Abstract
In contrast to earlier observations, recent studies have demonstrated that supratentorial lacunar infarcts in the white matter may cause mild neuropsychological impairments. The origin of these cognitive disturbances is yet unknown. In the current study proton magnetic resonance spectroscopy (1H MRS) was used to elucidate the hypothesized relation between a lacunar infarct, metabolic alterations, and neuropsychological function. Patients with a single supratentorial lacunar infarct (n=26) were compared with patients with a mild myocardial infarct (n=12) and healthy controls (n=12) on a comprehensive neuropsychological examination, and on the N-acetyl-aspartate/creatine, choline/creatine and lactate/creatine ratios. The volume of interest of the MRI/MRS examination was located in normal-appearing white matter of the centrum semiovale at a distance from the infarct, in both the ipsilateral and contralateral hemisphere. On neuropsychological examination patients with a lacunar infarct performed worse than both patients with a myocardial infarct and healthy controls. The N-acetyl-aspartate/creatine ratio was decreased in patients with a lacunar infarct compared with the other two groups. More important, this decrease in neurometabolites was significantly correlated to the level of cognitive functioning for the ipsilateral hemisphere and, although to a lesser extent, for the contralateral hemisphere. We conclude that a single symptomatic lacunar infarct in the white matter is associated with (distant) disturbances in neurometabolites and that this decrease is related to a reduced cognitive capacity.
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References
Fisher CM (1991) Lacunar infarct: a review. Cerebrovasc Dis 1:311–320
Markowitsch HF, von Cramon DY, Hofmann E, Sick CD, Kinzler P (1990) Verbal memory deterioration after unilateral infarct of the internal capsule in an adolescent. Cortex 26:597–609
Chukwudelunzu FE, Meschia JF, Graff-Radford NR, Lucas JA (2001) Extensive metabolic and neuropsychological abnormalities associated with discrete infarction of the genu of the internal capsule. J Neurol Neurosurg Psychiatry 71:658–662
Ferro JM, Kertesz A (1984) Posterior internal capsule infarction associated with neglect. Arch Neurol 41:422–424
Damasio AR, Damasio H, Rizzo M, Varney N, Gersh F (1982) Aphasia with nonhemorrhagic lesions in the basal ganglia and internal capsule. Arch Neurol 19:15–24
Bamford J, Warlow CP (1988) Evolution and testing of the lacunar hypothesis. Stroke 19:1074–1082
Aharon-Peretz J, Daskovski E, Mashiach T, Tomer R (2002) Natural history of dementia associated with lacunar infarctions. J Neurol Sci 15:53–55
Van Zandvoort MJE, Kappelle LJ, Algra A, de Haan EHF (1998) Decreased capacity for mental effort before and after single supratentorial lacunar infarct may affect performance in everyday life. J Neurol Neurosurg Psychiatry 65:697–702
Van Zandvoort MJE, de Haan EHF, Kappelle LJ (2001) Chronic cognitive disturbances after a single supratentorial lacunar infarct. Neuropsychiatry Neuropsychol Behav Neurol 14:98–102
Van Zandvoort MJE, de Haan EHF, Van Gijn J, Kappelle LJ (2003) Cognitive functioning in patients with a small infarct in the brainstem. J Int Neuropsychol Soc 9:490–494
de Haan RJ, Limburg M, Van der Meulen JH, Jacobs HM, Aaronson NK (1995) Quality of life after stroke. Impact of stroke type and lesion location. Stroke 26:402–408
Hart RP, Wade JB, Martelli MF (2003) Cognitive impairment in patients with chronic pain: the significance of stress. Pain Headache Rep 7:116–126
Kwan LT, Reed BR, Eberling JL, Schuff N, Tanabe J, Norman D, Weiner MW, Jagust WJ (1999) Effects of subcortical cerebral infarction on cortical glucose metabolism and cognitive function. Arch Neurol 56:809–814
Bates TE, Strangward M, Keelan J, Davey GP, Munro PM, Clark JB (1996) Inhibition of N-acetylaspartate production: implications for 1H MRS studies in vivo. Neuroreport 7:1397–1400
Pereira AC, Saunders DE, Doyle VL, Bland JM, Howe FA, Griffiths JR, Brown MM (1999) Measurement of initial N-acetyl aspartate concentration by magnetic resonance spectroscopy and initial infarct volume by MRI predicts outcome in patients with middle cerebral artery territory infarction. Stroke 30:1577–1582
Urenjak J, Williams SR, Gadian DG, Noble M (1993) Proton nuclear magnetic resonance spectroscopy unambiguously identifies different neural cell types. J Neurosci 13:981–989
Friedman SD, Brooks WM, Jung RE, Chiulli SJ, Sloan JH, Montoya BT, Hart BL,Yeo RA (1999) Quantitative proton MRS predicts outcome after traumatic brain injury. Neurology 52:1384–1391
