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The Relationship of High-Intensity Signals on Magnetic Resonance Images to Cognitive and Psychiatric State in Alzheimer's Disease

The Relationship of High-Intensity Signals on Magnetic Resonance Images to Cognitive and... Abstract • In Alzheimer's disease (AD), the relationship between white-matter changes on magnetic resonance images and behavior are unclear. Therefore, magnetic resonance images, cognition, and psychiatric state were assessed in patients with AD with depression (AD/DEP; n = 18) and without depression (AD; n = 45), older depressed patients (n = 12) and older normal individuals (n = 25). High-intensity signals in the cortex and subcortical regions were similar in number and proportions among all groups, even when hypertensive patients were excluded. No correlations to cognitive or psychiatric state were found. Periventricular signals were categorized using a 1- (absent) to 6- (thick, irregular caps and stripes) point scale. The categories were similar among groups except that patients with AD exhibited more category 5 changes than did normal subjects, neuropsychological performance was significantly worse in patients with AD who had category 5 and 6 changes when compared to those in category 1. These results suggest that periventricular changes may predict poor neuropsychological performance in patients with AD. However, neither deep white-matter lesions nor periventricular changes are useful for diagnostic purposes. References 1. Brant-Zawadzki M, Fein G, Van Dyke C, Kiernan R, Davenport L, de Groot J. MR imaging of the aging brain: patchy white-matter lesions and dementia . AJNR . 1985;6:675-682. 2. Bradley WG, Waluck V, Brant-Zawadzki M, Yadley RA, Wycoff RR. Patchy, periventricular white matter lesions in the elderly: common observations during NMR imaging . Noninvasive Med Imaging 1984;1:35-41. 3. Kertesz A, Black S, Tokar G, Benke T, Carr T, Nicholson L. Periventricular and subcortical hyperintensities on magnetic resonance imaging . Arch Neurol . 1988;45:404-408.Crossref 4. Fazekas F, Niederkorn K, Schmidt R, et al. White matter signal abnormalities in normal individuals: correlation with carotid ultrasonography, cerebral blood flow measurements, and cerebrovascular risk factors . Stroke . 1988;19:1285-1288.Crossref 5. Kertesz A, Polk M, Carr T. Cognition and white matter changes on magnetic resonance imaging in dementia . Arch Neurol . 1990;47:387-391.Crossref 6. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman R. MR signal abnormalities at 1.5T in Alzheimer's dementia and normal aging . AJNR . 1987;8:421-426. 7. Johnson KA, Davis KR, Buonanno FS, Brady TJ, Rosen TJ, Growdon JH. Comparison of magnetic resonance and roentgen ray computed tomography in dementia . Arch Neurol . 1987;44:1075-1080.Crossref 8. Leys D, Soetaert G, Petit H, Fauquette A, Pruvo J-P, Steinling M. Periventricular and white matter magnetic resonance imaging hyperintensities do not differ between Alzheimer's disease and normal aging . Arch Neurol . 1990;47:524-527.Crossref 9. Folstein MF, Folstein SE, McHugh PP. 'Mini-Mental State,' a practical method for grading the cognitive stage of patients for the clinician . J Psychiatr Res . 1975;12:189-197.Crossref 10. Hachinski VC, Iliff CD, Phil M, et al. Cerebral blood flow in dementia . Arch Neurol . 1975;32:632-637.Crossref 11. Hamilton M. A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;23:56-61.Crossref 12. Overall JE, Gorham DR. The brief psychiatric rating scale . Psychol Rep . 1962;10:799.Crossref 13. Mattis S. Mental status examination for organic mental syndrome in the elderly patient . In: Bellak L, Karaus T, eds: Geriatric Psychiatry . New York, NY: Grune & Stratton; 1976:77-121. 14. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group . Neurology . 1984;34:939-941.Crossref 15. Sarpel G, Chandry F, Hindo W. Magnetic resonance imaging of periventricular hyperintensity in Veterans Administration hospital population . Arch Neurol . 1984;44:725-728.Crossref 16. Bondareff W, Raval J, Colletti PM, Hauser DL. Quantitative magnetic resonance imaging and the severity of dementia in Alzheimer's disease . Am J Psychiatry . 1988;145:853-856. 17. Awad IA, Johnson PC, Spetzler RF, Hodak JA. Incidental subcortical lesions identified on magnetic resonance imaging in the elderly, II: postmortem pathological correlations . Stroke . 1986;17:1090-1097.Crossref 18. George AE, de Leon MJ, Kalnin A, Rosner L, Goodgold A, Chase N. Leukoencephalopathy in normal and pathological aging, 2: MRI of brain lucencies . AJNR . 1986;7:567-570. 19. Erkinjuntti T, Ketonen L, Sulkava R, Sepponen J, Vuorialho M, Ilvanainen M. Do white matter changes on MRI and CT differentiate vascular dementia from Alzheimer's disease? J Neurol Neurosurg Psychiatry . 1986;50:37-42.Crossref 20. Brun A, Englund E. A white matter disorder in dementia of the Alzheimer's type: a pathoanatomical study . Ann Neurol . 1986;19:253-262.Crossref 21. Rezek D, Morris J, Fulling KH, Gado MH. Periventricular white matter lucencies in senile dementia of the Alzheimer's type and in normal aging . Neurology . 1987;37:1365-1368.Crossref 22. Bottomly PA, Hart HR Jr, Edelsteen WA, et al. Anatomy and metabolism of the normal human brain studied by magnetic resonance at 1.5 tesla . Radiology . 1984;150:441-446.Crossref 23. Okazaki H. Cerebrovascular disease: effects of arteriolar (and arterial) sclerosis on brain parenchyma . In: Okazaki H, ed. Fundamentals of Neuropathology . New York, NY: Igaku-Shoin Medical Publishers; 1983:57-62. 24. Gerard G, Weisberg LA. MRI periventricular lesions in adults . Neurology . 1986;36:998-1002.Crossref 25. Knesevich JW, Martin RL, Berg L, et al. Preliminary report on affective symptoms in the early stages of senile dementia of the Alzheimer's type . Am J Psychiatry . 1983;140:232-235. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

