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October 1994, Vol 51, No. 10 >
Article | October 1994

Cognitive Dysfunction Following Subcortical Infarction

Alastair Corbett, MD, ChB, FRACP; Hayley Bennett, MA; Susan Kos, MBBS, FRACR
Arch Neurol. 1994;51(10):999-1007. doi:10.1001/archneur.1994.00540220045013
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Objective:  To determine the association between computed tomographic scan findings of subcortical infarction, periventricular lucency, and ventricular enlargement and a patient's performance on a range of neuropsychological tests.

Design:  Prospective study of patients in whom computed tomographic scanning identified discrete areas of subcortical lucency that were consistent with multiple subcortical infarcts and in whom there was no evidence for additional cerebral computer tomographic pathology.

Setting:  Hospital practice that included both inpatients and ambulatory patients.

Patients:  One hundred forty-seven consecutive appropriate computed tomographic scans were identified. Sixtytwo patients were excluded because of concomitant medical disorders, and eight refused participation. We describe 77 patients.

Main Outcome Measures:  Performance on a battery of neuropsychological tests.

Results:  The number of infarcts but not the volume of infarction, periventricular lucency, and cerebral ventricular enlargement but not cortical atrophy were significantly associated with impaired performance on neuropsychological tests. The number of infarcts correlated with impaired performance on tests, and this impaired performance was thought to be dependent on the function of frontal systems, while periventricular lucency and ventricular enlargement correlated with impaired performance on a wider range of tests, including tests that depended on memory and language.

Conclusions:  The number of infarcts, periventricular lucency, and ventricular enlargement are the computed tomographic head scan parameters that correlated with severity of impaired performance on neuropsychological tests in patients with subcortical infarction. Cognitive impairment is presumed to be the result of cortical disconnection following disruption of the connections between the subcortical regions and the frontal cortex.

