Cortical Abnormalities Associated With Subcortical Lesions in Vascular Dementia: Clinical and Positron Emission Tomographic Findings

doi:10.1001/archneur.1995.00540320049012

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Vol. 52 No. 8, August 1995

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Cortical Abnormalities Associated With Subcortical Lesions in Vascular Dementia

Clinical and Positron Emission Tomographic Findings

David L. Sultzer, MD; Michael E. Mahler, MD; Jeffrey L. Cummings, MD; Wilfred G. Van Gorp, PhD; Charles H. Hinkin, PhD; Charles Brown, MD

Arch Neurol. 1995;52(8):773-780.

Abstract

Objective
To examine the effects of subcortical lesions on cortical metabolicrate and clinical symptoms in patients with vascular dementia.

Method
Eleven elderly patients with vascular dementia who demonstratedno lesion involving the cerebral cortex on magnetic resonanceimaging underwent 18F-fluorodeoxyglucose positron emission tomographyto assess global cortical metabolism and metabolic activityin each cortical lobe. Subcortical lesions on magnetic resonanceimaging (periventricular hyperintensities, deep white matterhyperintensities, and subcortical lacunar infarcts) were measuredusing a graded scale of severity. Cognitive and noncognitivesymptoms were assessed with the Neurobehavioral Rating Scale.

Results
Reduced cortical metabolism was generally associated with theseverity of subcortical pathologic changes, but there was substantialheterogeneity in the relationship between subcortical lesionsand cortical metabolic activity. Mean global cortical metabolismwas lower in patients with periventricular hyperintensitiesin anterior subcortical regions than in those without such lesions.The metabolic rate in the frontal cortex was lower in patientswith a lacunar infarct of the basal ganglia or thalamus thanin those without. Neurobehavioral Rating Scale total score,the Verbal Output Disturbance factor score, and the Anxiety/Depressionfactor score were correlated with the severity of white matterlesions.

Conclusions
Cortical metabolic dysfunction is related to ischemic subcorticallesions in patients with vascular dementia. Metabolism in thefrontal cortex may be particularly dependent on pathologic alterationsof subcortical nuclei. Anxiety, depression, and the overallseverity of neuropsychiatric symptoms in vascular dementia areassociated with the extent of white matter ischemia.

Author Affiliations

From the Departments of Psychiatry and Biobehavioral Sciences (Drs Sultzer, Cummings, Van Gorp, and Hinkin) and Neurology (Drs Mahler and Cummings), University of California—Los Angeles School of Medicine; and Psychiatry Service (Drs Sultzer, Mahler, and Cummings), Psychology Service (Drs Van Gorp and Hinkin), and Nuclear Medicine Service (Dr Brown), Veterans Affairs Medical Center, West Los Angeles.

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