The Relationship of High-Intensity Signals on Magnetic Resonance Images to Cognitive and Psychiatric State in Alzheimer's Disease

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References (27)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1991.00530230044019
Publisher site
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Abstract

Abstract • In Alzheimer's disease (AD), the relationship between white-matter changes on magnetic resonance images and behavior are unclear. Therefore, magnetic resonance images, cognition, and psychiatric state were assessed in patients with AD with depression (AD/DEP; n = 18) and without depression (AD; n = 45), older depressed patients (n = 12) and older normal individuals (n = 25). High-intensity signals in the cortex and subcortical regions were similar in number and proportions among all groups, even when hypertensive patients were excluded. No correlations to cognitive or psychiatric state were found. Periventricular signals were categorized using a 1- (absent) to 6- (thick, irregular caps and stripes) point scale. The categories were similar among groups except that patients with AD exhibited more category 5 changes than did normal subjects, neuropsychological performance was significantly worse in patients with AD who had category 5 and 6 changes when compared to those in category 1. These results suggest that periventricular changes may predict poor neuropsychological performance in patients with AD. However, neither deep white-matter lesions nor periventricular changes are useful for diagnostic purposes. References 1. Brant-Zawadzki M, Fein G, Van Dyke C, Kiernan R, Davenport L, de Groot J. MR imaging of the aging brain: patchy white-matter lesions and dementia . AJNR . 1985;6:675-682. 2. Bradley WG, Waluck V, Brant-Zawadzki M, Yadley RA, Wycoff RR. Patchy, periventricular white matter lesions in the elderly: common observations during NMR imaging . Noninvasive Med Imaging 1984;1:35-41. 3. Kertesz A, Black S, Tokar G, Benke T, Carr T, Nicholson L. Periventricular and subcortical hyperintensities on magnetic resonance imaging . Arch Neurol . 1988;45:404-408.Crossref 4. Fazekas F, Niederkorn K, Schmidt R, et al. White matter signal abnormalities in normal individuals: correlation with carotid ultrasonography, cerebral blood flow measurements, and cerebrovascular risk factors . Stroke . 1988;19:1285-1288.Crossref 5. Kertesz A, Polk M, Carr T. Cognition and white matter changes on magnetic resonance imaging in dementia . Arch Neurol . 1990;47:387-391.Crossref 6. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman R. MR signal abnormalities at 1.5T in Alzheimer's dementia and normal aging . AJNR . 1987;8:421-426. 7. Johnson KA, Davis KR, Buonanno FS, Brady TJ, Rosen TJ, Growdon JH. Comparison of magnetic resonance and roentgen ray computed tomography in dementia . Arch Neurol . 1987;44:1075-1080.Crossref 8. Leys D, Soetaert G, Petit H, Fauquette A, Pruvo J-P, Steinling M. Periventricular and white matter magnetic resonance imaging hyperintensities do not differ between Alzheimer's disease and normal aging . Arch Neurol . 