Foong J, Rozewicz L, Davie CA, Thompson AJ, Miller DH, Ron MA (1999) Correlates of executive function in multiple sclerosis: the use of magnetic resonance spectroscopy as an index of focal pathology. J Neuropsychiatry Clin Neurosci 11:45–50
Hu MT, Taylor-Robinson SD, Chaudhuri KR, Bell JD, Morris RG, Clough C, Brooks DJ, Turjanski N (1999) Evidence for cortical dysfunction in clinically non-demented patients with Parkinson’s disease: a proton MR spectroscopy study. J Neurol Neurosurg Psychiatry 67:20–26
Grachev ID, Kumar R, Swarnkar A, Chang JK, Ramachandran TS (2002) Effect of posterior temporal-parietal hematoma on orbital frontal chemistry in relation to a cognitive and anxiety state: a combined 1H-MRS and neuropsychological study of an unusual case as compared with 16 healthy subjects. J Chem Neuroanat 23:223–230
Catani M, Mecocci P, Tarducci R, Howard R, Pelliccioli GP, Mariani E, Metastasio A, Benedetti C, Senin U, Cherubini A (2002) Proton magnetic resonance spectroscopy reveals similar white matter biochemical changes in patients with chronic hypertension and early Alzheimer’s disease. J Am Geriatr Soc 50:1707–1710
Van der Grond J, Balm R, Klijn CJ, Kappelle LJ, Eikelboom BC, Mali WP (1996) Cerebral metabolism of patients with stenosis of the internal carotid artery before and after endarterectomy. J Cereb Blood Flow Metab 16:320–326
Rutgers DR, Klijn CJ, Kappelle LJ, Van der Grond J (2000) Cerebral metabolic changes in patients with a symptomatic occlusion of the internal carotid artery: a longitudinal 1H magnetic resonance spectroscopy study. J Magn Reson Imaging 11:279–286
Collie A, Maruff P, Currie J (2002) Behavioral characterization of mild cognitive impairment. J Clin Exp Neuropsychol 24:720–733
Pasquier F (1999) Early diagnosis of dementia: neuropsychology. J Neurol 246:6–15
Sabri O, Ringelstein EB, Hellwig D, Schneider R, Schreckenberger M, Kaiser HJ, Mull M, Buell U (1999) Neuropsychological impairment correlates with hypoperfusion and hypometabolism but not with severity of white matter lesion on MRI in patients with microangiopathy. Stroke 30:556–566
O’Brien JT, Erkinjutti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler JV, Ballard C, DeCarli C,Gorelick PB, Rockwood K, Burns A, Gauthier S, DeKosky S (2003) Vascular cognitive impairment. Lancet Neurol 2:89–98
Van Zandvoort MJE, Aleman A, Kappelle LJ, de Haan EHF (2000) Cognitive functioning before and after a lacunar infarct. Cerebrovasc Dis 10:478–479
Kobayashi M, Takayama H, Suga S, Mihara B (2001) Longitudinal changes of metabolites in frontal lobes after hemorrhagic stroke of basal ganglia: a proton magnetic resonance spectroscopy study. Stroke 32:2237–2245
Meyerhoff DJ, Bloomer C, Cardenas V, Norman D, Weiner MW, Fein G (1999) Elevated subcortical choline metabolites in cognitively and clinically asymptomatic HIV+ patients. Neurology 52:995–1003
Jessen F, Block W, Traber F, Keller E, Flacke S, Lamerichs R, Schild HH, Heun R (2001) Decrease of N-acetylaspartate in the MTL correlates with cognitive decline of AD patients. Neurology 57:930–932
Garnett MR, Blamire AM, Corkill RG, Cadoux-Hudson TA, Rajagopalan B, Styles P (2000) Early proton magnetic resonance spectroscopy in normal-appearing brain correlates with outcome in patients following traumatic brain injury. Brain 123:2046–2054
Brooks WM, Jung RE, Ford CC, Greinel EJ, Sibbitt WL Jr (1999) Relationship between neurometabolite derangement and neurocognitive dysfunction in systemic lupus erythematosus. J Rheumatol 26:81–85
Huda A, Guze BH, Thomas A, Bugbee M, Fairbanks L, Strouse T, Fawzy FI (1998) Clinical correlation of neuropsychological tests with 1H magnetic resonance spectroscopy in hepatic encephalopathy. Psychosom Med 60:550–556
Ferguson KJ, MacLullich AM, Marshall I, Deary IJ, Starr JM, Seckl JR, Wardlaw JM (2002) Magnetic resonance spectroscopy and cognitive function in healthy elderly men. Brain 125:2743–2749
Hund-Georgiadis M, Norris DG, Guthke T, von Cramon DY (2001) Characterization of cerebral small vessel disease by proton spectroscopy and morphological magnetic resonance. Cerebrovasc Dis 12:82–90
Filley CM (1998) The behavioral neurology of cerebral white matter. Neurology 50:1535–1540
Mesulam MM (1991) Large-scale neurocognitive networks and distributed processing for attention, language, and memory. Ann Neurol 28:597–613
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van Zandvoort, M.J.E., van der Grond, J., Kappelle, L.J. et al. Cognitive deficits and changes in neurometabolites after a lacunar infarct. J Neurol 252, 183–190 (2005). https://doi.org/10.1007/s00415-005-0629-y
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DOI: https://doi.org/10.1007/s00415-005-0629-y