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A Threshold Effect

Kyle Brauer Boone, PhD; Bruce L. Miller, MD; Ira M. Lesser, MD; C. Mark Mehringer, MD; Elizabeth Hill-Gutierrez, RN; Mark A. Goldberg, MD; Nancy G. Berman, PhD

Arch Neurol. 1992;49(5):549-554.

Abstract
• The clinical significance of white-matter lesions (WMLs) detected by computed tomography and magnetic resonance imaging in healthy elderly subjects has been controversial, with some studies reporting associated deficits in cognition and others failing to document cognitive disturbance. In our sample of 100 healthy elderly individuals, almost half (n = 46) had no WMLs, approximately one fourth had minimal (1 cm²; n=27) or moderate (>1 cm² but 10 cm²; n=21) WML areas, and six subjects had large WML areas (>10 cm²). Substantial disturbances in basic attention and selected frontal lobe skills were detected in the six subjects with the large WML areas. These findings suggest that a "threshold" of WML area must be present before cognitive deficits are observed. Surprisingly, no significant relationships between duration of hypertension or cholesterol levels and WMLs were detected, suggesting that factors other than vascular disturbances are involved in the origin of at least some WMLs.

Author Affiliations
From the Departments of Psychiatry (Drs Boone and Lesser and Ms Hill-Gutierrez), Neurology (Drs Miller and Goldberg), and Radiology (Dr Mehringer) and the Research and Education Institute (Dr Berman), Harbor-UCLA Medical Center.

Footnotes
Accepted for publication January 8, 1992.

Reprint requests to the Department of Psychiatry, Harbor-UCLA Medical Center, 1000 W Carson St, D-5 Annex, Torrance, CA 90509 (Dr Boone).

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