Synergistic effects of ischemia and β-amyloid burden on cognitive decline in patients with subcortical vascular mild cognitive impairment

Mi Ji Lee, Sang Won Seo, Duk L. Na, Changsoo Kim, Jae Hyun Park, Geon Ha Kim, Chi Hun Kim, Young Noh, Hanna Cho, Hee Jin Kim, Cindy W. Yoon, Byoung Seok Ye, Juhee Chin, Seun Jeon, Jong Min Lee, Yearn Seong Choe, Kyung Han Lee, Jae Seung Kim, Sung Tae Kim, Jae Hong LeeMichael Ewers, David J. Werring, Michael W. Weiner

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

IMPORTANCE Cerebrovascular disease (CVD) and Alzheimer disease are significant causes of cognitive impairment in the elderly. However, few studies have evaluated the relationship between CVD and β-amyloid burden in living humans or their synergistic effects on cognition. Thus, there is a need for better understanding of mild cognitive impairment (MCI) before clinical deterioration begins. OBJECTIVE To determine the synergistic effects of β-amyloid burden and CVD on cognition in patients with subcortical vascular MCI (svMCI). DESIGN, SETTING, AND PARTICIPANTS A cross-sectional studywas conducted using a hospital-based sample at a tertiary referral center.We prospectively recruited 95 patients with svMCI; 67 of these individuals participated in the study. Forty-five patients with amnestic MCI (aMCI) were group matched with those with svMCI by the Clinical Dementia Rating Scale Sum of Boxes. MAIN OUTCOMES AND MEASURES We measured β-amyloid burden using positron emission tomography with carbon 11-labeled Pittsburgh Compound B (PiB). Cerebrovascular disease was quantified as white matter hyperintensity volume detected by magnetic resonance imaging fluid-attenuated inversion recovery. Detailed neuropsychological tests were performed to determine the level of patients' cognitive impairment. RESULTS On evaluation, 22 of the svMCI group (33%) and 28 of the aMCI group (62%) were found to be PiB positive. The mean PiB retention ratio was lower in patients with svMCI than in those with aMCI. In svMCI, the PiB retention ratio was associated with cognitive impairments in multiple domains, including language, visuospatial, memory, and frontal executive functions, but was associated only with memory dysfunction in aMCI. A significant interaction between PiB retention ratio and white matter hyperintensity volume was found to affect visuospatial function in patients with svMCI. CONCLUSIONS AND RELEVANCE Most patients with svMCI do not exhibit substantial amyloid burden, and CVD does not increase β-amyloid burden as measured by amyloid imaging. However, in patients with svMCI, amyloid burden and white matter hyperintensity act synergistically to impair visuospatial function. Therefore, our findings highlight the need for accurate biomarkers, including neuroimaging tools, for early diagnosis and the need to relate these biomarkers to cognitive measurements for effective use in the clinical setting.

Original languageEnglish
Pages (from-to)412-422
Number of pages11
JournalJAMA Psychiatry
Volume71
Issue number4
DOIs
Publication statusPublished - 2014 Jan 1

Fingerprint

Amyloid
Blood Vessels
Ischemia
Cerebrovascular Disorders
Cognition
Biomarkers
Cognitive Dysfunction
Neuropsychological Tests
Executive Function
Tertiary Care Centers
Neuroimaging
Positron-Emission Tomography
Dementia
Early Diagnosis
Alzheimer Disease
Research Design
Language
Carbon
Magnetic Resonance Imaging
2-(4'-(methylamino)phenyl)-6-hydroxybenzothiazole

