Scale. Psychological Corporation, New YorkGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • C. DeCarli
    • 1
  • C. L. Grady
    • 1
  • C. M. Clark
    • 2
  • G. Gouras
    • 1
  • J. V. Haxby
    • 1
  • J. A. Salerno
    • 1
  • S. I. Rapoport
    • 1
  • M. B. Schapiro
    • 1
  1. 1.Laboratory of Neurosciences, Section of Brain Aging and DementiaNational Institute of HealthBethesdaUSA
  2. 2.Memory Disorders ClinicDuke University Medical CenterDurhamUSA

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