REFERENCES

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Fisher CM.  Lacunar strokes and infarcts: a review . Neurology . 1982;;32: 871-876.
2 +
Parnetti L, Mecocci P, Santucci C, et al.  Is multi-infarct dementia representative of vascular dementias? a retrospective study . Acta Neurol Scand . 1990;; 81:484-487.
3 +
Kertesz A, Polk M, Carr T.  Cognition and white matter changes on magnetic resonance imaging in dementia . Arch Neurol . 1990;;47:387-391.
4 +
Mahler ME, Cummings JL.  Behavioral neurology of multi-infarct dementia . Alzheimer Dis Assoc Disord . 1991;;5:122-130.
5 +
Ishii N, Nishihara Y, Imamura T.  Why do frontal lobe symptoms predominate in vascular dementia with lacunes? Neurology . 1986;;36:340-345.
6 +
Wolfe N, Linn R, Babikian VL, Knoefel JE, Albert ML.  Frontal systems impairment following multiple lacunar infarcts . Arch Neurol . 1990;;47:129-132.
7 +
Hachinski VC, Potter P, Merskey H.  Leuko-araiosis . Arch Neurol . 1987;;44: 21-23.
8 +
Bogousslavsky J.  The plurality of subcortical infarction . Stroke . 1992;;23:629-631.
9 +
Nelson RF, Pullicino P, Kendall BE, Marshall J.  Computed tomography in patients presenting with lacunar syndromes . Stroke . 1980;;11:256-261.
10 +
Folstein MF, Folstein SE, McHugh PR.  'Mini-Mental State': a practical method for grading the cognitive status of patients for the clinician . J Psychiatr Res . 1975;;12:189-198.
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Wechsler D. Wechsler Adult Intelligence Scale—Revised . New York, NY: Psychological Corp; 1981;.
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Wechsler D, Stone CP.  Manual of the Wechsler Memory Scale . J Psychol . 1945;; 19:81-95.
13 +
Strub RL, Black FW. The Mental Status Examination in Neurology . 2nd ed. Philadelphia, Pa: FA Davis Co Publishers; 1985;.
14 +
Russell EW.  A multiple scoring method for the assessment of complex memory functions . J Consult Clin Psychol . 1975;;43:800-809.
15 +
Rey A. L'examen clinique en psychologie . Paris, France: Presses Universitaires de France; 1964;.
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Lezak MD. Neuropsychological Assessment . 2nd ed. New York, NY: Oxford University Press Inc; 1983;.
17 +
Porteus SD. The Porteus Maze Test: Fifty Years of Application . New York, NY: Psychological Corp; 1965;.
18 +
Benton AL, Hamsher K deS. Multilingual Aphasia Examination . Iowa City, Iowa: University of Iowa Press; 1978;.
19 +
Spreen O, Benton AL. Neurosensory Center Comprehensive Examination for Aphasia . Victoria, British Columbia: Neuropsychological Laboratory, Dept of Psychology, University of Victoria; 1969;.
20 +
Goldstein K, Scheerer M.  Abstract and concrete behaviour: an experimental study with special tests . Psychol Monogr . 1941;;53:110-130.
21 +
Robinson RG, Bolla-Wilson K, Kaplan E, Lipsey JR, Price TR.  Depression influences intellectual impairment in stroke patients . Br J Psychiatry . 1986;;148: 541-547.
22 +
Brink TL, Yesavage JA, Lum O, Heersema P, Adey M, Rose TL.  Screening tests for geriatric depression . Clin Gerontologist . 1982;;1:37-43.
23 +
Nelson HE. The Nelson Adult Reading Test (NART) Manual . Windsor, England: NFER-Nelson; 1982;.
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SAS/STAT Users Guide, Release 6.03 . Cary, NC: SAS Institute Inc; 1992;.
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Gorelick PB, Chatterjee A, Patel D, et al.  Cranial computed tomographic observations in multi-infarct dementia . Stroke . 1992;;23:804-811.
26 +
Liu CK, Miller BL, Cummings JL, et al.  A quantitative study of vascular dementia . Neurology . 1992;;42:138-143.
27 +
Hochanadel G, Kaplan E.  Neuropsychology of normal aging . In: Albert ML, ed. Clinical Neurology of Aging . New York, NY: Oxford University Press Inc; 1984;: 231-244.
28 +
Roman GC.  The identity of lacunar dementia and Binswanger disease . Med Hypotheses . 1985;;16:389-391.
29 +
Maguire F, Desmedt JE.  Focal capsular lesions can selectively deafferent the prerolandic or the parietal cortex: somatosensory evoked potential evidence . Ann Neurol . 1991;;30:71-75.
30 +
Brown JJ, Hesselink JR, Rothrock JF.  MR and CT of lacunar infarcts . AJNR Am J Neuroradiol . 1988;;9:477-482.
31 +
Tatemichi TK.  How acute brain failure becomes chronic: a view of the mechanisms of dementia related to stroke . Neurology . 1990;;40:1652-1659.
32 +
Tanaka Y, Tanaka O, Mizuno Y, Yoshida M.  A radiological study of dynamic processes in lacunar dementia . Stroke . 1989;;20:1488-1493.
33 +
George AE, de Leon MJ, Gentes CI, et al.  Leukoencephalopathy in normal and pathological aging, I: CT of brain lucencies . AJNR Am J Neuroradiol . 1986;;7: 561-566.
34 +
Kobari M, Meyer JS, Ichijo M.  Leuko-araiosis, cerebral atrophy, and cerebral perfusion in normal aging . Arch Neurol . 1990;;47:161-165.
35 +
Kawamura J, Meyer JS, Terayama Y, Weathers S.  Leukoaraiosis correlates with cerebral hypoperfusion in vascular dementia . Stroke . 1991;;22:609-614.
36 +
Terayama Y, Meyer JS, Kawamura J, Weather S, Mortel KF.  Patterns of cerebral hypoperfusion compared among demented and nondemented patients with stroke . Stroke . 1992;;23:686-692.
37 +
Awad IA, Johnson PC, Spetzler RF, Hodack JA.  Incidental subcortical lesions identified on magnetic resonance imaging in the elderly, II: postmortem pathological correlations . Stroke . 1986;;17:1090-1097.
38 +
DeCarli C, Kaye JA, Horowitz B, Rapaport SI.  Critical analysis of the use of computer-assisted transverse axial tomography to study human brain in aging and dementia of the Alzheimer type . Neurology . 1990;;40:872-883.
39 +
Aharon-Peretz J, Cummings JL, Hill MA.  Vascular dementia and dementia of the Alzheimer type . Arch Neurol . 1988;;45:719-721.
40 +
Loeb C, Gandolfo C, Bino G.  Intellectual impairment and cerebral lesions in multiple cerebral infarcts: a clinical computed tomography study . Stroke . 1988;; 19:560-565.
41 +
Tatemichi T, Foulkes M, Mohr J, et al.  Dementia in stroke: survivors in the Stroke Data Bank Cohort: prevalence, incidence, risk factors and computed tomography findings . Stroke . 1990;;21:858-866.
42 +
Pujol J, Junque C, Vendrell P, Capdevila A, Marti-Vilalta JL.  Cognitive correlates of ventricular enlargement in vascular patients with leuko-araiosis . Acta Neurol Scand . 1991;;84:237-242.