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health

Cite this

Lee, Mi Ji ; Seo, Sang Won ; Na, Duk L. ; Kim, Changsoo ; Park, Jae Hyun ; Kim, Geon Ha ; Kim, Chi Hun ; Noh, Young ; Cho, Hanna ; Kim, Hee Jin ; Yoon, Cindy W. ; Ye, Byoung Seok ; Chin, Juhee ; Jeon, Seun ; Lee, Jong Min ; Choe, Yearn Seong ; Lee, Kyung Han ; Kim, Jae Seung ; Kim, Sung Tae ; Lee, Jae Hong ; Ewers, Michael ; Werring, David J. ; Weiner, Michael W. / Synergistic effects of ischemia and β-amyloid burden on cognitive decline in patients with subcortical vascular mild cognitive impairment. In: JAMA Psychiatry. 2014 ; Vol. 71, No. 4. pp. 412-422.
@article{b4ff694f3b19425f9a2316ba727697f4,
title = "Synergistic effects of ischemia and β-amyloid burden on cognitive decline in patients with subcortical vascular mild cognitive impairment",
abstract = "IMPORTANCE Cerebrovascular disease (CVD) and Alzheimer disease are significant causes of cognitive impairment in the elderly. However, few studies have evaluated the relationship between CVD and β-amyloid burden in living humans or their synergistic effects on cognition. Thus, there is a need for better understanding of mild cognitive impairment (MCI) before clinical deterioration begins. OBJECTIVE To determine the synergistic effects of β-amyloid burden and CVD on cognition in patients with subcortical vascular MCI (svMCI). DESIGN, SETTING, AND PARTICIPANTS A cross-sectional studywas conducted using a hospital-based sample at a tertiary referral center.We prospectively recruited 95 patients with svMCI; 67 of these individuals participated in the study. Forty-five patients with amnestic MCI (aMCI) were group matched with those with svMCI by the Clinical Dementia Rating Scale Sum of Boxes. MAIN OUTCOMES AND MEASURES We measured β-amyloid burden using positron emission tomography with carbon 11-labeled Pittsburgh Compound B (PiB). Cerebrovascular disease was quantified as white matter hyperintensity volume detected by magnetic resonance imaging fluid-attenuated inversion recovery. Detailed neuropsychological tests were performed to determine the level of patients' cognitive impairment. RESULTS On evaluation, 22 of the svMCI group (33{\%}) and 28 of the aMCI group (62{\%}) were found to be PiB positive. The mean PiB retention ratio was lower in patients with svMCI than in those with aMCI. In svMCI, the PiB retention ratio was associated with cognitive impairments in multiple domains, including language, visuospatial, memory, and frontal executive functions, but was associated only with memory dysfunction in aMCI. A significant interaction between PiB retention ratio and white matter hyperintensity volume was found to affect visuospatial function in patients with svMCI. CONCLUSIONS AND RELEVANCE Most patients with svMCI do not exhibit substantial amyloid burden, and CVD does not increase β-amyloid burden as measured by amyloid imaging. However, in patients with svMCI, amyloid burden and white matter hyperintensity act synergistically to impair visuospatial function. Therefore, our findings highlight the need for accurate biomarkers, including neuroimaging tools, for early diagnosis and the need to relate these biomarkers to cognitive measurements for effective use in the clinical setting.",
author = "Lee, {Mi Ji} and Seo, {Sang Won} and Na, {Duk L.} and Changsoo Kim and Park, {Jae Hyun} and Kim, {Geon Ha} and Kim, {Chi Hun} and Young Noh and Hanna Cho and Kim, {Hee Jin} and Yoon, {Cindy W.} and Ye, {Byoung Seok} and Juhee Chin and Seun Jeon and Lee, {Jong Min} and Choe, {Yearn Seong} and Lee, {Kyung Han} and Kim, {Jae Seung} and Kim, {Sung Tae} and Lee, {Jae Hong} and Michael Ewers and Werring, {David J.} and Weiner, {Michael W.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1001/jamapsychiatry.2013.4506",
language = "English",
volume = "71",
pages = "412--422",
journal = "JAMA Psychiatry",
issn = "2168-622X",
publisher = "American Medical Association",
number = "4",

}

Lee, MJ, Seo, SW, Na, DL, Kim, C, Park, JH, Kim, GH, Kim, CH, Noh, Y, Cho, H, Kim, HJ, Yoon, CW, Ye, BS, Chin, J, Jeon, S, Lee, JM, Choe, YS, Lee, KH, Kim, JS, Kim, ST, Lee, JH, Ewers, M, Werring, DJ & Weiner, MW 2014, 'Synergistic effects of ischemia and β-amyloid burden on cognitive decline in patients with subcortical vascular mild cognitive impairment', JAMA Psychiatry, vol. 71, no. 4, pp. 412-422. https://doi.org/10.1001/jamapsychiatry.2013.4506

Synergistic effects of ischemia and β-amyloid burden on cognitive decline in patients with subcortical vascular mild cognitive impairment. / Lee, Mi Ji; Seo, Sang Won; Na, Duk L.; Kim, Changsoo; Park, Jae Hyun; Kim, Geon Ha; Kim, Chi Hun; Noh, Young; Cho, Hanna; Kim, Hee Jin; Yoon, Cindy W.; Ye, Byoung Seok; Chin, Juhee; Jeon, Seun; Lee, Jong Min; Choe, Yearn Seong; Lee, Kyung Han; Kim, Jae Seung; Kim, Sung Tae; Lee, Jae Hong; Ewers, Michael; Werring, David J.; Weiner, Michael W.

In: JAMA Psychiatry, Vol. 71, No. 4, 01.01.2014, p. 412-422.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Synergistic effects of ischemia and β-amyloid burden on cognitive decline in patients with subcortical vascular mild cognitive impairment

AU - Lee, Mi Ji

AU - Seo, Sang Won

AU - Na, Duk L.

AU - Kim, Changsoo

AU - Park, Jae Hyun

AU - Kim, Geon Ha

AU - Kim, Chi Hun

AU - Noh, Young

AU - Cho, Hanna

AU - Kim, Hee Jin

AU - Yoon, Cindy W.

AU - Ye, Byoung Seok

AU - Chin, Juhee

AU - Jeon, Seun

AU - Lee, Jong Min

AU - Choe, Yearn Seong

AU - Lee, Kyung Han

AU - Kim, Jae Seung

AU - Kim, Sung Tae

AU - Lee, Jae Hong

AU - Ewers, Michael

AU - Werring, David J.