1990;47:524-527.Crossref 9. Folstein MF, Folstein SE, McHugh PP. 'Mini-Mental State,' a practical method for grading the cognitive stage of patients for the clinician . J Psychiatr Res . 1975;12:189-197.Crossref 10. Hachinski VC, Iliff CD, Phil M, et al. Cerebral blood flow in dementia . Arch Neurol . 1975;32:632-637.Crossref 11. Hamilton M. A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;23:56-61.Crossref 12. Overall JE, Gorham DR. The brief psychiatric rating scale . Psychol Rep . 1962;10:799.Crossref 13. Mattis S. Mental status examination for organic mental syndrome in the elderly patient . In: Bellak L, Karaus T, eds: Geriatric Psychiatry . New York, NY: Grune & Stratton; 1976:77-121. 14. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group . Neurology . 1984;34:939-941.Crossref 15. Sarpel G, Chandry F, Hindo W. Magnetic resonance imaging of periventricular hyperintensity in Veterans Administration hospital population . Arch Neurol . 1984;44:725-728.Crossref 16. Bondareff W, Raval J, Colletti PM, Hauser DL. Quantitative magnetic resonance imaging and the severity of dementia in Alzheimer's disease . Am J Psychiatry . 1988;145:853-856. 17. Awad IA, Johnson PC, Spetzler RF, Hodak JA. Incidental subcortical lesions identified on magnetic resonance imaging in the elderly, II: postmortem pathological correlations . Stroke . 1986;17:1090-1097.Crossref 18. George AE, de Leon MJ, Kalnin A, Rosner L, Goodgold A, Chase N. Leukoencephalopathy in normal and pathological aging, 2: MRI of brain lucencies . AJNR . 1986;7:567-570. 19. Erkinjuntti T, Ketonen L, Sulkava R, Sepponen J, Vuorialho M, Ilvanainen M. Do white matter changes on MRI and CT differentiate vascular dementia from Alzheimer's disease? J Neurol Neurosurg Psychiatry . 1986;50:37-42.Crossref 20. Brun A, Englund E. A white matter disorder in dementia of the Alzheimer's type: a pathoanatomical study . Ann Neurol . 1986;19:253-262.Crossref 21. Rezek D, Morris J, Fulling KH, Gado MH. Periventricular white matter lucencies in senile dementia of the Alzheimer's type and in normal aging . Neurology . 1987;37:1365-1368.Crossref 22. Bottomly PA, Hart HR Jr, Edelsteen WA, et al. Anatomy and metabolism of the normal human brain studied by magnetic resonance at 1.5 tesla . Radiology . 1984;150:441-446.Crossref 23. Okazaki H. Cerebrovascular disease: effects of arteriolar (and arterial) sclerosis on brain parenchyma . In: Okazaki H, ed. Fundamentals of Neuropathology . New York, NY: Igaku-Shoin Medical Publishers; 1983:57-62. 24. Gerard G, Weisberg LA. MRI periventricular lesions in adults . Neurology . 1986;36:998-1002.Crossref 25. Knesevich JW, Martin RL, Berg L, et al. Preliminary report on affective symptoms in the early stages of senile dementia of the Alzheimer's type . Am J Psychiatry . 1983;140:232-235.

Journal

Archives of Neurology – American Medical Association

Published: Nov 1, 1991

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