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1 +
Fisher CM.  Lacunar strokes and infarcts: a review . Neurology . 1982;;32: 871-876.
2 +
Parnetti L, Mecocci P, Santucci C, et al.  Is multi-infarct dementia representative of vascular dementias? a retrospective study . Acta Neurol Scand . 1990;; 81:484-487.
3 +
Kertesz A, Polk M, Carr T.  Cognition and white matter changes on magnetic resonance imaging in dementia . Arch Neurol . 1990;;47:387-391.
4 +
Mahler ME, Cummings JL.  Behavioral neurology of multi-infarct dementia . Alzheimer Dis Assoc Disord . 1991;;5:122-130.
5 +
Ishii N, Nishihara Y, Imamura T.  Why do frontal lobe symptoms predominate in vascular dementia with lacunes? Neurology . 1986;;36:340-345.
6 +
Wolfe N, Linn R, Babikian VL, Knoefel JE, Albert ML.  Frontal systems impairment following multiple lacunar infarcts . Arch Neurol . 1990;;47:129-132.
7 +
Hachinski VC, Potter P, Merskey H.  Leuko-araiosis . Arch Neurol . 1987;;44: 21-23.
8 +
Bogousslavsky J.  The plurality of subcortical infarction . Stroke . 1992;;23:629-631.
9 +
Nelson RF, Pullicino P, Kendall BE, Marshall J.  Computed tomography in patients presenting with lacunar syndromes . Stroke . 1980;;11:256-261.
10 +
Folstein MF, Folstein SE, McHugh PR.  'Mini-Mental State': a practical method for grading the cognitive status of patients for the clinician . J Psychiatr Res . 1975;;12:189-198.
11 +
Wechsler D. Wechsler Adult Intelligence Scale—Revised . New York, NY: Psychological Corp; 1981;.
12 +
Wechsler D, Stone CP.  Manual of the Wechsler Memory Scale . J Psychol . 1945;; 19:81-95.
13 +
Strub RL, Black FW. The Mental Status Examination in Neurology . 2nd ed. Philadelphia, Pa: FA Davis Co Publishers; 1985;.
14 +
Russell EW.  A multiple scoring method for the assessment of complex memory functions . J Consult Clin Psychol . 1975;;43:800-809.
15 +
Rey A. L'examen clinique en psychologie . Paris, France: Presses Universitaires de France; 1964;.
16 +
Lezak MD. Neuropsychological Assessment . 2nd ed. New York, NY: Oxford University Press Inc; 1983;.
17 +
Porteus SD. The Porteus Maze Test: Fifty Years of Application . New York, NY: Psychological Corp; 1965;.
18 +
Benton AL, Hamsher K deS. Multilingual Aphasia Examination . Iowa City, Iowa: University of Iowa Press; 1978;.
19 +
Spreen O, Benton AL. Neurosensory Center Comprehensive Examination for Aphasia . Victoria, British Columbia: Neuropsychological Laboratory, Dept of Psychology, University of Victoria; 1969;.
20 +
Goldstein K, Scheerer M.  Abstract and concrete behaviour: an experimental study with special tests . Psychol Monogr . 1941;;53:110-130.
21 +
Robinson RG, Bolla-Wilson K, Kaplan E, Lipsey JR, Price TR.  Depression influences intellectual impairment in stroke patients . Br J Psychiatry . 1986;;148: 541-547.
22 +
Brink TL, Yesavage JA, Lum O, Heersema P, Adey M, Rose TL.  Screening tests for geriatric depression . Clin Gerontologist . 1982;;1:37-43.
23 +
Nelson HE. The Nelson Adult Reading Test (NART) Manual . Windsor, England: NFER-Nelson; 1982;.
24 +