AU - Weiner, Michael W.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - IMPORTANCE Cerebrovascular disease (CVD) and Alzheimer disease are significant causes of cognitive impairment in the elderly. However, few studies have evaluated the relationship between CVD and β-amyloid burden in living humans or their synergistic effects on cognition. Thus, there is a need for better understanding of mild cognitive impairment (MCI) before clinical deterioration begins. OBJECTIVE To determine the synergistic effects of β-amyloid burden and CVD on cognition in patients with subcortical vascular MCI (svMCI). DESIGN, SETTING, AND PARTICIPANTS A cross-sectional studywas conducted using a hospital-based sample at a tertiary referral center.We prospectively recruited 95 patients with svMCI; 67 of these individuals participated in the study. Forty-five patients with amnestic MCI (aMCI) were group matched with those with svMCI by the Clinical Dementia Rating Scale Sum of Boxes. MAIN OUTCOMES AND MEASURES We measured β-amyloid burden using positron emission tomography with carbon 11-labeled Pittsburgh Compound B (PiB). Cerebrovascular disease was quantified as white matter hyperintensity volume detected by magnetic resonance imaging fluid-attenuated inversion recovery. Detailed neuropsychological tests were performed to determine the level of patients' cognitive impairment. RESULTS On evaluation, 22 of the svMCI group (33%) and 28 of the aMCI group (62%) were found to be PiB positive. The mean PiB retention ratio was lower in patients with svMCI than in those with aMCI. In svMCI, the PiB retention ratio was associated with cognitive impairments in multiple domains, including language, visuospatial, memory, and frontal executive functions, but was associated only with memory dysfunction in aMCI. A significant interaction between PiB retention ratio and white matter hyperintensity volume was found to affect visuospatial function in patients with svMCI. CONCLUSIONS AND RELEVANCE Most patients with svMCI do not exhibit substantial amyloid burden, and CVD does not increase β-amyloid burden as measured by amyloid imaging. However, in patients with svMCI, amyloid burden and white matter hyperintensity act synergistically to impair visuospatial function. Therefore, our findings highlight the need for accurate biomarkers, including neuroimaging tools, for early diagnosis and the need to relate these biomarkers to cognitive measurements for effective use in the clinical setting.

AB - IMPORTANCE Cerebrovascular disease (CVD) and Alzheimer disease are significant causes of cognitive impairment in the elderly. However, few studies have evaluated the relationship between CVD and β-amyloid burden in living humans or their synergistic effects on cognition. Thus, there is a need for better understanding of mild cognitive impairment (MCI) before clinical deterioration begins. OBJECTIVE To determine the synergistic effects of β-amyloid burden and CVD on cognition in patients with subcortical vascular MCI (svMCI). DESIGN, SETTING, AND PARTICIPANTS A cross-sectional studywas conducted using a hospital-based sample at a tertiary referral center.We prospectively recruited 95 patients with svMCI; 67 of these individuals participated in the study. Forty-five patients with amnestic MCI (aMCI) were group matched with those with svMCI by the Clinical Dementia Rating Scale Sum of Boxes. MAIN OUTCOMES AND MEASURES We measured β-amyloid burden using positron emission tomography with carbon 11-labeled Pittsburgh Compound B (PiB). Cerebrovascular disease was quantified as white matter hyperintensity volume detected by magnetic resonance imaging fluid-attenuated inversion recovery. Detailed neuropsychological tests were performed to determine the level of patients' cognitive impairment. RESULTS On evaluation, 22 of the svMCI group (33%) and 28 of the aMCI group (62%) were found to be PiB positive. The mean PiB retention ratio was lower in patients with svMCI than in those with aMCI. In svMCI, the PiB retention ratio was associated with cognitive impairments in multiple domains, including language, visuospatial, memory, and frontal executive functions, but was associated only with memory dysfunction in aMCI. A significant interaction between PiB retention ratio and white matter hyperintensity volume was found to affect visuospatial function in patients with svMCI. CONCLUSIONS AND RELEVANCE Most patients with svMCI do not exhibit substantial amyloid burden, and CVD does not increase β-amyloid burden as measured by amyloid imaging. However, in patients with svMCI, amyloid burden and white matter hyperintensity act synergistically to impair visuospatial function. Therefore, our findings highlight the need for accurate biomarkers, including neuroimaging tools, for early diagnosis and the need to relate these biomarkers to cognitive measurements for effective use in the clinical setting.

UR - http://www.scopus.com/inward/record.url?scp=84898629330&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898629330&partnerID=8YFLogxK

U2 - 10.1001/jamapsychiatry.2013.4506

DO - 10.1001/jamapsychiatry.2013.4506

M3 - Article

C2 - 24554306

AN - SCOPUS:84898629330

VL - 71

SP - 412

EP - 422

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 4

ER -