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1、ImpactofWhiteMatterChangesonClinicalManifestationofAlzheimer'sDiseaseAQuantitativeStudyNobutsuguHirono,MD;HajimeKitagaki,MD;HiroakiKazui,MD;MamoruHashimoto,MD;EtsuroMori,MDBackgroundandPurposeÐTherehavebeenconflictingresultsinvolvingtheclinicalsignificanceofwhit
2、ematterchangesinpatientswithAlzheimer'sdisease(AD).Westudiedtheassociationbetweenthevolumeofwhitematterhyperintensities(WMHs)onT2-weightedimagesandcognitive,neurological,andneuropsychiatricsymptoms.MethodsÐThesubjectswere76ADpatientswhohadWMHsbutnoobviouscerebro
3、vasculardiseases.WequantifiedthevolumeofWMHsbyusingfast-fluid±attenuatedinversionrecoveryimagesandwholebrainatrophybyusing3Dspoiledgradient-echoimages.EffectsofWMHsandbrainatrophyondementiaseverity,cognitivefunction,neuropsychiatricdisturbances,andneurologicalfi
4、ndingswereexamined.ResultsÐWholebrainatrophywassignificantlyassociatedwithdementiaseverityandcognitivedisturbances,aswellaswithgraspreflexandsomekindsofneuropsychiatricdisturbances.Afterwecontrolledfortheeffectsofbrainatrophy,durationofsymptoms,anddemographicfac
5、tors,wefoundthatWMHvolumewasnotassociatedwithglobalcognitivedisturbancesordementiaseveritybutwassignificantlyassociatedwithurinaryincontinence,graspreflex,andaberrantmotorbehaviors.BrainatrophyandWMHvolumewerenotsignificantlycorrelatedeitherbeforeoraftercontroll
6、ingforage,sex,education,anddurationofsymptoms.WMHvolumewasassociatedwithhypertension,butbrainatrophywasnotpositivelycorrelatedwithanyvascularriskfactors.ConclusionsÐOurresultssupportthehypothesisthatWMHsinADpatientsaresuperimposedphenomenaofvascularorigin.WMHsco
7、ntributetospecificneurologicalandneuropsychiatricmanifestationsbutnottoglobalcognitiveimpairment,whichismorecloselyassociatedwithbrainatrophy.(Stroke.2000;31:2182-2188.)KeyWords:AlzheimerdiseasenatrophynneurologicaldeficitsnriskfactorsnwhitematterWhitematter(WM)
8、changesareoftenfoundinpatientsignoringtheclinicalsignificanceofWMchanges.Smallwithvasculardementia,especiallyofsmallvessel/subcorticalinfarctsfrequentlyaccompaniedbyW