SAS/STAT Users Guide, Release 6.03 . Cary, NC: SAS Institute Inc; 1992;.
25 +
Gorelick PB, Chatterjee A, Patel D, et al.  Cranial computed tomographic observations in multi-infarct dementia . Stroke . 1992;;23:804-811.
26 +
Liu CK, Miller BL, Cummings JL, et al.  A quantitative study of vascular dementia . Neurology . 1992;;42:138-143.
27 +
Hochanadel G, Kaplan E.  Neuropsychology of normal aging . In: Albert ML, ed. Clinical Neurology of Aging . New York, NY: Oxford University Press Inc; 1984;: 231-244.
28 +
Roman GC.  The identity of lacunar dementia and Binswanger disease . Med Hypotheses . 1985;;16:389-391.
29 +
Maguire F, Desmedt JE.  Focal capsular lesions can selectively deafferent the prerolandic or the parietal cortex: somatosensory evoked potential evidence . Ann Neurol . 1991;;30:71-75.
30 +
Brown JJ, Hesselink JR, Rothrock JF.  MR and CT of lacunar infarcts . AJNR Am J Neuroradiol . 1988;;9:477-482.
31 +
Tatemichi TK.  How acute brain failure becomes chronic: a view of the mechanisms of dementia related to stroke . Neurology . 1990;;40:1652-1659.
32 +
Tanaka Y, Tanaka O, Mizuno Y, Yoshida M.  A radiological study of dynamic processes in lacunar dementia . Stroke . 1989;;20:1488-1493.
33 +
George AE, de Leon MJ, Gentes CI, et al.  Leukoencephalopathy in normal and pathological aging, I: CT of brain lucencies . AJNR Am J Neuroradiol . 1986;;7: 561-566.
34 +
Kobari M, Meyer JS, Ichijo M.  Leuko-araiosis, cerebral atrophy, and cerebral perfusion in normal aging . Arch Neurol . 1990;;47:161-165.
35 +
Kawamura J, Meyer JS, Terayama Y, Weathers S.  Leukoaraiosis correlates with cerebral hypoperfusion in vascular dementia . Stroke . 1991;;22:609-614.
36 +
Terayama Y, Meyer JS, Kawamura J, Weather S, Mortel KF.  Patterns of cerebral hypoperfusion compared among demented and nondemented patients with stroke . Stroke . 1992;;23:686-692.
37 +
Awad IA, Johnson PC, Spetzler RF, Hodack JA.  Incidental subcortical lesions identified on magnetic resonance imaging in the elderly, II: postmortem pathological correlations . Stroke . 1986;;17:1090-1097.
38 +
DeCarli C, Kaye JA, Horowitz B, Rapaport SI.  Critical analysis of the use of computer-assisted transverse axial tomography to study human brain in aging and dementia of the Alzheimer type . Neurology . 1990;;40:872-883.
39 +
Aharon-Peretz J, Cummings JL, Hill MA.  Vascular dementia and dementia of the Alzheimer type . Arch Neurol . 1988;;45:719-721.
40 +
Loeb C, Gandolfo C, Bino G.  Intellectual impairment and cerebral lesions in multiple cerebral infarcts: a clinical computed tomography study . Stroke . 1988;; 19:560-565.
41 +
Tatemichi T, Foulkes M, Mohr J, et al.  Dementia in stroke: survivors in the Stroke Data Bank Cohort: prevalence, incidence, risk factors and computed tomography findings . Stroke . 1990;;21:858-866.
42 +
Pujol J, Junque C, Vendrell P, Capdevila A, Marti-Vilalta JL.  Cognitive correlates of ventricular enlargement in vascular patients with leuko-araiosis . Acta Neurol Scand . 1991;;84:237-242.

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