Aktuelle Neurologie 2007; 34 - P740
DOI: 10.1055/s-2007-988009

Hippocampal volume is an independent predictor of global cognitive performance in pure cerebral small vessel disease

M Sullivan 1, E Ngo 1, A Viswanathan 1, E Jouvent 1, A Gschwendtner 1, P Saemann 1, M Duering 1, C Pachai 1, M Bousser 1, H Chabriat 1, M Dichgans 1
  • 1München; Paris, F; Lyon, F

Background: Hippocampal atrophy is a hallmark of Alzheimer's disease (AD), but its importance in cerebral small vessel disease (SVD) is unclear. Attempts to study this in sporadic SVD are hampered by the advanced age of many patients and the presence of co-morbid neurodegenerative pathology. To clarify the role of hippocampal changes in SVD we investigated patients with CADASIL, a model of pure SVD and associated cognitive impairment.

Methods: 144 patients with CADASIL were recruited from two centres and underwent MRI, clinical and cognitive assessment. Dementia status was recorded according to DSM-IV criteria. Hippocampal volumetry was performed on high resolution T1-weighted MRI with a manual outlining protocol with very good intra-rater reliability (intraclass correlation 0.96). Whole brain atrophy and volumes of lacunar lesions and diffuse white matter hyperintensity (WMH) on FLAIR images were also quantified using automated tissue segmentation algorithms.

Results: Hippocampal volume (HV) correlated with age, whole brain atrophy and volume of lacunar lesions, but not WMH. HV was reduced in the 21 patients with dementia (mean left/right: 2272±333 v. 2642±349mm3, p<0.001) and correlated with MMSE (r=0.30, p<0.001) and Mattis Dementia Rating Scale (MDRS) (r=0.40, p<0.001). Correlations were found with the Memory (r=0.31, p<0.001), Initiation/Perseveration (r=0.37, p<0.001) and Conceptualization (r=0.38, p<0.001) subscales of the MDRS. In a multivariate model including age, lesion volumes and whole brain atrophy, HV was a significant independent predictor of MDRS performance (Beta 0.27, p<0.001). In patients less than 60 years of age, HV was significantly reduced in demented patients and remained an independent predictor of MDRS performance.

Conclusions: Hippocampal volume is reduced in dementia and is an independent predictor of global cognitive performance in a pure form of SVD. These results suggest that hippocampal atrophy is an integral and important part of SVD, independent of other disease processes.